Daunorubicin is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat acute myeloid leukaemia and acute lymphoblastic leukaemia. This information describes daunorubicin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of leukaemia, which give further information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Daunorubicin is a red fluid.

Daunorubicin may be given:

• By injection through a fine tube (cannula) inserted into the vein. The injection is usually given into a fast running drip (infusion) over about 10 minutes.
• As a drip (infusion) through a cannula. It can also be given through a central line (a tube inserted into a vein in the chest) or a PICC line (a tube inserted into the crook of your arm). The infusion takes about 60 minutes.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given daunorubicin, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information please discuss them with your doctor or chemotherapy nurse.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin 1–3 hours after the treatment is given and last for up to 48 hours. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Hair loss Your hair may fall out completely or may just thin. This usually starts 3–4 weeks after the first dose of daunorubicin, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all your hair will regrow once the treatment has finished. To help reduce hair loss, scalp cooling may be suitable for some people.

Lowered resistance to infection Daunorubicin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Daunorubicin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with daunorubicin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Discoloured urine Your urine may become a pink-red colour. This may last up to 48 hours after you have had daunorubicin, and is due to the colour of the drug. It is quite normal.

Sensitivity to the sun While you are taking daunorubicin, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but you should wear a high protection factor suncream and cover up with clothes and a hat.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Changes in the way your heart works High doses of daunorubicin may cause changes in the muscle of the heart, which can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected if you have standard doses. Tests to see how well your heart is working may sometimes be carried out before the drug is given.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Skin discoloration The skin along the vein used for the injection may become discoloured. This usually returns to normal over a few months once the treatment has finished.

Changes to nails They may become darker. White lines may also appear on them. These changes grow out over a few months after the treatment has ended.

Inflammation In some cases the drug may cause redness and inflammation of the skin in areas which have been treated with radiotherapy.

Some people have a red flush or itching along the vein while the drug is being given.

Leakage into the tissue If daunorubicin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or chemotherapy nurse.

If the area around the injection site becomes red or swollen you should either tell the doctor on the ward or, if you are at home, ring the clinic or ward and ask for the doctor or nurse.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or to father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking daunorubicin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Daunorubicin factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.