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's daunorubicin injection has a 12 month shelf-life after manufacturing. [2]
  • Teva states daunorubicin was on back order due to manufacturing delays.[2]

Available Products

• • Daunorubicin hydrochloride solution for injection, Teva, 5 mg/mL, 4 mL single dose vial, 10 count, NDC 00703-5233-13

• • All presentations are currently available.

• • 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.[3,4,5]
  • Refer to national guidelines such as those from the National Comprehensive Cancer Network (www.nccn.org) or American Society of Clinical Oncology (www.asco.org) for additional information regarding therapeutic use.
  • 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). [3,4,5]

• • Chemotherapy agents, such as daunorubicin hydrochloride, pose additional safety risks both for patients and for healthcare workers handling these agents.[3,4,5]
  • 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).[3,4,5]

• • 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.[3,4,5]
  • 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. http://www.ashp.org/DocLibrary/Policy/DrugShortages/ASHP_shortage_guide09.pdf

• 1. West-Ward (personal communications). August 19 and December 29, 2014; February 16 and May 4, 2015.
  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, August 18, October 13, December 29, 2014; January 28, February 17, March 4, April 7, May 6, June 10, and July 8, 2015.
  3. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2015 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2015: 839-1281.
  4. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. (http://online.factsandcomparisons.com/index.aspx). March 2015.
  5. Lexi-Drugs Online. Lexi-Comp, Inc.; 2015.