Idarubicin (Zavedos)

This pages tells you about the possible side effects of idarubicin. There are sections on

What idarubicin is
How you have treatment
Common side effects
Occasional side effects
Rare side effects
High dose treatment
Important points to remember
Immunisations and chemotherapy

Idarubicin is a chemotherapy drug used in treating some types of cancer including

One of the ways idarubicin works is by blocking an enzyme (called topoisomerase 2). If this enzyme is blocked the cell's DNA gets tangled up and the cell cannot split into 2 new cancer cells.

Idarubicin is a red liquid that you have as an injection through a fine tube (cannula) put into one of your veins (intravenously). Or you may have it through a central line put into a vein near your collarbone. It also comes in 5mg red capsules, 10 mg red and white capsules and white 25mg capsules. You should swallow the capsules whole with plenty of water. It is important to store your tablets in a safe place away from children. You should return unused tablets to the pharmacy. You should only get a prescription for idarubicin from your cancer specialist.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for idarubicin depends on which type of cancer you are being treated for. There is more about the way chemotherapy treatment is planned in this section of CancerHelp UK.

The side effects of idarubicin are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, please see our chemotherapy side effects section or click on search at the top of the page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery.
Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

Fatigue - for many people this is the most troublesome side effect of all. Tiredness often carries on after treatment has ended. Most people find their energy levels are back to normal from 6 months to a year after their treatment finishes.
Feeling or being sick happens to 9 out of 10 patients (90%) and usually starts about 2 to 4 hours after your treatment begins and lasts a couple of days. It is usually possible to control this side effect with anti-sickness injections and tablets. If you are still being sick, tell your doctor or nurse, as your anti-sickness medicines may need to be changed.
Hair Loss - nearly everyone has complete head and body hair loss. This begins 2 to 5 weeks after the treatment starts. Your hair will grow back after your treatment is finished.
Sore mouth and throat can happen about 2 to 3 days after each treatment. You may have red, sore skin in your mouth as well as mouth ulcers. It usually clears up within 3 weeks of treatment finishing.
Your urine may turn pink or red because idarubicin is red. This happens 1 to 2 hours after you have the drug and can last up to 2 days.
Idarubicin may have a harmful effect on a developing baby. It is not advisable to become pregnant or father a child if you are having this drug. You should talk about contraception with your doctor before having the treatment.

Some people have one or more of the following side effects

Inflammation around the drip site - if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately
Your skin may become more sensitive to the sun during your treatment and for several months afterwards. You should cover up and stay in the shade during these months and, if you must go out in the sun, use a high factor sun cream.
Diarrhoea - drink plenty of fluids and if it becomes severe, or lasts more than a couple of days, tell your doctor or nurse
Loss of appetite
Your nails may become darker and white lines may appear on them
Black or brown discoloration may occur in the creases of your skin. This is particularly common in children.
Idarubicin can cause changes in your liver, which can start 3 to 4 weeks after you begin treatment. This will return to normal when you stop treatment. Your doctor will take regular blood tests to check how your liver is working.

A few people may have one or more of these side effects

If you have had radiotherapy in the past, the skin in the treatment area may become dry and flaky, and you may have some pain and burning similar to sunburn.
Idarubicin can cause temporary damage to the muscles of the heart, which may change the rhythm of the heartbeat. In most people this will go back to normal after the treatment is completed. Your heart will be checked before you start treatment.
Allergic reaction causing raised temperature, shivering and rash
Loss of fertility - it is not known exactly what effect this drug may have on your fertility. It is important to talk with your doctor before starting treatment. Women may stop having periods (amenorrhoea). This may only be temporary.

With high doses, or many treatments, there is a small risk that

You may develop permanent heart problems
Another cancer could develop years after having the treatment

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

How many times you've had the drug before
Your general health
The amount of the drug you have (the dose)
Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

Your side effect may need treating
Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them.

Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.