idarubicin (Rx)

Brand and Other Names:Idamycin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1mg/mL

Acute Myeloid Leukemia

Induction: 12 mg/m² IV qDay over 10-15 min for 3 day with concomitant cytarabine  

Consolidation: 10-12 mg/m²/day IV for 2 days

Renal Impairment

Children

  • CrCl < 50 mL/min: 75% of dose
  • Peritoneal dialysis: 75% of dose
  • Hemodialysis: 75% of dose
  • Renal replacement therapy: 75% of dose

Adults

  • CrCl 10-50 mL/min: 75% of dose
  • CrCl <10 mL/min: 50% of dose
  • Hemodialysis: Supplemental dose not necessary
  • Peritoneal dialysis: Supplemental dose not necessary

Hepatic Impairment

Bilirubin 2.6-5 mg/dL: 50% of dose

Bilirubin >5 mg/dL: Avoid use

Monitor

CBC, LFTs, cardiac & renal function

Administration

Mucositis Development: Discontinue if severe mucositis after 1st course, after resolution continue w/ 25% dose reduction

Dosage Forms & Strengths

injectable solution

  • 1mg/mL

Acute Myeloid Leukemia

10-12 mg/m² IV qDay for 3 days q3weeks

Acute Lymphoblastic Leukemia (Orphan)

Treatment of acute lymphoblastic leukemia in pediatric patients.

Orphan indication sponsor

  • Pharmacia & Upjohn; 7000 Portage Road, Unit 0633-298-113; Kalamazoo, MI 49001-0199
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Interactions

Interaction Checker

and idarubicin

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              Serious - Use Alternative (13)

              • adenovirus types 4 and 7 live, oral

                idarubicin decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

              • cyclophosphamide

                cyclophosphamide increases toxicity of idarubicin by Other (see comment). Avoid or Use Alternate Drug. Comment: May increase formation of toxic anthracycline metabolites in heart tissue.

              • deferiprone

                deferiprone, idarubicin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

              • erdafitinib

                erdafitinib will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

              • influenza virus vaccine quadrivalent, adjuvanted

                idarubicin decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                idarubicin decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • lasmiditan

                lasmiditan increases levels of idarubicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • paclitaxel

                paclitaxel increases toxicity of idarubicin by Other (see comment). Avoid or Use Alternate Drug. Comment: May increase formation of toxic anthracycline metabolites in heart tissue.

              • palifermin

                palifermin increases toxicity of idarubicin by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • sotorasib

                sotorasib will decrease the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

              • tepotinib

                tepotinib will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

              • trastuzumab

                trastuzumab, idarubicin. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              • trastuzumab deruxtecan

                trastuzumab deruxtecan increases toxicity of idarubicin by Other (see comment). Avoid or Use Alternate Drug. Comment: May increase formation of toxic anthracycline metabolites in heart tissue.

                trastuzumab deruxtecan, idarubicin. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              Monitor Closely (27)

              • acalabrutinib

                acalabrutinib, idarubicin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

              • belatacept

                belatacept and idarubicin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • berotralstat

                berotralstat will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

              • bevacizumab

                bevacizumab, idarubicin. Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of cardiotoxicity (CHF). Caution is warranted.

              • bosutinib

                bosutinib increases levels of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • cholera vaccine

                idarubicin decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • dengue vaccine

                idarubicin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • denosumab

                idarubicin, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • elagolix

                elagolix will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • eliglustat

                eliglustat increases levels of idarubicin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

              • fingolimod

                idarubicin increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • fostamatinib

                fostamatinib will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

              • glecaprevir/pibrentasvir

                glecaprevir/pibrentasvir will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • hydroxyurea

                idarubicin, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

              • istradefylline

                istradefylline will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

              • lomitapide

                lomitapide increases levels of idarubicin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

              • lonafarnib

                lonafarnib will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

              • meningococcal group B vaccine

                idarubicin decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • ofatumumab SC

                ofatumumab SC, idarubicin. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                idarubicin and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • sarecycline

                sarecycline will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

              • siponimod

                siponimod and idarubicin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                idarubicin decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • stiripentol

                stiripentol will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

              • trastuzumab

                trastuzumab, idarubicin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, idarubicin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • tucatinib

                tucatinib will increase the level or effect of idarubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

              Minor (0)

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                Adverse Effects

                >10%

                Infection (95%)

                Nausea (30-60%)

                Vomiting (30-60%)

                Alopecia (25-30%)

                Hemorrhage (63%)

                Stomatitis (11%)

                Fever (26%)

                Elevated bilirubin and transaminases (20-30%)

                Myelosuppression: > 10%

                1-10%

                Seizure (4%)

                CHF (2%)

                Peripheral neuropathy (8%)

                Frequency Not Defined

                Fever

                Chills

                Headache

                Flushing

                Myocardial infarction

                Cardiac dysrhythmia

                Chest pain

                Diarrhea

                Inflammatory disease of mucous membrane

                Hyperuricemia

                Red discoloration of urine

                Rash

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                Warnings

                Black Box Warnings

                The drug should be administered under the supervision of a cancer chemotherapy physician experienced in acute leukemia treatment in a facility with appropriate equipment to monitor patients compromised by drug toxicity. Severe hemorrhagic conditions or overwhelming infection resulting from the therapy should also be able to be treated at the facility.

