Daunorubicin extravasation

Daunorubicin—monitor cumulative dose for possible cardiac toxicity vesicant-avoid extravasation... 

Daunorubicin -anthracycline antitumor antibiotic DNA intercalating agent -bone marrow suppression -nausea and vomiting—mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated —cardiotoxicity (550 mg/M2) -Liposomal daunorubicin there is significantly less bone marrow suppression, nausea and vomiting, stomatitis, and cardiotoxicity... 

Four cases of extravasation of liposomal daunorubicin have been reported and were associated with only mild irritation and transient erythema and swelhng, similar to pegylated liposomal doxorubicin (36). 

Cabriales S, Bresnahan J, Testa D, Espina BM, Scadden DT, Ross M, Gill PS. Extravasation of liposomal daunorubicin in patients with AIDS-associated Kaposi s sarcoma a report of four cases. Oncol Nurs Forum 1998 25(l) 67-70. 

The usual dose of daunorubicin is 50 to 45 mg/m iliJ for 5 days. It is administered intravenously, taking w prevent extravasation. 

Myelosuppression mucositis moderately emetogenic vesicant extravasation alopecia cardiac toxicities acute and chronic, as with daunorubicin and doxorubicin (total cumulative dose not well established >150 mg/m reported to be associated with decreased LVEF Myelosuppression low... 

Daunorubicin (daunomycin, rubidomycin Cerubidine, others) is available for intravenous use. The recommended dosage is 30 to 60 mg/m daily for 3 days. The agent is administered with appropriate care to prevent extravasation, as severe local vesicant action may result. Total doses greater than 1000 mg/m are associated with a high risk of cardiotoxicity. A daunorubicin citrate liposomal product (Daunoxome) is indicated in the treatment of AIDS-related Kaposi s sarcoma. It is given in a dose of 40 mg/m infused over 60 minutes and repeated every 2 weeks. Patients should be advised that the drug may impart a red color to the urine. 

Daunorubicin, doxorubicin, epirubicin, and idarubicin usually are administered intravenously. Careful infusion over 10-15 minutes is recommended to prevent extravasation, since severe local vesicant action may result. The drugs are cleared by a complex pattern of hepatic metabolism and biliary excretion. The plasma disappearance curve for doxorubicin is multipha-sic, with elimination half-lives of 3 hours and - SO hours. All anthracyclines are converted to an active alcohol intermediate that plays a variable role in their therapeutic activity. Idarubicin has a tj of 15 hours, and its active metabolite, idarubicinol, has a tj of - 40 hours. There is rapid upt e of the drugs in the heart, kidneys, lungs, liver, and spleen. They do not cross the blood-brain barrier. Daunorubicin and doxorubicin are eliminated by metabolic conversion to a variety of aglycones and other inactive products. Idarubicin is primarily metabolized to idarubicinol, which accumulates in plasma and likely contributes significantly to its activity. Clearance is delayed in the presence of hepatic dysfunction, and at least a 50% initial reduction in dose should be considered in patients with elevated serum bilirubin levels. 

MAINTAINING TISSUE INTEGRITY. Some antineoplastic dni are vesicants (ie, tliey cause tissue necrosis if tliey infiltrate or extravasate out of tlie blood vessel and into tlie soft tissue). If extravasation occurs, underlying tissue is damaged. The damage can be severe, causing physical deforarity or loss of vascularity or tendon function. Examples of vesicant dni are daunorubicin, doxorubicin, and vinblastine... 

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