daunorubicin citrate liposome (redirected from DaunoXome)

daunorubicin citrate liposome Warning - Hazardous drug!

DaunoXome

Pharmacologic class: Anthracycline glycoside

Therapeutic class: Antibiotic antineoplastic

Pregnancy risk category D

FDA Boxed Warning

• Monitor cardiac function regularly during therapy, because of potential cardiotoxicity and congestive heart failure. Also monitor cardiac function in patients who have cardiac disease or received previous anthracyclines.
• Severe myelosuppression may occur.
• Give under supervision of experienced physician.
• Reduce dosage in patients with hepatic impairment.
• Drug may cause triad of back pain, flushing, and chest tightness. Triad usually occurs within first 5 minutes of infusion, subsides with infusion interruption, and doesn't recur when infusion resumes at slower rate.

Action

Inhibits DNA synthesis and DNA-dependent RNA synthesis through intercalation. Formulation increases selectivity of daunorubicin for solid tumors; may increase permeability of tumor neovasculature to some particles in drug's size range.

Availability

Injection: 2 mg/ml

⊘Indications and dosages

➣ First-line cytotoxic therapy for advanced Kaposi's sarcoma associated with human immunodeficiency virus (HIV)

Adults: 40 mg/m² I.V. over 1 hour. Repeat q 2 weeks until evidence of disease progression or other complications occur.

Dosage adjustment

• Renal or hepatic impairment

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:
• renal or hepatic impairment, bone marrow depression, cardiac disease, gout, infections
• pregnant or breastfeeding patients.

Administration

• Follow facility policy for preparing and handling antineoplastics.
• Dilute 1:1 with 5% dextrose injection.
• Don't use in-line filter for I.V. infusion.
• If prescribed, premedicate with allopurinol to help prevent hyperuricemia.
• Take steps to prevent extravasation.
• Protect solution from light.

Route	Onset	Peak	Duration
I.V.	Unknown	Unknown	Unknown

Adverse reactions

CNS: headache, fatigue, malaise, confusion, depression, dizziness, drowsiness, emotional lability, anxiety, hallucinations, syncope, tremors, rigors, insomnia, neuropathy, amnesia, hyperactivity, abnormal thinking, meningitis, seizures

CV: hypertension, chest pain, palpitations, myocardial infarction, cardiac arrest

EENT: abnormal vision, conjunctivitis, eye pain, hearing loss, earache, tinnitus, rhinitis, sinusitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastritis, enlarged spleen, fecal incontinence, hemorrhoids, tenesmus, melena, difficulty swallowing, dry mouth, mouth inflammation, GI hemorrhage

GU: dysuria, nocturia, polyuria

Hematologic: thrombocytopenia, neutropenia

Hepatic: hepatomegaly

Metabolic: hyperuricemia, dehydration

Musculoskeletal: joint pain, myalgia, muscle rigidity, back pain, abnormal gait

Respiratory: dyspnea, cough, hemoptysis, increased sputum, pulmonary infiltrations, pulmonary hypertension

Skin: pruritus, dry skin, seborrhea, folliculitis, alopecia, sweating

Other: bleeding gums, dental caries, altered taste, lymphadenopathy, opportunistic infections, fever, hot flashes, hiccups, thirst, infusion site inflammation, edema, allergic reactions

Interactions

Drug-diagnostic tests. Granulocytes: decreased count

Uric acid: increased level

Patient monitoring

• Assess cardiac, renal, and hepatic function before each course of treatment.
• Determine left ventricular ejection fraction before and during therapy.
• Evaluate CBC with white cell differential before each dose. Withhold dose if granulocyte count is below 750 cells/mm³.
• Monitor serum uric acid level.

Patient teaching

☞ Instruct patient to immediately report swelling, pain, burning, or redness at infusion site, as well as persistent nausea, vomiting, diarrhea, chest pain, arm or leg swelling, difficulty breathing, palpitations, rapid heartbeat, yellowing of skin or eyes, abdominal pain, or bloody stools.
• Tell patient drug makes him more susceptible to infection. Advise him to avoid crowds and exposure to illness.
• Advise patient to minimize GI upset by eating small, frequent servings of healthy food, drinking plenty of fluids, and chewing gum.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.