                Only administer intravenously into a freely flowing IV infusion. Do not administer intramuscularly or subcutaneously. Severe local tissue damage can occur with extravasation.

                Myocardial toxicity leading to CHF may occur. Toxicity is more common with prior anthracycline use or preexisting cardiac disease.

                Myelosuppression can be severe at therapeutic doses

                Reduce dose in renal or hepatic impairment

                Contraindications

                Hypersensitivity

                Serum bilirubin >5 mg/dL [>85.5 umol/L]

                Cautions

                Vesicant-avoid extravasation

                Risk of myocardial toxicity leading to potentially fatal CHF; pre-existing heart disease and previous therapy with anthracyclines at high cumulative doses or other potentially cardiotoxic agents are co-factors for increased risk of cardiac toxicity; benefit to risk ratio of idarubicin therapy in such patients should be weighed before starting treatment

                Monitor cardiac function during treatment in order to minimize risk of cardiac toxicity of the type described for other anthracycline compounds

                Prior radiation treatment to mediastinal-pericardial area & prior anthracyclines increases cardiotoxic risk

                Cumulative doses >150 mg/m² associated with decreased ejection fraction

                Possibility of injection site reactions

                Use caution in hepatic/renal impairment; dose reduction may be necessary

                Not for administration to patients with pre-existing bone marrow suppression induced by previous drug therapy or radiotherapy unless the benefit warrants the risk

                Due to the increased risk of cardiotoxicity, avoid concomitant use until cardiotoxic agent has been discontinued for at least 5 half-lives; specifically avoid therapy for up to 7 months after stopping trastuzumab

                Avoid pregnancy

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                Pregnancy & Lactation

                Pregnancy

                There is no conclusive information about therapy adversely affecting human fertility or causing teratogenesis; there has been one report of a fetal fatality after maternal exposure to drug during second trimester

                There are no adequate and well-controlled studies in pregnant women; drug should be used during pregnancy only if potential benefit justifies potential risk to fetus

                If drug is to be used during pregnancy, or if patient becomes pregnant during therapy, patient should be apprised and informed of potential hazard to fetus

                Women of childbearing potential should be advised to avoid pregnancy and advised to use effective contraception during treatment and for at least 6.5 months after the last dose

                Men with female partners of childbearing potential should be advised to use effective contraception during treatment and for at least 3.5 months after last dose

                Both men and women should seek advice for fertility preservation before treatment

                Animal data

                • Drug was embryotoxic and teratogenic in rat at dose of 1.2 mg/m2/day or one tenth the human dose, which was nontoxic to dams; Drug was embryotoxic but not teratogenic in rabbit even at a dose of 2.4 mg/m2/day or two tenths the human dose, which was toxic to dams

                Lactation

                Not known whether drug is excreted in human milk; because many drugs are excreted in human milk and because of potential for serious adverse reactions in nursing infants from drug, mothers should discontinue nursing prior to taking drug

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Anthracycline; intercalates between DNA base pairs, inhibits topoisomerase II, which in turn inhibits DNA and RNA synthesis

                Pharmacokinetics

                Half-Life: 14-35 hr (PO); 12-27 hr (IV)

                Bioavailability: 30%

                Protein Bound: 94-97%

                Vd: 64 L/kg

                Peak plasma time: 1-5 hr

                Metabolism: Liver

                Metabolites: Idarubicinol

                Clearance: 122.8 L/hr

                Excretion: Urine (5-13%)

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                Administration

                IV Incompatibilities

                Additive: heparin

                Syringe: heparin

                Y-site: acyclovir, allopurinol, ampicillin/sulbactam, cefazolin, cefepime, ceftazidime, clindamycin, dexamethasone Na-phosphate, etoposide, fluorouracil, furosemide, gentamicin, heparin, hydrocortisone Na-succinate, lorazepam, meperidine, methotrexate, piperacillin/tazobactam, Na-bicarb, teniposide, vancomycin, vincristine

                IV Compatibilities

                Solution: with most common diluents

                Y-site (partial list): cimetidine, diphenhydramine, etoposide PO4, granisetron, MgSO4, metoclopramide, KCl

                IV Preparation

                Vials: reconstitute with NS to a concentration of 1 mg/mL

                Standard dilution

                • IV push: dose/syringe (concentration is 1 mg/mL); maximum syringe size for IVP is 30 mL syringe & syringe should be <75% full
                • IVPB: dose/100 mL D5W or NS

                IV Administration

                Vesicant

                Administer by intermittent infusion over 10-15 min

                Administer into a free flowing IV solution of NS or D5W

                Local erythematous streaking along the vein may indicate rapid administration

                Extravasation Management

                Topical cooling may be achieved using ice packs or cooling pad with circulating ice water

                Cooling of site for 25 hr as tolerated by pt.

