Romidepsin
Histone deacetylase (HDAC) inhibitors
Histone deacetylase (HDAC) inhibitorsHigh alert
An error with this medicine can cause serious harm: double checks and protocols are used.
Intravenous HDAC inhibitor, a natural prodrug from a bacterium, for cutaneous T-cell lymphoma. Watch ECG, electrolytes, blood counts and infections.
Also called: depsipeptide
Quick facts
- Group
- Histone deacetylase (HDAC) inhibitors
- Target
- Histone deacetylases (zinc-dependent enzymes)
- Used for
- Cutaneous T-cell lymphoma
- Key effects
- Nausea · Fatigue · Taste changes
- Monitor
- Potassium and magnesium before each dose
- ATC
- L01XH02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Romidepsin is a natural product of the bacterium Chromobacterium violaceum and acts as a prodrug. Inside the cell it is reduced, freeing a thiol that binds the zinc atom in the HDAC binding pocket and blocks the enzyme. Acetylated histones accumulate, gene expression changes and the lymphoma cells stop growing or die.
- Romidepsin enters the cell as an inactive prodrug
- Reduction frees a zinc-binding thiol
- The thiol blocks the zinc in the HDAC pocket
- Histone acetylation rises: lymphoma growth slows
Indications
- Cutaneous T-cell lymphoma in adults who have received at least one prior systemic therapy (its former peripheral T-cell lymphoma indication was withdrawn). Mycosis fungoides and Sézary syndrome (cutaneous T-cell lymphoma) →
Adverse effects
Common
- Nausea, vomiting, decreased appetite
- Fatigue
- Taste changes, constipation, diarrhoea
- Anaemia, thrombocytopenia, leukopenia
- Itching
Contraindications
- Caution in congenital long QT, significant heart disease and with QT-prolonging drugs
- Caution in liver impairment
Key interactions
- Strong CYP3A4 inhibitors (e.g. ketoconazole)
- Raise romidepsin exposure; toxicity is monitored closely.
- Strong CYP3A4 inducers (e.g. rifampicin, St John's wort)
- Lower romidepsin levels; avoided.
- Oestrogen-containing contraceptives
- Romidepsin may make them less effective; non-hormonal contraception is used.
- QT-prolonging drugs (e.g. some antiarrhythmics)
- Add to the risk of rhythm problems.
What is monitored
- Potassium and magnesium before each dose, corrected if low
- ECG at baseline and during treatment in patients at risk
- Complete blood count before each dose
- Signs of infection during and after each cycle
Administration and safety
- Intravenous infusion over several hours, in a clinic or hospital, on a repeating cycle.
- Reconstituted and diluted only as the product instructions describe; hazardous drug handled with chemotherapy precautions.
- Fluids are encouraged for a few days after each dose.
Pregnancy and breastfeeding
May harm the fetus; a pregnancy test is done before treatment and non-hormonal contraception is used during and after it; breastfeeding is avoided.
Nursing care
- Check potassium and magnesium and report low values before the infusion.
- Ask about palpitations, chest pain, dizziness or fainting.
- Review blood counts and watch for fever.
- Teaching: drink plenty of fluids after each dose, use non-hormonal contraception, report fever or signs of infection, tell dentists and surgeons about the treatment.
Pharmacokinetics
- Absorption
- Intravenous infusion over several hours, in cycles.
- Metabolism
- Mainly CYP3A4.
- Half-life
- Short, about 3 hours.
Test yourself
Think of the answer, then tap the question to see it.
Where does romidepsin come from?
It is a natural product of the bacterium Chromobacterium violaceum.
Why is romidepsin called a prodrug?
It must be reduced inside the cell to free the thiol that binds the HDAC zinc.
Which electrolytes are checked before each romidepsin dose?
Potassium and magnesium, because of the risk of ECG changes.
Why are oestrogen-containing contraceptives a problem with romidepsin?
Romidepsin may make them less effective, so non-hormonal contraception is used.
Connections
← Back to the class: Histone deacetylase (HDAC) inhibitors
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Romidepsin Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Romidepsin - NCI (National Cancer Institute, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.