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Pharmacology · Antitumour antibiotics

Daunorubicin !

The first anthracycline, used to induce remission in acute leukaemias. Like doxorubicin it is red, a vesicant and toxic to the heart.

Updated 2026-11-01

  • Class: Antitumour antibiotics
  • Enzyme: Topoisomerase IIα (and DNA, by intercalation)
  • ATC code: L01DB02
  • WHO Model List of Essential Medicines

Also called: daunomycin, rubidomycin

The crystal shows daunorubicin (daunomycin) intercalated in a short DNA duplex.

Target in 3D: Topoisomerase IIα (and DNA, by intercalation). PDB structure 1DA0 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Daunorubicin intercalates in DNA and traps topoisomerase II on the cut DNA, leaving double-strand breaks; its quinone ring also produces free radicals. The effect is the same as doxorubicin's, but its use is centred on acute leukaemias.

  1. Intercalates between DNA base pairs
  2. Traps topoisomerase II: double-strand breaks
  3. Free radicals add damage; leukaemic blasts die

Pharmacokinetics

Absorption
Intravenous only.
Metabolism
Extensively metabolised in the liver and other tissues to daunorubicinol, an active metabolite.
Elimination
The urine turns red for a short time after a dose; doses are reduced in liver or kidney impairment.

Indications

  • Remission induction in adult acute myeloid (nonlymphocytic) leukaemia, in combination.
  • Remission induction in acute lymphocytic leukaemia in children and adults, in combination.

Adverse effects

Common

  • Hair loss
  • Nausea, vomiting and mouth sores
  • Red urine for a short time after the dose

Contraindications

  • Hypersensitivity to daunorubicin
  • Previous maximum cumulative doses of doxorubicin or daunorubicin

Key interactions

Doxorubicin (previous treatment)
Raises the risk of cardiotoxicity; total anthracycline exposure is counted.
Other myelosuppressive drugs
Additive marrow suppression; the dose may be reduced.
Hepatotoxic drugs (e.g. high-dose methotrexate)
Impaired liver function increases daunorubicin toxicity.

What is monitored

  • Ejection fraction (echocardiogram or MUGA) before, during and after treatment, by the same method each time.
  • Blood counts closely during induction
  • Bilirubin and creatinine before each dose

Administration and safety

  • Vesicant: given only into a free-flowing intravenous line, never intramuscularly or subcutaneously; the site is checked before and during the dose.
  • Suspected extravasation (burning, stinging, swelling): stop the drug, try to aspirate without flushing, apply ice intermittently, elevate the limb and notify; dexrazoxane may be used in adults.
  • Look-alike risk: daunorubicin, doxorubicin, idarubicin and liposomal products are different drugs; the full name is checked.
  • Hazardous drug: prepared and given following hazardous-drug handling procedures (impervious gloves, no skin contact) and disposed of as cytotoxic waste.

Nursing care

  • Independent double check of drug, patient, route and cycle before giving it (high-alert medicine).
  • Neutropenic and bleeding precautions during induction.
  • Teaching: report shortness of breath, swelling of the legs, palpitations or fast weight gain, even months after treatment.
  • Teaching: red urine for a short time is expected.

Pregnancy and breastfeeding

May cause fetal harm; pregnancy is avoided during treatment.

Test yourself

Think of the answer, then tap the question to see it.

In which cancers is daunorubicin mainly used?

Remission induction in acute myeloid and acute lymphocytic leukaemia.

Why is a previous course of doxorubicin important before giving daunorubicin?

Anthracycline cardiotoxicity is cumulative across drugs, so earlier doxorubicin raises the risk of heart failure.

By which routes must daunorubicin never be given?

Intramuscular or subcutaneous: it causes severe tissue necrosis.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - DAUNORUBICIN HYDROCHLORIDE injection, solution (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).

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Representative model, for educational purposes only.