                Elevate & rest extremity 24-48 hr, then resume normal activity as tolerated

                Cold inhibits vesicant's cytotoxicity

                Heat can be harmful & is contraindicated

                If pain, erythema, &/or swelling persist beyond 48 hr, refer pt immediately to plastic surgeon for consultation & possible debridement

                See also Totect

                Storage

                Store intact vials of lyophilized powder at room temp

                Protect from light

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Idamycin PFS intravenous
                -
                1 mg/mL vial
                Idamycin PFS intravenous
                -
                1 mg/mL vial
                Idamycin PFS intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial
                idarubicin intravenous
                -
                1 mg/mL vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                idarubicin intravenous

                IDARUBICIN - INJECTION

                (eye-duh-REWB-eh-sin)

                COMMON BRAND NAME(S): Idamycin

                WARNING: Idarubicin must be given only by injection slowly into a vein. Do not give by injection into a muscle or under the skin. If this medication accidentally leaks into the skin/muscle around the injection site, it may cause severe damage. Tell your doctor right away if you notice redness, pain, or swelling at or near the injection site.This medication may rarely cause serious (rarely fatal) heart problems (including heart failure). This may occur both during treatment or after treatment is completed. The risk of heart problems is affected by your dose, medical history (including heart disease, radiation treatment to the chest area, current infections, anemia), and previous use of this and other drugs (including doxorubicin). Tell your doctor right away if you notice symptoms such as irregular heartbeat, shortness of breath, swelling ankles/feet, unusual tiredness, or unusual/sudden weight gain.Idarubicin may cause certain severe blood and bone marrow disorders (low red blood cells/white blood cells/platelets). This can affect your body's ability to stop bleeding or fight infection. Tell your doctor right away if you develop easy bleeding/bruising or signs of infection (e.g., fever, chills, persistent sore throat).Very rarely, people with cancer who are treated with this type of medication have developed other cancers (e.g., secondary leukemia). The risk may be increased when this medication is given with certain anti-cancer drugs or radiation treatment. Consult your doctor for more details.Before starting treatment with this medication, tell your doctor if you have liver or kidney problems. Your dose may need to be adjusted.

                USES: Idarubicin is used to treat a certain type of cancer (leukemia). It belongs to a class of drugs known as anthracyclines and works by slowing or stopping the growth of cancer cells.

                HOW TO USE: This medication is given by injection into a vein by a health care professional, as directed by your doctor. Dosage is based on your medical condition, body size, and response to treatment.If this medication touches your skin, immediately wash the area well with soap and water. If this medication gets in your eye, open the eyelids and flush with water for 15 minutes, then seek immediate medical attention.Drink plenty of fluids while using this medication unless otherwise directed by your doctor. Doing so helps decrease the risk of certain side effects (e.g., increased uric acid).

                SIDE EFFECTS: See also Warning section.Nausea, vomiting, abdominal cramps, diarrhea, and headache may occur. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If these effects persist or worsen, tell your doctor or pharmacist promptly.Temporary hair loss is a common side effect. Normal hair growth should return after treatment has ended.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: severe abdominal pain, mental/mood changes (e.g., confusion), numbness/tingling of arms/legs, rash/blisters on palms of hands/soles of feet, unusual bleeding/bruising (e.g., small red spots on the skin, black/bloody stools, bloody urine, vomit that looks like coffee grounds).Pain or sores in the mouth and throat may occur. Brush your teeth gently/carefully, avoid using mouthwash that contains alcohol, and rinse your mouth frequently with cool water mixed with baking soda or salt. It may also be best to eat soft, moist foods.Get medical help right away if this rare but very serious side effect occurs: seizure.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), trouble breathing, severe dizziness.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before using idarubicin, tell your doctor or pharmacist if you are allergic to it; or to other anthracyclines (e.g., doxorubicin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood/bleeding disorders (e.g., anemia, low blood cell counts), gout, heart disease (e.g., congestive heart failure, irregular heartbeat), kidney disease, liver disease, radiation treatment (especially to chest area).Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower your risk of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist that you are using this medication.Caution is advised when using this medication in the elderly because they may be more sensitive to the effects of the drug, especially the effects on the heart.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using idarubicin. Idarubicin may harm an unborn baby. Women using this medication should ask about reliable forms of birth control during treatment and for at least six and a half months after stopping treatment. Men using this medication should ask about reliable forms of birth control during treatment and for at least three and a half months after stopping treatment. If you or your partner becomes pregnant, talk to your doctor right away about the risks and benefits of this medication.It is not known whether this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that may affect the heart (including trastuzumab, anthracyclines such as doxorubicin).

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: irregular heartbeat, severe nausea/vomiting.

                NOTES: Laboratory and/or medical tests (e.g., kidney/liver function tests, complete blood count, certain heart function tests such as LVEF) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

                MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

                STORAGE: Not applicable. This medication is given in a clinic and will not be stored at home.

                MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

                Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
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                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.