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# 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](https://durgical.com/en/pharmacology/classes/antitumour-antibiotics/)
- Enzyme: Topoisomerase IIα (and DNA, by intercalation)
- ATC code: L01DB02
- WHO Model List of Essential Medicines

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

Also called: daunomycin, rubidomycin

✂**Topoisomerase IIα (and DNA, by intercalation)**Daunorubicin

ⓘ 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](https://www.rcsb.org/structure/1DA0) · Drag to rotate · pinch to zoom

## 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.

- Intercalates between DNA base pairs
- Traps topoisomerase II: double-strand breaks
- 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

### Serious (rare, important)

- Severe myelosuppression with infection or bleeding
- Cardiomyopathy and heart failure, related to cumulative dose; may appear months or years later
- Severe tissue necrosis after extravasation

## 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.

## Memory aid

DAUNOrubicin «DAwns» in leukaemia: the anthracycline of acute leukaemia induction, with the same red colour and the same heart warning.

## 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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## Related drugs

- [Doxorubicin](https://durgical.com/en/pharmacology/doxorubicin/)
- [Idarubicin](https://durgical.com/en/pharmacology/idarubicin/)
- [Epirubicin](https://durgical.com/en/pharmacology/epirubicin/)

[← Back to the class: Antitumour antibiotics](https://durgical.com/en/pharmacology/classes/antitumour-antibiotics/)

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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9705fa12-499e-41a3-8fb4-f6df0858b851) (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](https://atcddd.fhi.no/atc_ddd_index/?code=L01DB02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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