Cardiotoxicity:
Dose-limiting and potentially irreversible. Risk increases with cumulative dose >900 mg/m², prior anthracycline use, mediastinal irradiation, or cardiac disease.
Baseline and periodic ECG and echocardiogram (or MUGA) required.
Stop if LVEF decreases significantly or if symptoms of heart failure appear (dyspnoea, oedema, arrhythmia).
Myelosuppression (Bone marrow suppression):
Common and dose-related — monitor CBC prior to each cycle.
Risk of infection, bleeding, and anaemia.
Delay or reduce dose if WBC <3.5 × 10⁹/L or platelets <100 × 10⁹/L.
Extravasation:
Vesicant — causes severe tissue necrosis if leakage occurs during IV administration.
Stop infusion immediately if burning or pain at injection site; treat per extravasation protocol.
Mucositis and GI toxicity:
Common and may be severe — causes mouth ulcers, esophagitis, and diarrhoea.
Supportive care required; ensure adequate hydration and oral hygiene.
Secondary leukaemia:
Rare but reported after anthracycline therapy, especially with alkylating agents or radiotherapy.
Hepatotoxicity:
Use with caution in hepatic impairment; monitor LFTs and reduce dose if bilirubin or transaminases elevated.
Fertility and teratogenicity:
May cause amenorrhoea, azoospermia, or infertility (possibly permanent).
Teratogenic — contraindicated in pregnancy and breastfeeding.
Contraception required during treatment and for ≥6 months post-therapy.
Generic name: Epirubicin hydrochloride
Brand name: Aspen Epirubicin
Drug class: Anthracycline antineoplastic agent
Formulation: Intravenous solution (vials: 10 mg/5 mL, 20 mg/10 mL, 50 mg/25 mL, 100 mg/50 mL, 200 mg/100 mL)
Mechanism of Action:
Intercalates into DNA and inhibits topoisomerase II, blocking replication and transcription; generates free radicals, causing DNA strand breaks and cell death in rapidly dividing cells.
Malignant diseases:
Breast cancer
Ovarian cancer
Gastric (stomach) and colorectal cancers
Lung cancer (including small cell)
Lymphomas (Hodgkin and non-Hodgkin)
Leukaemias (acute and chronic)
Multiple myeloma
Route: Intravenous injection only — never intrathecal or intramuscular.
Typical IV dose (monotherapy): 60–90 mg/m² every 3 weeks.
Combination regimens: Dose adjusted depending on protocol.
Cumulative lifetime dose: Do not exceed ~900 mg/m² due to risk of cardiomyopathy.
Administer via a free-flowing IV line; monitor for extravasation.
Dose adjustments:
Hepatic impairment:
Bilirubin 1.2–3 mg/dL → reduce by 50%.
Bilirubin >3 mg/dL → reduce by 75%.
Renal impairment: Caution; monitor for accumulation.
Myelosuppression: Delay or reduce dose per CBC.
Cardiac dysfunction: Discontinue permanently.
Severe mucositis, hepatotoxicity, or extravasation: Stop or delay treatment.
Avoid or use with caution:
Other cardiotoxic drugs (e.g., doxorubicin, trastuzumab, paclitaxel, amiodarone).
Cimetidine — increases epirubicin exposure (avoid or monitor closely).
Live vaccines — contraindicated during and after chemotherapy.
CYP450 inhibitors (fluconazole, verapamil) may increase toxicity.
Concurrent radiotherapy — additive cardiac or mucosal toxicity.
Hypersensitivity to epirubicin or other anthracyclines
Prior maximum cumulative anthracycline dose
Existing severe myelosuppression
Severe hepatic impairment
Active infections or mouth ulcers
Pregnancy or breastfeeding
Baseline and periodic:
CBC with differential
LFTs and renal function
ECG and echocardiogram (LVEF)
Clinical exam for signs of infection, mucositis, or cardiac dysfunction
Urinalysis for haematuria (rare nephrotoxicity)
| Frequency | Adverse Effect | Management |
|---|---|---|
| Very common (>10%) | Myelosuppression, nausea, vomiting, alopecia, mucositis | Antiemetics, oral care, supportive care |
| Common (1–10%) | Fatigue, diarrhoea, infection, skin/nail changes | Symptomatic treatment |
| Serious (<5%) | Cardiac toxicity, extravasation necrosis, hepatic dysfunction | Stop drug, treat per protocol |
| Long-term | Secondary leukaemia, infertility, amenorrhoea | Monitoring, counselling |
Elderly: Greater risk of myelosuppression and cardiac events — monitor closely.
Hepatic impairment: Dose reduction as above.
Renal impairment: Use with caution.
Pregnancy/Lactation: Contraindicated.
Paediatrics: Use under specialist supervision.
Continue until:
Completion of planned chemotherapy cycles, or
Disease progression or unacceptable toxicity.
Stop if:
Severe cardiotoxicity (heart failure, ECG/LVEF changes)
Grade 3–4 myelosuppression or mucositis
Severe hepatic dysfunction or extravasation injury
| Trade Name | |
|---|---|
| Drug Class | Anthracycline |
| Cost | |
| Company | |
|---|---|
| Drug Rep | Admin |
| Indications | |
| Dosage |
No indications found.