Epirubicin (Intravenous)

Often used in combination with other cancer medications, epirubicin is prescribed for women who have had breast surgery to remove cancerous cells.

Overview

Epirubicin is a medication which is made available as a liquid that can be injected intravenously, generally in a clinical setting by a medical professional. It is most commonly administered in cycles of 21 days, and for a maximum of six cycles of treatment. Once a female patient has had surgery to remove a malignant tumor, epirubicin is prescribed to kill off any remaining cancerous cells, and hopefully to prevent a return of them.

This medication is frequently used in tandem with other cancer-killing drugs, and is effective at stopping the spread of cancer cells in women who have had surgery to remove a tumor. It is important that this medication is administered by a trained doctor or nurse, because if it is improperly delivered into muscle or under the skin, there is a potential for it to cause severe damage to surrounding tissue. Whenever a dosage of this medication is administered, the injection site should be carefully observed, to ensure that no irritation or other symptoms develop.

Condition Treated

  • Breast Cancer

Type Of Medicine

  • Anthracycline

Side Effects

While epirubicin can deliver some important medical benefits, it may also carry with it some undesirable side effects which vary from person to person. Some people may never experience any side effects whatsoever, while others may experience some fairly severe side effects that require medical attention. Every patient's body is different, so it is impossible to predict whether or not any given patient will undergo any side effects as a result of taking epirubicin, and it is also impossible to predict how severe these may be if they do appear.

Every patient who has been a prescribed a program of treatment which includes epirubicin should review the side effects below carefully to determine if they match any symptoms which may appear for you after taking this medication. In all cases, you should report the side effects to your doctor, and you should also be prepared to discuss the severity of any of these side effects, especially if you feel some kind of relief is necessary.

The first side effect to be on the lookout for is an allergic reaction, and this should be dealt with immediately, because the symptoms could possibly become so severe that they are life-threatening. People who are allergic to epirubicin may experience any or all of the following side effects:

  • Hives and/or rashes appearing on the skin
  • A tightness in the chest or other manifestations of breathing difficulty
  • Dizziness or disorientation
  • An extreme itchiness
  • Pronounced swelling around the face, especially in the tongue, lips, or throat.

The side effects in the group listed below are considered to be fairly serious in nature, and you should therefore contact your doctor right away if you experience any of these:

  • Unusual tendency toward bruising
  • Unexplained bleeding from the nose, mouth, rectum, or vagina
  • Purple spots or red spots which appear just under the skin
  • Any kind of irritation, pain, or burning on the skin at the site where the injection was given
  • Lower back pain
  • Blood in the urine
  • Urinating less frequently than normal or not urinating at all
  • Flu symptoms such as fevers, chills, body aches, and sores in the throat or mouth
  • Swelling or bloated feeling
  • Unexplained or sudden weight gain, particularly in evidence through the midsection and/or the facial area
  • Irregular heartbeat, especially much faster than normal
  • A numbness or tingling sensation in the area around the mouth
  • Low pulse rate
  • Hypersensitive reflexes
  • Confusion or disorientation
  • Lightheadedness with the sensation you are about to faint
  • Shortness of breath even from relatively mild exertion
  • Nausea, vomiting, and upper stomach pain
  • Persistent itching
  • Loss of appetite
  • Yellowish look on the skin or around the eyes
  • Clay-colored stools
  • Dark-colored urine
  • Severe shortness of breath, sometimes accompanied by a gasping and or wheezing
  • Profuse sweating
  • Anxiety and or irritability
  • Muscle weakness, tightness or contractions of the muscles
  • Pale skin
  • Difficulty focusing or concentrating
  • Chest pains
  • Coughing up mucous or blood

Some of the milder side effects which may appear do not necessarily call for immediate medical attention, but should be reported to your doctor at the next regularly scheduled visit. These include the following:

  • Missed menstrual periods
  • Hot flashes
  • Mild nausea and/or vomiting
  • Diarrhea
  • A sensation of being fatigued or weak
  • Temporary hair loss
  • Eyes and or eyelids being puffy or reddish in color

Dosage

A standard initial dosage for a patient being treated for breast cancer would be 100 mg to 120 mg every three or four weeks, delivered intravenously. At the doctor's discretion, this total amount can be injected all on the first day, or divided up equally between the first and eighth day of each dosage cycle. After the initial cycle, your doctor may prescribe an increased dosage up to 200 mg, which would also be delivered either on the first day all at once, or divided up between the first and eighth days equally.

