How does this medication work? What will it do for me?

Idarubicin belongs to the group of cancer-fighting medications known as antineoplastics, and specifically to the family of antineoplastics called anthracyclines. Idarubicin is used alone or in combination with other antineoplastic medications to treat leukemia. Idarubicin causes the death of cancer cells by interfering with the genetic material DNA that is necessary for reproduction and growth of cells.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Idarubicin HCl by PPC is no longer being manufactured for sale in Canada. For brands that may still be available, search under idarubicin. This article is being kept available fro reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The recommended dose and dosing schedule of idarubicin varies according to the specific condition being treated, the response to therapy, and the other medications being used. The dose administered is also based on body size.

While you are receiving idarubicin, your doctor may want you to drink extra fluids to help prevent kidney problems.

Idarubicin is usually injected into a vein through a site on your skin that has been specially prepared for this purpose. Very careful handling of this medication is required. Idarubicin is always given under the direct supervision of a doctor in a hospital or similar setting with access to sterile equipment for preparation.

As well as interfering with the genetic material DNA of cancer cells, idarubicin can interfere with some of your normal cells. This can cause a number of side effects such as hair loss and mouth sores. Keep track of any side effects and report them to your doctor.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be given exactly as prescribed by your doctor. If you miss an appointment to receive a dose of idarubicin, contact your doctor as soon as possible to reschedule your appointment.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to idarubicin or any ingredients of the medication or the container
  • are allergic to any anthracycline medication (such as epirubicin, daunorubicin, mitoxantrone, mitomycin C)
  • have a history of severe heart disease
  • have an irregular heart rhythm
  • have an uncontrolled infection
  • have had a recent heart attack
  • have low blood cell counts caused by previous cancer treatment or radiation therapy
  • have previously been treated with maximum allowable lifetime doses of any anthracycline drug (e.g., doxorubicin, daunorubicin, epirubicin, idarubicin) or mitoxantrone
  • have severely reduced heart function
  • have severely reduced kidney function
  • have severely reduced liver function

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • diarrhea
  • fatigue
  • headache
  • hot flashes
  • loss of appetite
  • nausea
  • skin and nail changes, discolouration
  • temporary total loss of hair (returns after treatments end)
  • urine turning reddish in colour (not blood) – this is normal, and lasts 1 to 2 days after each dose
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abdominal pain
  • severe diarrhea with or without blood in the stool
  • signs of bleeding (e.g., bloody nose, blood in urine or stools, coughing blood, cuts that don't stop bleeding, unusual bleeding or bruising, black, tarry stools)
  • signs of decreased red blood cells (anemia; e.g., pale skin, fatigue, shortness of breath, rapid heartbeat)
  • signs of dehydration (e.g., decreased urine, dry skin, dry and sticky mouth, sleepiness, dizziness, headache, thirst, confusion)
  • signs of gout (e.g., joint pain, swelling and warmth of joints)
  • signs of kidney stones (e.g., lower back or side pain, painful or difficult urination)
  • signs of infection (e.g., cough, fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
  • skin rash or hives and itching
  • skin sensitivity of an area that has received radiation
  • sores in mouth and on lips

Stop using the medication and seek immediate medical attention if any of the following occur:

  • fever or chills
  • painful or difficult urination with fever or chills
  • severe stomach pain
  • signs of blood clots (e.g., difficulty breathing, pain, swelling and warmth in one leg or arm, chest pain)
  • signs of heart problems (e.g., fast or irregular heartbeat, swelling of lower legs, feet, and abdomen, wheezing, trouble breathing, or shortness of breath)
  • signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • skin reaction at the injection site (e.g., pain, blistering, stinging or burning)
  • symptoms of tumour lysis syndrome (e.g., producing less urine, cloudy urine, kidney problems, muscle spasms, nausea, shortness of breath)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, easy bruising or cuts that won't stop bleeding.

Gout and kidney stones: Idarubicin may increase the level of uric acid in the body as the cancer cells are destroyed. If you develop painful, warm and swollen joints or difficulty with urination, contact your doctor as soon as possible.

If you have a history of gout or kidney stones, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart problems: This medication increases the risk of heart problems such as abnormal heart rhythm, congestive heart failure, and a weakened heart (cardiomyopathy). Some of these problems occur early in treatment, while others occur later in treatment or after treatment is completed.

If you have existing heart disease, have had radiotherapy, have been treated with this medication in the past, and are taking certain medications that act on the heart, you are more at risk of these problems.

If you have heart disease, your doctor should closely monitor your condition while you are receiving treatment with idarubicin.

Infection: As well as killing cancer cells, idarubicin can reduce the number of cells that fight infection in the body (white blood cells). If possible, avoid contact with people that have contagious infections.

Tell your doctor immediately if you notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Kidney function: The kidneys help remove idarubicin from the body. When they are not working well, the risk of side effects is increased.

If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: The liver helps remove idarubicin from the body. When the liver is not working well, the risk of side effects is increased.

If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Red blood cells: Idarubicin may cause low levels of red blood cells. If you experience symptoms of reduced red blood cell count (anemia) such as shortness of breath, feeling unusually tired or pale skin, contact your doctor as soon as possible.

Secondary leukemia: Like other similar cancer medications, idarubicin has been linked to blood cancer, developing several years after treatment has finished. Talk to your doctor if you have concerns.

Tumour Lysis Syndrome: Idarubicin, like many other cancer medications, causes many cancer cells to be suddenly killed when treatment is first started. This can overwhelm the body with waste products from the cells. When this happens, you may experience nausea, shortness of breath, notice cloudy urine or joint pain. This is called tumour lysis syndrome. Your doctor may prescribe some medications to help your body get rid of the waste products. Make sure you understand how to use these medications and report any of these signs or symptoms to your doctor immediately.

Vaccines: The effectiveness of other vaccines while using this medication may be decreased. Talk to your doctor about ensuring your vaccinations are up to date.

Pregnancy: There is a possibility of birth defects if either the father or mother is using idarubicin at the time of conception, or if it is taken during pregnancy. Effective birth control should be practiced while using this medication as this medication may harm the baby if used during pregnancy.

If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if idarubicin passes into breast milk. Due to the potential for serious harm to the baby, women receiving idarubicin should not breast-feed.

Seniors: Seniors appear to have an increased risk of severe side effects, such as heart attack, heart failure or developing irregular heart rhythms.

What other drugs could interact with this medication?

There may be an interaction between idarubicin and any of the following:

  • amiodarone
  • amphotericin B
  • "azole" antifungals (e.g., fluconazole, itraconazole, voriconazole)
  • BCG
  • calcium channel blockers (e.g., amlodipine, diltiazem, verapamil) and other cardiac medications that lower the heart's ability to pump blood
  • carvedilol
  • clozapine
  • cyclosporine
  • deferiprone
  • dexamethasone
  • digoxin
  • dipyridamole
  • dipyrone
  • dronedarone
  • echinacea
  • fingolimod
  • other cancer drugs, especially anthracyclines
  • grapefruit juice
  • leflunomide
  • macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin)
  • pimecrolimus
  • protein kinase inhibitors (e.g., crizotinib, dasatinib, imatinib, nilotinib)
  • quinidine
  • quinine
  • rifampin
  • roflumilast
  • St John's wort
  • tacrolimus
  • tenofovir
  • tofacitinib
  • vaccines

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, decongestants, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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