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Daunorubicin Hydrochloride Injection

[19 August 2014]

Products Affected - Description

Daunorubicin hydrochloride solution for injection, 5 mg/mL, West-Ward (formerly Bedford product) 
4 mL single-dose vial (NDC 55390-0108-10)
10 mL single-dose vial (NDC 55390-0108-01)  

Cerubidine lyophilized powder for injection, West-Ward (formerly Bedford product) 
20 mg single-dose vial, package of 10 (NDC 55390-0281-10)

Reason for the Shortage

  • West-Ward Pharmaceuticals’ parent company, Hikma Pharmaceuticals, acquired daunorubicin injection and Cerubidine injection from Bedford in July 2014. West-Ward is not actively marketing daunorubicin injection or Cerubidine injection at this time.1
  • Teva states daunorubicin was on back order due to manufacturing delays.2

Available Products

Daunorubicin hydrochloride solution for injection, 5 mg/mL, Teva
4 mL single-dose vial (NDC 00703-5233-13)

Estimated Resupply Dates

West-Ward is not actively marketing daunorubicin injection or Cerubidine injection.1

Implications for Patient Care

  • Daunorubicin hydrochloride is an anthracycline antineoplastic antibiotic. It is labeled for the treatment of acute lymphocytic leukemia (adults, children) and for acute myelocytic leukemia (adults), usually used in combination with other antineoplastic agents.3-5
  • Daunorubicin hydrochloride is also used off-label for a variety of neoplastic diseases including chronic myelogenous leukemia (combination therapy), acute promyelocytic leukemia (combination therapy), and anaplastic large cell lymphoma (children).3-5

Safety

  • Chemotherapy agents, such as daunorubicin hydrochloride, pose additional safety risks both for patients and for healthcare workers handling these agents.3,4
  • Use additional caution when processing orders for chemotherapy drugs, especially when switching between chemotherapy agents or when processing orders for chemotherapy agents with which staff may be unfamiliar (eg, those not normally prescribed at a specific institution).3,4

Alternative Agents & Management

  • The choice of an alternative agent must be patient-specific and based on renal function, liver function, and the neoplasm type and location. No single agent can be substituted for daunorubicin hydrochloride.3-5
  • Consider evaluating the health-care system’s total supply of daunorubicin hydrochloride before beginning patients on combination chemotherapy regimens containing daunorubicin hydrochloride. If adequate supplies are not available, select an alternative regimen.
  • Consult a Hematology/Oncology specialist for patient- and neoplasm-specific recommendations.
  • Refer to the ASHP Guidelines on Managing Drug Product Shortages for more guidance on developing a multidisciplinary plan when the supply must be allocated.

Related Shortages

References

  1. West-Ward (personal communications). August 19, 2014.
  2. Teva (personal communications). January 26, February 22, March 1 and 10, April 5 and 28, May 20, June 8 and 29, July 1 and 27, August 17, September 29, 2010; March 1 and 30, May 9 and 31, June 14, August 1, September 13, October 4 and 27, December 14, 2011; January 17, February 27, March 20, April 12, May 9, and June 18, July 12, August 28, October 22, and November 27, 2012; February 5, March 28, May 20, July 11, August 28, September 13, 19, and 30, October 14 and 30, and December 4, 2013; January 14, March 31, May 29, June 10, and August 18,  2014. 
  3. Beckwith MC, Tyler LS, eds. Cancer Chemotherapy Manual. St. Louis, MO: Wolters Kluwer Health Inc. 2010.
  4. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2010 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2010: 902-1260.
  5. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. September 2010.

Updated

Updated August 19, 2014 by Jane Chandramouli, PharmD, Drug Information Specialist. Created September 3, 2010, by Michelle M. Wheeler, PharmD, and M. Christina Beckwith, PharmD, Drug Information Specialists. Copyright 2014, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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