Dosage adjustment

Daunorubicin Hydrochloride

Daunorubicin Citrate (Liposomal)

*in Renal impairment:a)CLcr <10ml/min.

b)Scr > 3mg/dl

*in Hepatic impairment:a)Serum Bilirubin 1.2-3 mg/dl or AST 60-180 int. units

b)Serum Bilirubin 3.1-5mg/dl or AST >180 int. units

c)Serum Bilirubin >5mg/dl

Administer 75% of normal dose.

Omit use

Reduce dose to 75%

Reduce dose to 50%

Dosage Adjustment

Doxorubicin Epirubicin Idarubicin Mitoxantrone

*renal impairment:a)Mild to moderate renal failureb) Clcr.<10ml/min

Not required.

administer 75% of normal dose.

Hemodialysis: supplemental dose is not necessary

Severe (Scr >5mg/dl) lower doses should be considered.

Serum cr ≥ 2mg/dladminister 75%of dose

In hemo/peritoneal dialysis: significant drug removal is unlikely based on physicochemical characteristics.

Safety & Efficacy have not established.

Hemo/peritoneal dialysis: supplemental dose is not necessary.

Elderly: Cl is decreased in elderly pt’s; use with caution.

*hepatic impairmenta)Bilirubin (1.2-3mg/dl)

b) Bil.3.1-5mg/dl

c) >5mg/dl Do not administer

1.5-5mg/dl or AST 60-180 int. units/l administer 50% of normal dose.

Do not administer

Official dosage adj. recommended have not been established.

Moderate dysfunction (bil1.5-3mg/dl):some clinicians recommend a 50%dosage reduction.

Severe dysfunction(bil. >3 mg/dl)may require a dosage adj. to 8mg/m2,some clinicians recommend a dose reduction to 25% of dose.

administer 50% of dose

admin. 25% of dose.

Patient Information:::::::Daunorubicin HCl

Only administered IV During therapy do not use alcohol, aspirin-containing products and/or OTC medications without consulting prescriber.It is important to maintain adequate nutrition & hydration (2-3L/day of fluids unless instructed to restrict fluid intake)during therapy, frequent small meals may help.Patient may experience nausea & vomiting (frequent small meals ,frequent mouth care, sucking lozenges, or chewing gum may help)You may experience loss of hair(reversible),more susceptible to infectionUrine may turn Red(normal)Yoghurt or butter milk may help reduce diarrhea.

Patient Info::::::Mitoxantrone

Urine may turn blue-green for 24hrs after infusion & the whites of your eyes may have a blue-green tinge ; this is normal.

Drug Interactions

Cyclosporine Hematologic toxicity.

Cyclophosphamide cardiac toxicity(myocardium cell damage)

Doxorubicin

Paclitaxel, streptozocin, Mercaptopurine, Verapamil & high dose of progesterone.

Toxicity

Ppt with heaprin & fluorouracil

Drug Interactions

Vaccines

Taxane derivati

ve

Natalizumab&Trastuzum

ab