Patients who are being treated for any kind of liver disease would typically be given only about half this dosage, although depending on the status or progression of the disease, a patient might also be prescribed only one quarter of the recommended initial dosage.

There are other factors which your doctor may consider that could cause an adjustment to the standard dosage for a breast cancer patient. For instance, patients who are heavily pretreated, have bone marrow depression, or have neoplastic infiltration of the bone marrow may have their standard dosage adjusted lower.

After the initial cycle for all breast cancer patients, there is likely to be a dosage adjustment up or down by your doctor, depending on how your body is tolerating the medication and how effective the initial cycle of treatment was. Another strong consideration for dosage adjustment are the platelet counts in your blood, since a breast cancer patient may also be receiving chemotherapy which affects that platelet count.

Interactions

There are a number of other drugs which have the potential of interacting with epirubicin, and that makes it important that your doctor review all medications you are currently taking, so as to avoid the possibility of an unfavorable reaction occurring for you. In order to facilitate this review process, you should prepare a list of all medications you are currently taking, or you have recently taken, as well as all the dosages of each.

This list should include all the vitamins, herbal supplements, over-the-counter drugs, and all other prescription medications which you are currently using. You should keep a copy of this list on hand to take with you if you should ever have to visit an emergency room for treatment, or if you have to go to a healthcare clinic where your primary care doctor is not in residence. It will be much easier for any doctor at one of these facilities to prescribe some kind of treatment for your condition if they know beforehand what kind of medications you are taking. Once they know about all your current medications, they can avoid prescribing any kind of treatment that will interact with your epirubicin medicine or any other medication which you are now using.

A partial list of the drugs which have the potential to interact with epirubicin is listed below, and while this is not a comprehensive list, it does include all of the most commonly checked medications, and they're the ones your doctor will be especially interested in.

  • Seizure medications such as carbamazepine, divalproex, phenobarbital, valproic acid, and phenytoin
  • Auranofin or other kinds of gold injections intended to treat arthritis
  • Acetaminophen
  • Any kind of antibiotics or antifungal medications
  • Cimetidine
  • Medications which treat HIV/AIDS
  • Cancer medications such as docetaxel or paclitaxel
  • Any nonsteroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen, celecoxib, meloxicam, diclofenac, indomethacin, and naproxen
  • Birth control pills
  • Hormone replacement medications
  • Medicines which are intended to be antidepressants such as desipramine, clomipramine, notriptyline, imipramine, doxepin, and amitriptyline
  • Rosiglitazone
  • Blood pressure medications such as amlodipine, atenolol, carvedilol, methyldopa, lisinopril, nifedipine, diltiazem, digoxin, verapamil, enalapril, or labetalol
  • Medications to treat high cholesterol including atorvastatin, fluvastatin, pravastatin, rosuvastatin, simvastatin, lovastatin, and pitavastatin.

Warnings

There are a few precautions and warnings which should be taken into account for any patient being treated with epirubicin. If you know you are allergic to epirubicin or any of the ingredients used in its manufacture, be sure to alert your doctor to this during consultation. It's also a good idea to make your doctor aware of any kind of allergic reactions you have to other medications, or to pets, foods, preservatives, or different kinds of fabric. It's possible for inactive ingredients within epirubicin to trigger one of those other allergic reactions you may have, so be sure to make your doctor aware of these.

You should avoid receiving any kind of live vaccine when you're being treated with epirubicin, because there's a possibility of developing a serious infection. Some of the live vaccines to note include those for measles, oral polio, chickenpox, shingles, oral typhoid vaccine, mumps, rubella, influenza, Bacillus-Calmette Guerin, rotavirus, and yellow fever.

It's a good practice to avoid being in the company of people who are sick or have infections while you're being treated with epirubicin. If you should develop any signs of infection yourself, you should immediately report this to your doctor so that you can be treated.

You should avoid any kind of activity which might elevate the risk of injury or trigger some kind of bleeding. You should also exercise caution while brushing your teeth or shaving your legs, so as not to induce bleeding from either of those two sources.

Women who are of age to bear children are strongly advised to avoid becoming pregnant while being treated with epirubicin. Any male sexual partners should be urged to use contraceptive methods to avoid the potential of causing pregnancy. A fair amount of research has been conducted on animal subjects in association with the usage of epirubicin, and this evidence has revealed a potential for embryotoxicity, retarded growth of fetuses, and teratogenicity.

