Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
ADRIAMYCIN PFS vs IDAMYCIN
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Intercalation between DNA base pairs, inhibition of topoisomerase II, and generation of free radicals leading to DNA damage and apoptosis.
Idarubicin is an anthracycline antineoplastic agent that intercalates with DNA and inhibits topoisomerase II, leading to inhibition of DNA replication and transcription, and ultimately cell death. It also generates free radicals and induces apoptosis.
Acute lymphoblastic leukemia,Acute myeloblastic leukemia,Wilms tumor,Neuroblastoma,Soft tissue and bone sarcomas,Breast cancer,Ovarian cancer,Transitional cell bladder cancer,Thyroid cancer,Gastric cancer,Hodgkin lymphoma,Non-Hodgkin lymphoma,Multiple myeloma,Small cell lung cancer
Treatment of acute myeloid leukemia (AML) in adults, including induction therapy in combination with other agents,Treatment of acute lymphoblastic leukemia (ALL) (off-label)
60-75 mg/m² IV every 21 days as a single agent; 40-60 mg/m² IV every 21-28 days in combination regimens. Cumulative lifetime dose not to exceed 450-550 mg/m² (or 400 mg/m² with prior chest irradiation).
12 mg/m² IV daily for 3 days (acute myeloid leukemia) or 12 mg/m² IV daily for 3 days (acute lymphoblastic leukemia); maximum cumulative dose 600 mg/m².
Triphasic: initial α half-life 30 min (distribution), intermediate β half-life 3-4 hours (metabolism), terminal γ half-life 20-48 hours (prolonged due to extensive tissue binding and slow efflux from tissues).
Terminal elimination half-life: 20-30 hours (mean ~22 hours). Prolonged in severe hepatic impairment (up to 40 hours) and may be extended in patients with renal impairment due to accumulation of active metabolite idarubicinol (half-life > 60 hours).
Primarily hepatic metabolism via aldo-keto reductases to doxorubicinol; also undergoes 4-O-demethylation and glucuronidation. CYP450 minimally involved.
Idarubicin is extensively metabolized in the liver to its active metabolite idarubicinol, which has similar antineoplastic activity. The primary enzyme involved is aldo-keto reductase. Idarubicin and idarubicinol are eliminated via biliary excretion and renal excretion.
Primarily hepatobiliary (∼50% as unchanged drug and metabolites in bile); renal excretion accounts for ∼5-12% over 72 hours; fecal elimination ~40%.
Primarily hepatic metabolism; biliary excretion of metabolites accounts for ~50% of total elimination. Renal excretion of unchanged drug is minimal (<10%). Approximately 30-40% of the dose is recovered in urine as metabolites. Fecal elimination of metabolites accounts for ~50%.
∼70% bound to plasma proteins, primarily albumin; binding is concentration-dependent and saturable at high doses.
Parent drug: 94-97% bound, primarily to albumin. Idarubicinol (active metabolite): ~95% bound to albumin.
Extensive: 20-30 L/kg (total body water far exceeded, indicating deep tissue compartment binding, especially in liver, spleen, heart, and bone marrow).
Vd: 20-30 L/kg (mean ~25 L/kg). Very large distribution indicates extensive tissue binding and penetration into cells, particularly in bone marrow.
Not bioavailable orally (0%, due to extensive first-pass metabolism and instability in GI tract); administered only intravenously.
Oral bioavailability: approximately 28% (range 10-40%) due to first-pass metabolism. Not available orally in typical clinical practice; IV administration is standard. Oral formulations exist for investigational use but not FDA-approved.
No specific dose adjustment recommended for renal impairment; however, monitor for toxicity. GFR < 10 m L/min: consider dose reduction by 50% due to potential accumulation of active metabolites.
If serum creatinine > 2 mg/d L or creatinine clearance < 30 m L/min, reduce dose by 25-50% and monitor cardiac function.
Child-Pugh A: reduce dose by 25%; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated or reduce by 75% with extreme caution.
Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 25%; Child-Pugh C: reduce dose by 50% or consider alternative therapy.
30-75 mg/m² IV every 21-28 days; cumulative dose limit 400-550 mg/m². Dose based on body surface area; for infants < 1 year or BSA < 0.5 m², use weight-based dosing: 1-2 mg/kg IV every 21 days.
