Daunorubicin Disease Interactions

Daunorubicin can cause myocardial toxicity leading to congestive heart failure. Patients with preexisting heart disease or prior anthracycline therapy are at increased risk of congestive heart failure. The benefit-to-risk ratio of daunorubicin therapy in such patients should be weighed before starting treatment. The incidence of drug-induced congestive heart failure in adults is increased when the total cumulative dose of daunorubicin exceeds 550/mg/m2. An electrocardiogram and/or determination of systolic ejection fraction prior to each course of therapy is recommended.

Daunorubicin can induce severe myelosuppression at therapeutic doses. The use of daunorubicin may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during therapy with daunorubicin. Close clinical monitoring of hematopoietic function is recommended.

Daunorubicin hydrochloride is a potent bone marrow suppressant. Suppression will occur in all patients given a therapeutic dose of the drug. Therapy with daunorubicin hydrochloride should not be started in patients with preexisting drug-induced bone marrow suppression unless the benefit from such treatment warrants the risk. Persistent, severe myelosuppression may result in superinfection or hemorrhage. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitory of hematopoietic function is recommended.

Daunorubicin is extensively metabolized to a biologically active form within normal erythrocytes and leukocytes. Further metabolism via reduction and conjugation has been demonstrated. Approximately 40% of daunorubicin is eliminated in an active form by biliary excretion. Patients with hepatic impairment may be at increased risk for toxicity. Therapy with daunorubicin should be administered cautiously and the dosage reduced in patients with compromised hepatic function. Clinical evaluation of liver function prior to each course of treatment with daunorubicin is recommended.

Approximately 25% of daunorubicin is eliminated in an active form in the urine. Patient with renal impairment are at risk of greater toxicity noted at the recommended dose of daunorubicin. Therapy with daunorubicin should be administered cautiously and at a reduced dosage in patients with significantly compromised renal function. Clinical evaluation of renal function prior to each course of treatment is recommended.