Idarubicin is a chemotherapy drug that is given as a treatment for some types of cancer. It is used to treat some types of leukaemia. This information describes idarubicin, 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.

• Idarubicin is a red fluid.
• It is also available as 5mg red capsules, 10mg red and white capsules and 25mg white capsules.

Idarubicin may be given:

• as an injection into the vein (intravenously) through a fine tube (cannula) inserted into the vein. It may be given through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line inserted into a vein in the crook of the arm.
• as capsules swallowed whole with plenty of water.

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 idarubicin, 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 which 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.

Lowered resistance to infection Idarubicin 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 Idarubicin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding.

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

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

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin 2–3 hours after the treatment is given and last for a couple of days. 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.

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 medicine 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.

Hair loss This usually starts 3–­4 weeks after the first dose of idarubicin, although it may happen earlier. Your hair may fall out completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all of your hair will regrow once the treatment ends.

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

Sensitivity of the skin to sunlight During treatment with idarubicin, 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 always wear a high protection factor suncream, protective clothing and a hat.

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

Skin changes Idarubicin can cause a rash, which may be itchy. Your doctor can prescribe medicine to help. Areas of skin that have previously been treated with radiotherapy may become red and sore. Tell your doctor if this happens. Your skin may darken, due to excess production of pigment. The darkening usually returns to normal a few months after the treatment has finished. The skin over the vein used for the injection may become discoloured.

Changes in nails Your nails may darken, but this change grows out over a few months once the treatment has finished.

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

Your liver may be temporarily affected Idarubicin may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.

Leakage into the tissue If idarubicin 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 nurse immediately. If the area around the injection site becomes red or swollen at any time you should either tell the doctor or nurse on the ward, or, if you are at home, ring the clinic or ward and ask to speak to 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 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 idarubicin, 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.

• It is important to take your capsules at the right times. You must take them as directed by your doctor.
• Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
• Keep the capsules in a safe place where children cannot reach them, as idarubicin could harm them.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the capsules let your doctor know, as you may need to take another dose. Do not take another capsule without first telling your doctor.
• If you forget to take a capsule do not take a double dose. Tell your doctor and keep to your regular dose schedule.

This section is based on our Idarubicin 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.