[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Histone deacetylase (HDAC) inhibitors](https://durgical.com/en/pharmacology/classes/histone-deacetylase-inhibitors/) › Romidepsin

# Romidepsin

## Histone deacetylase (HDAC) inhibitors?

Histone deacetylase (HDAC) inhibitors

## High 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.

Updated Nov 1, 2026

Also called: depsipeptide

## Quick facts

**Group**
[Histone deacetylase (HDAC) inhibitors](https://durgical.com/en/pharmacology/classes/histone-deacetylase-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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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in adults who have received at least one prior systemic therapy (its former peripheral T-cell lymphoma indication was withdrawn).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) →](https://durgical.com/en/conditions/mycosis-fungoides-and-sezary-syndrome/)

## Adverse effects

### Common

- Nausea, vomiting, decreased appetite
- Fatigue
- Taste changes, constipation, diarrhoea
- Anaemia, thrombocytopenia, leukopenia
- Itching

### Serious (rare, important)

- ECG changes and QT prolongation
- Electrolyte disturbances (low potassium or magnesium)
- Serious infections, which can appear up to a month after treatment
- Severe thrombocytopenia with bleeding
- Severe skin reactions

## 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.

## Memory aid

«ROMIdepsin from ROtten bacteria»: a bacterial prodrug that frees a thiol to grab the HDAC zinc; check «K, Mg and the ECG» before each dose.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/romidepsin/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

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

## Connections

## Related drugs 3

- [Vorinostat](https://durgical.com/en/pharmacology/vorinostat/)
- [Rifampicin](https://durgical.com/en/pharmacology/rifampicin/)
- [Ketoconazole](https://durgical.com/en/pharmacology/ketoconazole/)

## Related conditions 1

- [Mycosis fungoides and Sézary syndrome (cutaneous T-cell lymphoma)](https://durgical.com/en/conditions/mycosis-fungoides-and-sezary-syndrome/)

[← Back to the class: Histone deacetylase (HDAC) inhibitors](https://durgical.com/en/pharmacology/classes/histone-deacetylase-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](https://medlineplus.gov/druginfo/meds/a610005.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Romidepsin - NCI](https://www.cancer.gov/about-cancer/treatment/drugs/romidepsin) (National Cancer Institute, 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01XH02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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