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Daunorubicin

Daunorubicin is a chemotherapy drug. It is a treatment for:

  • acute myeloid leukaemia (AML)
  • acute lymphoblastic leukaemia (ALL)

How daunorubicin works

Daunorubicin works by destroying quickly dividing cells, such as cancer cells. This helps to stop the cancer growing.

How you have daunorubicin

Daunorubicin is a red liquid. You have it into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

Your nurse injects the drug into a fast running drip over about 20 minutes. 

When you have daunorubicin

You have daunorubicin as a course of several cycles of treatment. A cycle means that you have the drug and then a rest to allow your body to recover.

You usually have daunorubicin with other drugs (such as cytarabine) as part of a treatment regimen.

How often and when you have it depends on which type of leukaemia you have.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You will also have regular heart trace tests (ECG) to check how your heart is working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Possible side effects

You might have one or more of these side effects:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Tell your nurse or doctor immediately if at any time you feel unwell. They can give you medicine to help.

Not enough fluid in your body (dehydration)

If you are dehydrated you might find you aren't passing much urine and the colour is a very dark yellow. Your skin might be very dry and you might feel dizzy. So make sure you drink around 2 litres of fluid every day. Tell your nurse or doctor if you are not able to drink this much.

High uric acid levels

High uric acid levels in the blood are due to the breakdown of tumour cells (tumour lysis syndrome). You have regular blood tests to check your uric acid levels and you may take a tablet called allopurinol. Drinking plenty helps to flush out the excess uric acid.

Inflammation around your drip site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Hair loss 

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Red or pink urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Facial flushing

The skin on your face may appear red (flushed), and you may feel warm at the same time. This can happen at the same time as you have the medicine into your bloodstream. This is temporary.

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Inflammation of your food pipe and bowel

This drug can cause inflammation of your food pipe (oesophagus) and bowel. Symptoms that your food pipe might be inflamed include difficulty and painful swallowing, heartburn or indigestion, food getting stuck, chest pain that’s worse when eating, feeling or being sick. 

Symptoms of inflammation of the bowel include feeling bloated or swollen, loose or watery poo, being sick and blood in your poo.

Talk to your treatment team if you have any of these symptoms.

Periods stopping

You might stop having periods (amenorrhoea) but this may be temporary. Your periods usually start again within 6 to 12 months of your treatment finishing. 

If you are close to the menopause age, your periods may not come back.

No sperm in semen

Talk to your treatment team if you are planning to father a child after treatment. You may be able to store some of your sperm before you start treatment.

Heart problems 

This might be changes to the heart rhythm or a build up of fluid around the heart. You might have tests to check for this.

Changes in the brain

Changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to vision (reversible posterior leukoencephalopathy syndrome).

Contact your healthcare team straight away if you have any of these symptoms.

Kidney changes (nephrotic syndrome)

Nephrotic syndrome is a collection of symptoms that show there are changes to how well your kidneys are working. You may have large amounts of protein in your urine and low amounts in your blood. You may also have a build up of fluid in your body, usually in your feet, ankles and legs. Your nurse regularly checks your urine for protein while you are having treatment.

Second cancers  

There is a very small risk that you may get a second cancer, such as leukaemia, some years after this treatment. Your doctor will discuss this with you.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception 

This drug can harm a baby developing in the womb. You should avoid becoming pregnant, or fathering a child during treatment, and for 6 months after treatment. 

Talk to your team about reliable contraception before starting treatment. 

Fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.