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Care During Chemotherapy and Beyond

Daunorubicin and Cytarabine (Liposomal)

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Trade Name(s): VyxeosTM

Daunorubicin and cytarabine (liposomal) is the generic name for the trade name drug Vyxeos™. In some cases, health care professionals may use the trade name Vyxeos™ when referring to the generic drug name daunorubicin and cytarabine (liposomal).

Drug Type: Daunorubicin and cytarabine (liposomal) is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is a combination of two chemotherapy medications, daunorubicin which is classified as an "anthracycline" and cytarabine which is classified as an "antimetabolite". (For more detail, see “How Daunorubicin and Cytarabine (Liposomal) Works” below)

What Daunorubicin and Cytarabine (Liposomal) Is Used For

  • To treat adults who have been newly diagnosed with acute myeloid leukemia related to therapy (t-AML).
  • To treat adults who have been newly diagnosed with AML with changes related to the bone marrow not functioning properly and not producing enough blood cells (AML with myelodysplasia-related changes).

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 Daunorubicin and Cytarabine (Liposomal) Is Given

  • Daunorubicin and cytarabine (liposomal) is given as an infusion into the vein (intravenous or IV) over 90 minutes.
  • You will be given anti-nausea medications approximately 30 minutes before the infusion to reduce the risk of chemotherapy-induce nausea or vomiting.

The amount of daunorubicin and cytarabine (liposomal) that you will receive depends on many factors, including your height and weight and your general health or other health problems. Your doctor will determine your exact dosage and schedule.

Important - Daunorubicin and cytarabine (liposomal) has different dosage recommendations than other daunorubicin- and cytarabine- containing medications. Do not interchange daunorubicin and cytarabine (liposomal) with other daunorubicin- and/or cytarabine-containing medications.

Side Effects

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

  • Most people will not experience all of the daunorubicin and cytarabine (liposomal) side effects listed.
  • Daunorubicin and cytarabine (liposomal) side effects are often predictable in terms of their onset, duration, and severity.
  • Daunorubicin and cytarabine (liposomal) side effects will improve after therapy is complete.
  • Daunorubicin and cytarabine (liposomal) side effects may be quite manageable. There are many options to minimize or prevent the side effects of daunorubicin and cytarabine (liposomal).

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

These are less common side effects (occurring in 10-29%) for patients receiving daunorubicin and cytarabine (liposomal):

These are rare but serious side effects of daunorubicin and cytarabine (liposomal):

  • Cardiac toxicity
    • A serious, but uncommon side effect of daunorubicin and cytarabine (liposomal) can be interference with the pumping action of the heart. The chance of heart problems may be raised if you are using other drugs that may cause heart problems, if you have ever had heart problems, if you have had radiation to the chest area, or if you have ever had this drug or other anthracyclines similar to this drug before.
    • Your chance of heart problems depends on your dose of this drug and your health condition.
    • Your doctor will check your heart function before you may take any daunorubicin and cytarabine (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.
  • Hypersensitivity reaction
    • Some individuals will experience certain side effects during the infusion such as back pain, flushing, and tightness of their chest and throat. The chance of having an infusion reaction is very low and generally only happens during the first 5 minutes of the first infusion.
    • Tell your doctors right away if you experience any of these side effects during the infusion. The side effects go away upon stopping the infusion and typically do not reoccur when the infusion is restarted at a slower rate.

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But 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 100.4º F (38º C) or higher, chills (possible signs of infection)

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)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Blood in the urine
  • Pain or burning with urination
  • Extreme fatigue (unable to carry on self-care activities)
  • Mouth sores (painful redness, swelling or ulcers)

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

Precautions

  • Before staring daunorubicin and cytarabine (lipsomal) 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.
  • People who have had a serious allergic reaction with daunorubicin, cytarabine, or any component of this medication cannot take daunorubicin and cytarabine (liposomal).
  • Do not receive any kind of immunication or vaccination without your doctor's approval while taking daunorubicin and cytarabine (liposomal).
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (daunorubicin and cytarabine [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: Use contraceptives, and do not conceive a child (get pregnant) while taking daunorubicin and cytarabine (liposomal). Barrier methods of contraception, such as condoms, are recommended for up to 6 months after last dose of daunorubicin and cytarabine (lipsomal).
  • Do not breast feed while taking daunorubicin and cytarabine (lipsomal) and for at least 2 weeks after the last dose.

Self-Care Tips

  • 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 teaspoon of baking soda 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.
  • Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
  • 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.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • 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 While Taking Daunorubicin and Cytarabine (Liposomal)

You will be checked regularly by your doctor while you are taking daunorubicin and cytarabine (liposomal) to monitor side effects and check your response to therapy. A baseline heart evaluation will be done before you start treatment. Periodic blood work will be obtained 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 Daunorubicin and Cytarabine (Liposomal) 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 genetic material, RNA or DNA, which 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 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, and/or hair loss.

Daunorubicin and cytarabine (liposomal) is composed of two medications, daunorubicin and cytarabine. Daunorubicin is classified as an anthracycline. Anthracyclines interact with your genetic material causing cell death of both your cancerous and noncancerous cells. Daunorubicin (liposomal) is the drug daunorubicin encapsulated in a liposome. By enclosing a drug in a liposome (lipid sphere or coating), 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 allowing for an extended treatment effect. In some cases, liposomal drugs have been shown to accumulate at the site of a tumor delivering high concentrations of the drug to the disease target. The liposome carrier is believed to play a role in reducing the harmful effects of certain drugs on healthy tissues.

Cytarabine belongs to the category of chemotherapy called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells at very specific phases in the cycle.

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.

References:

  • Daunorubicin and cytarabine. Lexicomp Online® [February 22, 2018; March 6, 2018]. Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.; March 6, 2018.

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