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Eribulin

(err-uh-BYOO-lin)

Trade/other name(s): Halaven, eribulin mesylate

Why would this drug be used?

This chemotherapy drug is used to treat advanced breast cancer. It is used when certain other chemotherapy medicines have not worked. It is also being studied for treating other types of cancer.

How does this drug work?

Eribulin belongs to a class of drugs called microtubule inhibitors. When cells divide (and multiply), structures called microtubules are needed to pull the chromosomes apart into the new cells. Eribulin stops the microtubules from forming so that the cells are stuck in the middle of dividing. When this happens, the cells die. Because cancer cells divide more quickly than normal cells, they are more likely than normal cells to be affected by this drug.

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 or kidney disease. Reduced liver or kidney function might result in more of the drug staying in the body than expected, which could lead to unwanted side effects. Your doctor may need to adjust your dose accordingly.
  • If you have a heart disease such as congestive heart failure, an abnormal heart rhythm, slow heartbeat, heart block, AV block, heart failure, long QT syndrome, or any problem with the heart's electrical system. This drug can change the electrical activity in the heart, which can lead to irregular heartbeats and can be life threatening. Your doctor may need to monitor your heart during treatment with this drug.
  • Let the doctor know if you have had low levels of potassium or magnesium in the blood, which can increase your chances of having a heart rhythm problem with this drug.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if taken at the time of conception or during pregnancy. Check with your doctor about birth control methods to prevent pregnancy while you are taking this medicine. Tell your doctor right away if you become pregnant or think you may be pregnant.
  • If you are breast-feeding or are planning to breast-feed. The drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. This drug may affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • 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

Other drugs that affect the heart’s rhythm or electrical impulses can increase the risk of a serious abnormal heart rhythm that could lead to death. Examples of these drugs include:

  • Amiodorone (Cordarone, Pacerone)
  • Disopyramide (Norpace)
  • Dofetilide (Tikosyn)
  • Flecainide (Rhythmol)
  • Ibutilide (Corvert)
  • Mexiletine (Mexitil)
  • Moricizine (Ethmozine)
  • Procainamide (Procan, Pronestyl)
  • Propafenone (Tambocor)
  • Quinidine (Quinidex, Cardioquin)
  • Tocainide (Tonocard)

Beta blocker drugs also slow the heart rate and can worsen effects on the heart. This class includes drugs like acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), esmolol (Brevibloc), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and timolol (Blocadren).

These drugs can also increase your risk of abnormal heart rhythm if you take them during the same times you take dolasetron.

  • The blood pressure and heart drug verapamil
  • Anti-psychotic drugs such as thioridazine (Mellaril), haloperidol (Haldol), mesoridazine (Serentil)
  • Antidepressants such as venlafaxine (Effexor) and amitriptyline (Elavil)
  • Certain antibiotics (e.g., erythromycin, clarithromycin, levofloxacin, ofloxacin, moxifloxacin, sparfloxacin, pentamidine)

This is not a complete list. Other drugs that can slow the heart rate or prolong the QT interval of the heart can increase the increase the danger of an abnormal rhythm. Check with your doctor or pharmacist to find out if other drugs you’re taking have this effect.

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:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • Warfarin (Coumadin)
  • Ticlopidine (Ticlid)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Clopidogrel (Plavix)
  • Any type of heparin injections

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen, and there are many types of non-steroidal anti-inflammatory drugs (NSAID). Ask your pharmacist if you aren't sure what is in the medicines you take, or whether a medicine is an NSAID.

Research on interactions with other drugs is incomplete at this time. 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?

Eribulin is given by an injection into a vein (IV) over 2 to 5 minutes, usually once a week for 2 weeks in a row, followed by a week off.

The dose of eribulin that you will get at first will depend on your body size and on your liver and kidney function. Future doses may need to be lowered or treatment delayed if you had severe side effects or your blood counts or other lab test results are not normal.

Precautions

This drug can cause low blood counts. Your doctor will test your blood before each treatment, looking for possible effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you may be given 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. Keep all your appointments for lab tests and doctor visits.

Serious (sometimes life-threatening) infections may occur in patients taking eribulin because of low white blood cell counts. 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, diarrhea, or bringing up sputum.

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 vitamin E. 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 may lower your red blood cell count. If this occurs, it will usually happen a few months after starting treatment. A low red blood cell count (known as anemia) can cause low energy, shortness of breath, or make you to feel weak or tired all the time. Tell your doctor if you have any of these symptoms.

Eribulin can damage nerves (called neuropathy), which can cause numbness, tingling, burning sensations, weakness, sensitivity to hot and cold, or even pain in the hands or feet. This can be more of a problem in someone who had diabetes or neuropathy before treatment is started. Tell your doctor if you notice this.

This drug can affect the heart's rhythm and prolong the QT interval (slow down the electrical impulses in the heart). Eribulin should be used with caution in people with known heart problems, so tell your doctor if you have ever been diagnosed with heart disease. Your doctor will test your heart rhythm with an EKG and will test your blood levels of certain minerals that could affect heart rhythm before you start treatment and several times during treatment. Report any episodes of fast or irregular heartbeat, chest pain, lightheadedness, dizziness, or shortness of breath to your doctor right away. These changes can be life-threatening.

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 red blood cell count (anemia) which can cause low energy and fatigue*
  • Numbness, tingling, burning, or pain in the hands or feet (neuropathy)*
  • Hair loss or thinning
  • Fatigue (tiredness)
  • Weakness, lack of energy
  • Nausea
  • Fever
  • Constipation
  • Muscle or joint pain
  • Loss of appetite
  • Weight loss

Less common

  • Headache
  • Vomiting
  • Mouth sores or dry mouth
  • Diarrhea
  • Back pain
  • Bone pain
  • Cough
  • Shortness of breath
  • Urinary tract infection
  • Watery eyes
  • Swelling in the hands or feet
  • Dizziness
  • Altered taste
  • Trouble sleeping
  • Rash
  • Abnormal blood test results suggesting the drug may be affecting the liver

Rare

  • Low platelet count with increased risk of bruising and bleeding*
  • Hepatitis (liver inflammation)
  • Pancreatitis (inflammation of the pancreas, leading to belly pain, nausea, and vomiting)
  • Itching
  • Pneumonia or other serious infection
  • Changes in the rhythm of the heart*
  • Death from serious infection, irregular heartbeat, or other problem

*See Precautions section for more 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 2010

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: 11/08/2013
Last Revised: 11/08/2013