There have also been a number of skeletal malformations reported in these same studies, both visceral and external. An unusually high number of abortions and delayed ossification also turned up in these animal studies, suggesting that there's an increased likelihood of adverse reactions which could be passed on to an unborn fetus. Epirubicin also has the potential to damage sperm and testicular tissue, raising the possibility of degraded fertility and potential genetic abnormalities in fetuses.

While there are no definitive studies which have been conducted on human subjects using epirubicin, the evidence derived from these animal studies strongly suggests that this medicine should not be used by any woman who is pregnant or thinking of becoming pregnant. Since there is unlikely to be any significant research conducted on human populations because of the potential harm to fetuses, the evidence made available through research on animal studies should be regarded as a strong warning against pregnancy.

With regard to breastfeeding, this is another area females are strongly advised to avoid when being treated with epirubicin. Although no body of research exists from which conclusions might be drawn, it is known that other anthracyclines similar to epirubicin are passed on through breast milk to infants, and that raises the possibility of serious adverse reactions in those infants. It is therefore strongly recommended that women discontinue breastfeeding while undergoing therapy with epirubicin.

Epirubicin may also interfere with a woman's normal menstrual cycle, causing unusual symptoms not typically experienced by a given patient. If any unusual side effects related to your menstrual cycle should appear while you are being treated with epirubicin, you should report this to your doctor at the earliest opportunity.

You should make sure to keep all appointments with your doctor, as well as any appointments made for laboratory testing. This information will be important so that an understanding can be had of how your body is managing the medication you are being given. It may be necessary for your doctor to alter your dosage, or in some cases, even to discontinue your treatment with epirubicin if your body is having difficulty tolerating it, or if side effects from the drug warrant discontinuance.

You should not use epirubicin if you have any kind of uncontrolled infection such as sores in your mouth, or any other untreated infection. People who have liver disease or liver problems should also not be treated with epirubicin, and the same is true for patients who have any kind of heart disease or heart problems, especially those who have had a heart attack or stroke.

When you are consulting with your doctor about your medical history, be sure to point out if you have any kind of liver or kidney disease, any kind of heart arrhythmia or congestive heart failure, or if you know that your immune system has been weakened by prior cancer therapy. This is especially important because there is a possibility that epirubicin will lower your immune system too, and this could leave you vulnerable to all kinds of attack. There is a potential for epirubicin to elevate your risk of contracting other kinds of cancer, for instance leukemia.

You should alert your doctor immediately if you feel a burning sensation or pain around the injection site, and if any of the medication gets on your exposed skin, it should be washed off immediately with warm water and soap.

This, as well as all other warnings and precautions described above, should be discussed with your doctor so that you have a thorough understanding of the risks associated with taking this drug, as opposed to the benefits and advantages which you might derive from being treated with epirubicin.

Storage

Epirubicin comes in single-use vials and should be stored in a refrigerated setting, between 36 degrees Fahrenheit and 46 degrees Fahrenheit. If you are self-administering at home, this medication must not be frozen or allowed to receive direct lighting. It should be kept well out of reach of any curious children who might want to experiment with tasting it. After the medication is removed from the refrigerator, it should be used within 24 hours, or it should then be discarded.

When it is necessary to discard any unused epirubicin, be sure to follow proper disposal methods, as recommended by your doctor or pharmacist. You can also consult the website maintained by the FDA for safe disposal of medicines if you can't immediately reach a knowledgeable authority. In any case, do not flush this medication down a drain or down the toilet, but follow recommended guidelines for appropriate disposal.

Summary

Epirubicin is a drug belonging to the class of drugs known as anthracyclines, and it is used primarily in the treatment of breast cancer in women, although it is often used in conjunction with other cancer medications. Since there are a number of known side effects which might be experienced by a patient being treated with this medication, and there are a number of warnings which are associated with treatment, a thorough discussion of risks and rewards should be scheduled with your doctor.

This drug should not be used by patients with a medical history of heart disease, liver disease, or kidney disease, and should also not be used by patients whose immune systems have been compromised in any way. Women of childbearing age should be very careful to avoid pregnancy when taking this drug because studies conducted on animal populations suggest strongly that certain kinds of adverse reactions can be felt by unborn fetuses.