Idarubicin

Idarubicin is a chemotherapy treatment for acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL).

What is idarubicin?

Idarubicin is a type of chemotherapy drug. It is treatment for:

• acute myeloid leukaemia (AML)
• acute lymphoblastic leukaemia (ALL) which has come back after having treatment with another chemotherapy drug

You might have idarubicin on its own or in combination with other chemotherapy drugs.

How does idarubicin work?

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

How do you have idarubicin?

You might have idarubicin as capsules or you might have it as a drip into your bloodstream (intravenously).

Into your bloodstream

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

If you don't have a central line you might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taken as a capsule

You take idarubicin as a capsule that you swallow whole with a glass of water. Your doctor can tell you how many capsules you need to take every day. It depends on your individual needs. You may take the capsules with a light meal.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

How often do you have idarubicin?

You usually have idarubicin as capsules for treating AML and ALL. Your doctor or pharmacist will tell you how to take them and how long for. 

You might have idarubicin as a drip into your bloodstream. Each treatment lasts about 10 minutes. 

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.

Idarubicin can affect heart function in some people. You might have a test to look at your heart function before you start your treatment, for example, an echocardiogram (ECHO). 

What are the side effects of idarubicin?

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.

The side effects you have will be different depending on whether you have capsules or an infusion into your bloodstream. Your doctor will explain which ones are more common to the treatment you have. 

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. 

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

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. 

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).

Breathlessness

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

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Tummy (abdominal) cramps

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

Indigestion or heartburn

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. 

Red coloured urine

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

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

High temperature or chills

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• heart problems such as heart failure, heart disease or changes in heart rate – you will have regular checks. It is important that you tell your doctor or nurse if you have any chest pain
• swelling in your lower legs and feet
• bleeding in the gut
• liver changes which are usually mild
• skin problems include a skin rash, dry skin and itching
• sensitive skin where you have had previous radiotherapy treatment
• redness, swelling or leaking around the drip site if you are having idarubicin intravenously
• blood clots and inflammation in the vein (deep vein thrombosis or DVT)
• unusual bleeding - such as blood in your poo, vaginal bleeding, or coughing up blood, contact your health care team straight away if you have any unexpected bleeding

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• shock which includes low blood pressure, shallow breathing, cold clammy skin, weakness, dizziness or feeling faint
• a severe allergic reaction that can be life threatening (anaphylaxis)
• dehydration
• increase in uric acid levels causing pain in the joints (gout)
• inflammation of the bowel and food pipe
• changes in skin and nail colour
• swelling, redness and flaking of the skin on the palms of your hands and soles of your feet
• skin infections including hives and bacterial skin infections
• bleeding in the brain
• tissue necrosis - this means tissue breaks down due to little or no blood supply
• increased risk of developing a second blood cancer (leukaemia)

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 drinks

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.

You should not have idarubicin if you've had trastuzumab (Herceptin) in the last 7 months. Trastuzumab is a treatment for some cancer types including breast cancer. It can affect heart function and can remain in the body for around 7 months after treatment. Idarubicin can also affect heart function, so this should be avoided until you no longer have trastuzumab in your body.

Loss of fertility

You may not be able to become pregnant or get someone pregnant 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.    

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Men must use effective contraception up to 3 months after treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.