Epirubicin

Intravenous
Acute leukaemia, Lymphoma, Multiple myeloma, Solid tumours

Intravenous
Adjuvant treatment of axillary-node positive breast cancer

Intravesical
Local treatment of bladder carcinoma

Patients with heavy pre-treatment, preexisting bone marrow depression, or the presence of neoplastic bone marrow infiltration: Starting dose of 75-90 mg/m². Dosage modifications after the 1st treatment cycle: Nadir platelet counts < 50,000/mm², ANC < 250/mm², neutropenic fever, or grades 3 or 4 nonhaematogenic toxicity: Reduce day 1 dose in subsequent cycles to 75% of the day 1 dose in the current cycle. Day 1 chemotherapy in subsequent courses of treatment should be delayed until platelet counts are exceeding 100,000/mm³, ANC exceeding 1500/mm³, and nonhaematogenic toxicities have recovered to almost grade 1. In addition, for patients receiving divided dose (day 1 and day 8) regimen: Day 8 platelet counts 75,000-100,000/mm³ and ANC 1000-1499/mm³: dose should be 75% of the day 1 dose. Day 8 platelet counts <75,000/mm³, ANC <1000/mm³ or grade 3 or 4 nonhaematologic toxicity: Omit day 8 dose.

Intravenous:
Adjuvant treatment in axillary-node positive breast cancer: Dosage adjustment may be needed in severe impairment.

Moderate liver dysfunction (serum bilirubin concentrations: 12-30 mcg/mL): Doses should be halved; severe liver impairment (serum bilirubin >30 mcg/mL): A quarter of the usual dose.

Cardiac impairment, severe or recent MI; previous full cumulative doses of anthracyclines. Hypersensitivity; severe hepatic dysfunction. Not for intravesical use where invasive tumours have penetrated the bladder wall; urinary infections, bladder inflammation or catheterisation problems. Pregnancy, lactation.

Previous extensive radiotherapy, bone infiltration by tumour, severe renal and hepatic dysfunction. May cause tumor lysis syndrome or radiation recall. Elderly women >70 yr. CV disease, hypertensive cardiomyopathy; monitor hematological and cardiac function regularly. Extravasation during IV admin may result in severe local tissue necrosis. Do not give via IM/SC routes as extravasation can lead to severe local necrosis.

Myelosuppression; cardiotoxicity, alopoecia; mucositis; hyperpyrexia; lethargy; amenorrhoea; nausea and vomiting; diarrhoea; fever; rash, skin changes, anorexia; anaphylaxis; photosensitivity; premature menopause; skin and nail hyperpigmentation; harmless reddish appearance of urine for 1-2 days.

Intravesical/IV/Parenteral: D

Treatment should be supportive (including antibiotic therapy, blood and platelet transfusions, colony-stimulating factors, and intensive care as needed) until the recovery of toxicities. Delayed CHF may be observed mth after anthracycline admin.

Paclitaxel and other anthracyclines. Cimetidine, heparin. Antineoplastic drugs, cardiotoxic drugs, radiation, hepatoactive drugs.

St. John's wort, alcohol, black cohosh, dong quai.

Increased transaminases.

Description:
Mechanism of Action: Epirubicin, an anthracycline with cytotoxic properties. It inhibits DNA and RNA synthesis by steric obstruction after intercalating between DNA base pairs that triggers DNA cleavage by topoisomerase II. It also inhibits DNA helicase and generates cytotoxic free radicals.
Pharmacokinetics:
Distribution: Rapidly and extensively distributed into body tissues.
Metabolism: Hepatically metabolised.
Excretion: Eliminated mainly in bile. Terminal elimination half-life: About 30-40 hr.

Refrigerate at 2-8°C.

Cytotoxic Chemotherapy