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Epirubicin

(ep-ee-roo-buh-sin)

Trade/other name(s): Ellence, Farmorubicin(e), Farmorubicina, Pharmorubicin

Why would this drug be used?

Epirubicin is used to treat breast cancer. Your doctor may also use it to treat other types of cancer.

How does this drug work?

Epirubicin is part of the general group of chemotherapy drugs known as anthracycline antibiotics. These drugs slow or stop the growth of cancer cells.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any type of liver disease, including hepatitis or cirrhosis. This drug is broken down by the liver, and your dose may need to be adjusted (see “Precautions” below).
  • If you have any other medical conditions such as kidney disease, diabetes, gout, or infections. Your doctor may need to monitor you more closely during treatment.
  • If you have ever had heart problems (such as congestive heart failure, an abnormal heart rhythm, or a recent heart attack), radiation to the chest, or if you have ever had medicines that might have damaged your heart. This drug may raise your risk of heart failure (see “Precautions” below).
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it may harm the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Cimetidine (Tagamet), paclitaxel (Taxol, Abraxane, Onxol), and docetaxel (Taxotere) can raise the levels of epirubicin in your blood. This can lead to worse side effects from epirubicin.

This drug can cause heart damage. The risk of heart damage may be higher if it is taken with or shortly after other drugs that can damage the heart, such as trastuzumab (Herceptin), pertuzumab (Perjeta), ado-trastuzumab emtansine (Kadcyla), other antracyclines (like daunorubicin, doxorubicin, and idarubicin), or mitoxantrone (See “Precautions”).

Using epirubicin at the same time as other drugs that can cause heart failure, such as calcium channel blockers like verapamil (Covera, Verelan, Calan), diltiazem (Cardizem, Tiazac), and amlodipine (Norvasc) may require closer watch on heart function.

This drug can lower your blood platelet count, which can increase your risk of uncontrolled bleeding (see “Precautions”). If your platelet count becomes low, you may need to avoid other drugs or supplements that interfere with blood clotting, because they might further raise the risk of bleeding. These include:

    · Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and many others

    · Warfarin (Coumadin)

    · Dabigatran (Pradaxa)

    · Rivaroxaban (Xarelto)

    · Apixaban (Eliquis)

  • Any type of heparin injections, such as enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep)
  • · Anti-platelet drugs such as clopidogrel (Plavix) or prasugrel (Effient)

    · Vitamin E

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren’t sure what’s in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Epirubicin is given into a vein (IV) over a period of about 15 minutes. Tell the nurse right away if you feel pain, burning, or discomfort in the vein when the drug is given. You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. You will be given anti-nausea medicine before and after taking epirubicin.

Your dose and how often you’ll get epirubicin depend on several factors: your size, your blood counts, how well your liver is working, and the type of cancer being treated. Your doctor will check your blood counts before each treatment; if they are too low, your treatment will be delayed.

This medicine is sometimes given along with other chemotherapy medicines.

Precautions

This drug is given into the vein (IV), and can damage small veins. If the drug leaks out of the vein and under the skin, it may damage the skin and underlying tissue, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV.

It is common to have nausea and vomiting on the day you receive epirubicin or in the first few days afterward. Your doctor will likely give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug may damage the muscle of the heart and lead to congestive heart failure. The risk of heart damage might be higher if you are also treated with HER2 targeted drugs such as trastuzumab (Herceptin) or if you received other anthracyclines in the past (see “Interactions with other drugs”). Your doctor will test your heart function before treatment and regularly (about every 3 months) during treatment with this drug. Possible symptoms of heart damage and congestive heart failure can include increased coughing, trouble breathing (especially at night), heart palpitations, rapid weight gain (5 pounds or more in 24 hours), dizziness, fainting, or swelling in the ankles or legs. Tell your doctor right away if you start to notice any of these symptoms once treatment starts.

Do not get any immunizations (vaccines) either during or after treatment with this drug, without your doctor’s OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Epirubicin causes the urine to turn reddish for 1 to 2 days after each dose is given. This is normal while your body gets rid of the drug, but it may stain clothes.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given other medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin) or other “blood thinners”, or vitamin E (see “Interactions with other drugs” above). Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug can kill large numbers of cancer cells within the first 24 hours of treatment, spilling the cells’ contents into the blood. This can lead to electrolyte imbalances and tumor lysis syndrome, which can result in serious kidney damage and other problems. If your doctor thinks you may be at risk, he or she will give you medicines and/or fluids to help prevent it. If you notice pain in the back or sides of your chest, or blood in your urine, call your doctor right away.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, and if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Epirubicin can cause radiation recall, a severe skin reaction that occurs when certain chemotherapy drugs are given during or soon after radiation treatment. This reaction is similar to a sun burn, and appears where you had skin or tissue damage from prior radiation therapy. It may last hours or even days. Tell your doctor if you notice any redness or itching where radiation was given. Epirubicin may also cause radiation to damage the skin and tissues more if the radiation is done during treatment with this drug.

This drug is broken down by the liver, and so may be more toxic in patients with liver problems. Your doctor will check blood tests of liver function before and during treatment with this drug. If you have liver problems, your doctor may have to lower your dose of this drug, or may not be able to treat you with it at all.

Some patients being treated with this drug have developed problems with serious blood clots, such as heart attack, angina, deep venous thrombosis (blood clot in the veins of the leg or arm), pulmonary embolus (blood clot in the lungs), stroke, and transient ischemic attack (TIA). Get help right away if you have pain and swelling in the leg, chest pain, trouble breathing, trouble moving or speaking, dizziness, or other serious symptoms.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Low white blood cell count with increased risk of infection*
  • Low platelet count with increased risk of bleeding*
  • Low red blood cell count with increased risk of anemia and tiredness (fatigue)*
  • Stopping of menstrual periods in women, which can be permanent
  • Tiredness (fatigue)
  • Nausea*
  • Vomiting*
  • Sores in mouth
  • Diarrhea
  • Hair loss
  • Damage to the vein into which it is given*

Less common

  • Irritation of the eyes (conjunctivitis)
  • Sores in esophagus (swallowing tube)

Rare

  • Severe allergic reaction with symptoms such as hives and itching, trouble breathing, dizziness or faintness, and swelling in the mouth or throat
  • Damage to the skin and underlying tissues if it leaks out of the vein*
  • Tumor lysis syndrome, kidney damage*
  • Loss of appetite
  • Fever
  • Darkening of nails and skin
  • Radiation recall skin changes*
  • Sensitivity to sunlight
  • Blood clots in the legs, lungs, and other parts of the body, which can be serious*
  • Facial flushing
  • Heart damage which can lead to congestive heart failure, with symptoms of shortness of breath, swollen feet and ankles, which can happen during treatment or months or years later*
  • Irregular heartbeat or serious heart rhythm problems such as heart block and ventricular tachycardia
  • Leukemia (a second cancer), which may happen years after treatment*
  • Death due to bleeding, infection, heart damage, serious blood clots, or other causes*

*See “Precautions” section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1999.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 03/14/2013
Last Revised: 01/06/2015