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Incompatibilities: Daunorubicin has been reported to be incompatible with heparin sodium, which might cause the drug to precipitate in the solution, and with aluminum. Incompatibility has also been reported when a daunorubicin hydrochloride solution is mixed with a solution of dexamethasone sodium phosphate, aztreonam, allopurinol sodium, fludarabine, piperacillin/tazobactam and aminophylline. Daunorubicin can be used in combination with other antitumor agents, but it is not recommended that it be mixed with other drugs in the same syringe.
Special precautions for disposal and other handling: Preparation of the solution: Daunorubicin hydrochloride powder for injection should be reconstituted by adding 4 mL of sterile Water for Injection. The vial content is under a negative pressure to minimize aerosol formation during reconstitution; particular care is needed when the needle is inserted: inhalation of any aerosol produced during reconstitution must be avoided. The vial should be gently shaken until the drug is completely dissolved. The resultant solution contains 5 mg of daunorubicin per mL. The reconstituted solution should be protected from light and is stable for 24 hours at room temperature or 48 hours at 4°C - 10°C.
Intravenous administration: The required dose of the reconstituted solution has to be withdrawn into a syringe containing 10 to 15 mL of 0.9% sodium chloride and slowly injected into the tubing of a freely flowing IV infusion of 0.9% sodium chloride or 5% dextrose to minimize the risk of drug extravasation and make sure that the vein is flushed after the administration of the drug.
Protective measures: The following protective recommendations are given due to the toxic nature of the compound: Personnel should be trained in good technique for reconstitution and handling;
Pregnant staff should be excluded from working with this drug;
Personnel handling daunorubicin should wear protective clothing: goggles, gowns and disposable gloves and masks;
A designated area should be defined for reconstitution (preferably under a laminar flow system). The work surface should be protected by disposable, plastic-backed, absorbent paper;
All items used for reconstitution, administration or cleaning, including gloves, should be placed in high-risk waste-disposal bags for high-temperature incineration;
Spillage or leakage should be treated with diluted sodium hypochlorite (1% available chlorine) solution, preferably by soaking, and then water;
All cleaning materials should be disposed of as indicated previously;
Accidental contact with the skin or eyes should be treated immediately by copious lavage with water, or soap and water, or sodium bicarbonate solution; medical attention should be sought;
Always wash hands after removing gloves;
The drug should be used within 24 hours of first penetration of the rubber stopper. Discard any unused solution.
