Daunorubicin — Drug Monograph
Brand names: Cerubidine
Drug class: Anthracycline
Mechanism of Action
Daunorubicin exerts its antineoplastic effect through high-affinity intercalation between DNA base pairs, leading to the inhibition of DNA synthesis and DNA-dependent RNA synthesis. It also inhibits topoisomerase II, preventing the re-ligation of DNA strands and causing double-strand breaks. Furthermore, it undergoes intracellular reduction to generate reactive oxygen species (ROS), which results in oxidative damage to DNA, proteins, and cell membranes. These combined mechanisms trigger apoptosis in rapidly dividing malignant cells.
FDA Indications
- For remission induction in acute nonlymphocytic leukemia (myelogenous, monocytic, erythroid) of adults
- For remission induction in acute lymphocytic leukemia of children and adults
Common Side Effects
- Nausea
- Vomiting
- Alopecia
- Mucositis
- Red-colored urine (not hematuria)
- Diarrhea
- Myelosuppression
Clinical Pearl
Daunorubicin is a potent vesicant; if extravasation is suspected, the infusion must be stopped immediately and dexrazoxane should be considered. Counsel patients that the drug will turn their urine a red or orange color for 1-2 days after administration, which is a harmless side effect and not blood. Lifetime cumulative doses must be tracked meticulously across all facilities to prevent irreversible cardiomyopathy.
Related Therapies & Mechanisms
- Doxorubicin (Adriamycin) — Anthracycline · Leukemia
- Idarubicin (Idamycin PFS) — Anthracycline · Leukemia
- Liposomal Daunorubicin and Cytarabine (Vyxeos) — Anthracycline · Leukemia
- Epirubicin (Ellence) — Anthracycline