10-12 mg/m² IV daily for 3 days; maximum cumulative dose 600 mg/m²; adjust for renal/hepatic impairment.
No specific dose adjustment based on age alone; use with caution due to increased risk of cardiotoxicity and myelosuppression. Consider starting at lower end of dosing range (e.g., 45-60 mg/m² every 21 days) and monitor cardiac function.
Start at lower end of dosing range (e.g., 10-12 mg/m²), monitor cardiac function closely due to increased risk of cardiomyopathy; reduce dose for renal impairment.
Myocardial toxicity (including delayed congestive heart failure) may occur with cumulative doses >550 mg/m²; less if prior mediastinal irradiation. Extravasation causes severe tissue necrosis. Secondary acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) reported. Hepatic impairment requires dose adjustment. Use during pregnancy only if benefit outweighs risk.
Idarubicin should be administered only under the supervision of physicians experienced in leukemia chemotherapy. Severe myelosuppression occurs. Cardiotoxicity (including heart failure, arrhythmias, and cardiomyopathy) may occur, especially with cumulative doses exceeding 150 mg/m². Extravasation can cause severe tissue necrosis. Reduction of left ventricular ejection fraction (LVEF) and congestive heart failure have been reported.
Cardiotoxicity (cumulative dose-dependent, enhanced by prior chest irradiation, age >70, pre-existing cardiac disease); myelosuppression; extravasation injury; secondary malignancies; tumor lysis syndrome; hepatic impairment; radiation recall; mutagenic and carcinogenic potential; impairment of fertility.
Myelosuppression: severe bone marrow suppression leading to infection, bleeding, and anemia,Cardiotoxicity: acute (arrhythmias, myocardial depression) and chronic (cumulative dose-related cardiomyopathy); monitor LVEF,Secondary malignancies: higher risk of therapy-related myelodysplasia or acute leukemia,Extravasation: severe tissue damage if extravasation occurs; use central line administration,Tumor lysis syndrome: rapid lysis of tumor cells can cause uric acid nephropathy,Hepatic impairment: requires dose reduction,Renal impairment: requires dose reduction,Immunosuppression: live vaccines contraindicated
Hypersensitivity to doxorubicin or any component; severe hepatic impairment; severe myelosuppression; baseline cardiac dysfunction; previous treatment with maximum cumulative doses of doxorubicin or other anthracyclines.
Hypersensitivity to idarubicin or any component of the formulation,Severe hepatic impairment (bilirubin >5 mg/d L),Severe renal impairment (creatinine clearance <15 m L/min),Inadequate bone marrow reserve due to prior chemotherapy or radiotherapy,Pregnancy (category D): can cause fetal harm,Lactation: discontinue nursing or drug
Grapefruit and grapefruit juice should be avoided as they may inhibit CYP3A4 metabolism and increase doxorubicin toxicity. No other significant food interactions; maintain adequate hydration and nutrition.
Avoid grapefruit and grapefruit juice as they may inhibit CYP3A4 metabolism and increase idarubicin toxicity. No other significant food interactions are reported. Maintain adequate hydration to prevent tumor lysis syndrome; avoid alcohol as it may exacerbate hepatic toxicity.
FDA Pregnancy Category D. First trimester: high risk of major congenital malformations (e.g., CNS, cardiovascular) and spontaneous abortion. Second and third trimesters: risk of fetal growth restriction, oligohydramnios, and neonatal myelosuppression. Avoid use unless maternal benefit outweighs fetal risk.
Pregnancy category D. First trimester: high risk of fetal malformations (central nervous system, cardiovascular, skeletal). Second and third trimesters: increased risk of fetal growth restriction, preterm birth, and neonatal myelosuppression. Avoid use unless maternal benefit outweighs risks.
Not recommended. Doxorubicin is excreted into human breast milk; M/P ratio not available. Potential for serious adverse reactions in nursing infants (e.g., immunosuppression, neutropenia). Discontinue breastfeeding during treatment and for at least 10 days after last dose.
Not recommended. Idarubicin is excreted into breast milk; M/P ratio not available. Potential for severe adverse effects in nursing infant including neutropenia and cardiotoxicity.
No established dose adjustments in pregnancy. Pharmacokinetic changes (increased plasma volume, altered protein binding) may require monitoring for toxicity or efficacy. Use lowest effective dose; consider dose reduction for myelosuppression or cardiotoxicity. Administration frequency may be modified based on gestational age and maternal tolerance.
