DaunoXome^® (Daunorubicin Citrate Liposome Injection)

Generic name: Daunorubicin (liposomal)

Chemocare.com uses generic names in all descriptions of drugs. DaunoXome is the trade name for Daunorubicin. In some cases, health care professionals may use the trade name DaunoXome when referring to the generic drug name Daunorubicin.

Drug type: DaunoXome is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. DaunoXome is the drug Daunorubicin encapsulated in a closed lipid sphere (liposome). DaunoXome is classified as an "anthracyline antitumor antibiotic."  (For more detail, see "How this drug works" section below).

What This Drug Is Used For:

• DaunoXome is used as first-line therapy against advanced Kaposi's sarcoma associated with HIV.

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How This Drug Is Given:

• Daunorubicin (liposomal) is given through a vein by intravenous injection (IV).  The syringe needle is placed directly into the vein or central line and the drug is given over several minutes. 
• Because the parent drug daunorubicin is a vesicant this liposomal form is treated with equal caution.  A vesicant is a chemical that causes extensive tissue damage and blistering if it escapes from the vein.  The nurse or doctor who gives this drug must be carefully trained.  If you notice redness or swelling at the IV site while you are receiving daunorubicin (liposomal), alert your health care professional immediately.
• There is no pill form of daunorubicin (liposomal).
• The amount of daunorubicin (liposomal) you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dose and schedule. 

Side Effects:

Important things to remember about the side effects of daunorubicin (liposomal):

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

Infusion-related reaction (symptoms which may occur during the actual treatment) include:

• Occurs within the first 5 minutes of infusion.  Symptoms include back pain, flushing, and tightness in the chest and throat.  Happens in about 15% of patients and usually only with the first infusion.  Symptoms go away when the infusion is stopped and typically does not recur when the infusion is restarted at a slower rate.

The following side effects are common (occurring in greater than 30%) for patients taking daunorubicin (liposomal):

• Low blood counts.  Your white and red blood cells and platelets may temporarily decrease.  This can put you at increased risk for infection, anemia and/or bleeding.

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 7 days
Nadir: 14 days
Recovery: 21 days

• Nausea. 
• Fatigue.
• Fever.
• Heart rhythm abnormalities, generally without symptoms and short lived.
• Diarrhea.

These side effects are less common, meaning they occur in 10-29 percent of patients receiving daunorubicin (liposomal):

• Cough 
• Shortness of breath 
• Headache 
• Abdominal pain
• Poor appetite 
• Chills (see flu like symptoms)
• Numbness or tingling in the hands or feet
• Runny nose (see cold symptoms)
• Mouth sores

A serious but uncommon side effect of daunorubicin - parent drug to daunorubicin (liposomal) - can be interference with the pumping action of the heart.  You can receive only up to a certain amount of daunorubicin (liposomal) during your lifetime.  This "lifetime maximum dose" may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs.  Your doctor will check your heart function before you may take any daunorubicin (liposomal) and will monitor your heart closely during your treatment.  Dose-related heart problems can occur as late as 7 or 8 years after treatments have ended.

Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher or chills (possible signs of infection).
• Blistering at the IV site.

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Mouth sores (painful redness, swelling or ulcers)
• Fast or irregular heart beats
• Unusual bleeding or bruising
• Extreme fatigue (unable to carry on self-care activities)
• Swelling of the feet or ankles
• Yellowing of the eyes or skin

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting daunorubicin (liposomal) treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).   Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking daunorubicin (liposomal).
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category D (daunorubicin (liposomal) may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking daunorubicin (liposomal). Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.
• You may be more sensitive to sunlight, take extra care to avoid sun exposure. 
• People with congestive heart failure, those who have already had high doses of this drug or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive this drug.

Self-Care Tips:

• Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor. 
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.  
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest. 
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

A baseline heart evaluation is recommended before starting treatment, and a heart function test will be done as your doctor prescribes.  You will be checked regularly by your doctor while you are taking daunorubicin (liposomal), to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How This Drug Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Daunorubicin is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.  There are several types of antitumor antibiotics:

• Anthracyclines:  Doxorubicin, Daunorubicin, Mitoxantrone, and Idarubicin.
• Chromomycins:  Dactinomycin and Plicamycin.
• Miscellaneous:  Mitomycin and Bleomycin.

Daunorubicin (liposomal) is the drug daunorubicin encapsulated in a liposome.   Liposomes are closed lipid spheres made of the basic components of natural human cell walls.  By enclosing a drug in a liposome, scientists have demonstrated improvements in the way a drug is released throughout the body and the amount of time it remains within the body. Liposomes may circulate in the bloodstream for extended periods, as compared to the same drug in a non-liposomal form. This may result in an extended treatment effect and a simplified dosing regimen. In some cases, liposomal drugs have been shown to accumulate at the site of a tumor delivering higher concentrations of the drug to a disease target. The liposome carrier is believed to play a role in reducing the harmful effects of certain drugs on healthy tissues.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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