Daunorubicin

CLINICAL USE

Antineoplastic agent:Acute leukaemias

DOSE IN NORMAL RENAL FUNCTION

30–45 mg/m2, or as for local protocol

PHARMACOKINETICS

Molecular weight :564 (as hydrochloride)

%Protein binding :50–90

%Excreted unchanged in urine : 5–18

Volume of distribution (L/kg) :39.2

half-life – normal/ESRD (hrs) :18.5; Liposomal: 4–5.2/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function. See ‘Other Information’

10 to 20 : Dose as in normal renal function. See ‘Other Information’

<10 : Dose as in normal renal function. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as GFR <10 mL/min

HD :Unlikely to be dialysed. Dose as GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as GFR <10 mL/min

CAV/VVHD :Unlikely to be dialysed. Dose as GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

Reconstitute 20 mg vial with 4 mL water for injection giving a concentration of 5 mg/mL. Dilute calculated dose of daunorubicin further in sodium chloride 0.9% to give a final concentration of 1 mg/mL

Route

Rate of Administration

1 mg/mL solution should be infused over 20 minutes into the tubing or a side arm of a rapidly flowing

IV infusion

of sodium chloride 0.9%

Comments

–

OTHER INFORMATION

Potentially cardiotoxic Monitor blood uric acid and urea levels Rapidly taken up by the tissues, especially by the kidneys, liver, spleen and heart. Subsequent release of drug and metabolites is slow (T½ ~55 hrs). Rapidly metabolised in the liver, and the major metabolite daunorubicinol is also active. It is excreted slowly in the urine, mainly as metabolites with 25% excreted within 5 days. Biliary excretion accounts for 40–50% eliminationManufacturer’s literature suggests that in patients with a serum creatinine of 105–265 µmol/L the dose should be reduced to 75% of normal; if the creatinine is >265 µmol/L, the dose should be 50% of normalA liposomal formulation of daunorubicin is now available (DaunoXome ). Dilute to 0.2–1 mg/mL with glucose 5% and administer over 30–60 minutes

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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