No established dose adjustments in pregnancy. Pharmacokinetic changes (increased volume of distribution, altered clearance) may require dose individualization based on BSA and toxicity monitoring. Use lowest effective dose with aggressive supportive care.
Pre-medicate with antiemetics (e.g., 5-HT3 antagonist) prior to administration. Monitor left ventricular ejection fraction (LVEF) at baseline and periodically due to cumulative dose-related cardiotoxicity (lifetime max 450-550 mg/m2, lower with prior chest radiation). Extravasation causes severe tissue necrosis; administer through a free-flowing IV line. Reduce dose in hepatic impairment (bilirubin >1.2 mg/d L). Observe for urine discoloration (red) for 1-2 days post-infusion. Avoid concurrent use with trastuzumab or other cardiotoxic agents.
Idarubicin is a potent anthracycline with significant cardiotoxicity; cumulative lifetime dose should not exceed 150 mg/m² in adults. Administer IV slowly over 5-10 minutes to reduce risk of extravasation, which causes severe tissue necrosis. Monitor for acute infusion reactions and premedicate with antiemetics. Renal and hepatic impairment require dose adjustment; check bilirubin and creatinine levels before each cycle. Concomitant use with other cardiotoxic agents increases risk of heart failure.
Doxorubicin may cause temporary reddish discoloration of urine for 1-2 days after treatment; this is harmless.,Report any signs of infection (fever, sore throat), unusual bleeding or bruising, mouth sores, or shortness of breath.,Your heart function will be checked before and during treatment; report any chest pain, palpitations, or swelling of ankles/feet.,This drug can cause nausea and vomiting; you will receive medications to prevent these symptoms.,Avoid pregnancy during treatment; use effective contraception. Doxorubicin can harm a fetus and may cause infertility.,Do not receive live vaccines during chemotherapy. Avoid contact with people who have recently received oral polio vaccine.,Take oral care measures (soft toothbrush, bland rinses) to prevent mouth sores.,Limit intake of grapefruit and grapefruit juice as they may affect the drug's metabolism.
Tell your doctor if you have heart, liver, or kidney problems before starting treatment.,You will need regular blood tests to monitor blood counts and heart function.,Report any chest pain, shortness of breath, or swelling in your ankles immediately.,Avoid grapefruit and grapefruit juice during treatment as it may increase side effects.,Use effective contraception during and for at least 6 months after treatment.,Notify your healthcare provider if you experience fever, chills, or signs of infection.,This medication may cause your urine to turn reddish-orange for 1-2 days after administration.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about ADRIAMYCIN PFS vs IDAMYCIN, answered by our medical review team.
ADRIAMYCIN PFS is a Anthracycline Antineoplastic that works by Intercalation between DNA base pairs, inhibition of topoisomerase II, and generation of free radicals leading to DNA damage and apoptosis.. IDAMYCIN is a Anthracycline Antineoplastic that works by Idarubicin is an anthracycline antineoplastic agent that intercalates with DNA and inhibits topoisomerase II, leading to inhibition of DNA replication and transcription, and ultimately cell death. It also generates free radicals and induces apoptosis.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between ADRIAMYCIN PFS and IDAMYCIN depend on the specific clinical indication. These are both Anthracycline Antineoplastic agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of ADRIAMYCIN PFS is: 60-75 mg/m² IV every 21 days as a single agent; 40-60 mg/m² IV every 21-28 days in combination regimens. Cumulative lifetime dose not to exceed 450-550 mg/m² (or 400 mg/m² with prior chest irradiation).. The standard adult dose of IDAMYCIN is: 12 mg/m² IV daily for 3 days (acute myeloid leukemia) or 12 mg/m² IV daily for 3 days (acute lymphoblastic leukemia); maximum cumulative dose 600 mg/m².. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between ADRIAMYCIN PFS and IDAMYCIN in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. ADRIAMYCIN PFS is classified as Category C. FDA Pregnancy Category D. First trimester: high risk of major congenital malformations (e.g., CNS, cardiovascular) and spontaneous abortion. Second and third trimesters: risk of fe. IDAMYCIN is classified as Category C. Pregnancy category D. First trimester: high risk of fetal malformations (central nervous system, cardiovascular, skeletal). Second and third trimesters: increased risk of fetal gro. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.