Idarubicin

Severe myelosuppression occurs when idarubicin is used at effective therapeutic doses. Patients are at risk of developing infection and bleeding due to neutropenia and thrombocytopenia, respectively (may be fatal). Monitor blood counts frequently. Do not use in patients with preexisting bone marrow suppression unless the benefit outweighs the risk.

[US Boxed Warning] Vesicant; may cause severe local tissue necrosis if extravasation occurs. For IV administration only; not for IM or SubQ administration. Administer through a freely flowing IV infusion line. Ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation.

Idarubicin is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Dupuis 2011; Hesketh 2017; Roila 2016). Abdominal pain, diarrhea, and mucositis may commonly occur. Severe enterocolitis with perforation has been reported (rare).

Rapid lysis of leukemic cells may lead to hyperuricemia. Ensure adequate hydration and consider use of antihyperuricemic prophylaxis.

Idarubicin may cause myocardial toxicity leading to heart failure. Cardiotoxicity is more common in patients who have previously received anthracyclines or have preexisting cardiac disease. The risk of myocardial toxicity is also increased in patients with concomitant or prior mediastinal/pericardial irradiation, patients with anemia, bone marrow depression, infections, leukemic pericarditis, or myocarditis. Patients with active or dormant cardiovascular disease, concurrent administration of cardiotoxic drugs, prior therapy with other anthracyclines or anthracenediones are also at increased risk for cardiotoxicity. Other risk factors for anthracycline-induced cardiotoxicity include ≥60 years of age at time of treatment and ≥2 cardiovascular risk factors (smoking, hypertension, diabetes, dyslipidemia, or obesity) during or after treatment (Armenian 2017). Potentially fatal heart failure, acute arrhythmias (may be life-threatening) or other cardiomyopathies may also occur. Regular monitoring of LVEF is recommended, especially in patients with cardiac risk factors or impaired cardiac function. The half-life of other cardiotoxic agents must be considered. Avoid the use of anthracycline-based therapy for at least 5 half-lives after discontinuation of the cardiotoxic agent. Monitor cardiac function during treatment. Disease-related concerns:

Dosage reductions are recommended in patients with hepatic impairment. Idarubicin use is not recommended if bilirubin >5 mg/dL.

Systemic infections should be controlled prior to initiation of treatment.

Dosage reductions are recommended in patients with renal impairment. Concurrent drug therapy issues:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations:

Patients >60 years of age who were undergoing induction therapy experienced heart failure, serious arrhythmias, chest pain, MI, and asymptomatic declines in LVEF more frequently than younger patients. Other warnings/precautions:

Should be administered under the supervision of an experienced cancer chemotherapy physician. Use in facilities with laboratory and supportive resources adequate to monitor drug tolerance and protect and maintain a patient compromised by drug toxicity. The physician and institution must be capable of responding rapidly and completely to severe hemorrhagic conditions and/or overwhelming infection.