II. Indications

  1. FDA Approved
    1. Breast Cancer (primary cancer, adjuvant therapy)
  2. Off-Label
    1. Esophageal Cancer
    2. Gastric Cancer
    3. Osteosarcoma
    4. Soft Tissue Sarcoma

III. Mechanism

  1. See Antibiotic Chemotherapy
  2. Epirubicin is an Anthracycline aminoglycoside Antineoplastic Agent
    1. Epirubicin is the 4'-epi-isomer of Doxorubicin
  3. Epirubicin (like Doxorubicin) inserts between adjacent DNA base pairs
    1. Blocks DNA Transcription by RNA Polymerase
  4. Epirubicin (like Doxorubicin) also inhibits Topoisomerase 2
    1. Inhibits normal Nucleotide strand ligation during DNA Replication
  5. Epirubicin (like Doxorubicin) also induces free radical formation with several secondary effects
    1. Lipid peroxidation of cell membrane lipids (cytotoxic effects)
    2. Toxic effects (esp. cardiovascular adverse effects)

IV. Medications

  1. Epirubicin IV solution: 2 mg/ml in 100 ml vial

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Severe skin and soft tissue necrosis on extravasation
    1. Epirubicin is a strong Vesicant (causes Blistering)
  2. Carcinogenic
    1. Risk of secondary malignancy (esp. Acute Myelogenous Leukemia)
  3. Cardiotoxicity (esp. children)
    1. Risk of Congestive Heart Failure (esp. with multiple doses)
  4. Myelosuppression
  5. Hyperuricemia
  6. Alopecia
  7. Impaired future fertility
  8. Urine Discoloration (transient red coloration)

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function Tests
    4. Serum Uric Acid
    5. Echocardiogram with ejection fraction

VIII. Drug Interactions

  1. Cimetidine
    1. Increases Epirubicin levels

X. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Ontology: Epirubicin (C0014582)

Definition (NCI_NCI-GLOSS) A drug used together with other drugs to treat early breast cancer that has spread to lymph nodes. It is also being studied in the treatment of other types of cancer. Epirubicin is a type of anthracycline antibiotic.
Definition (NCI) A 4'-epi-isomer of the anthracycline antineoplastic antibiotic doxorubicin. Epirubicin intercalates into DNA and inhibits topoisomerase II, thereby inhibiting DNA replication and ultimately, interfering with RNA and protein synthesis. This agent also produces toxic free-radical intermediates and interacts with cell membrane lipids causing lipid peroxidation.
Definition (MSH) An anthracycline which is the 4'-epi-isomer of doxorubicin. The compound exerts its antitumor effects by interference with the synthesis and function of DNA.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D015251
SnomedCT 349848009, 417916005
English 4' Epi Adriamycin, 4' Epi Doxorubicin, 4' Epi DXR, 4' Epiadriamycin, 4' Epidoxorubicin, 4'-Epi-Adriamycin, 4'-Epi-Doxorubicin, 4'-Epi-DXR, 4'-Epiadriamycin, 4'-Epidoxorubicin, 5,12-Naphthacenedione, 10-((3-amino-2,3,6-trideoxy-alpha-L-arabino-hexopyranosyl)oxy)-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, (8S-cis)-, Epidoxorubicin, 4'-epi-DX, 4'-epi-doxorubicin, 4'-epi-Adriamycin, (8S-cis)-10-((3-Amino-2,3,6-trideoxy-beta-L-arabino-hexopyranosyl)oxy-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-5,12-naphthacenedione, (8S-cis)-10-[(-Amino-2,3,6-trideoxy-alpha-L-arabino-hexpyranosyl)oxy]-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxacetyl)-1-methoxy-5,12-naphthacenedione, Pidorubicin, EPIDOXORUBICIN 04, EPIADRIAMYCIN 04, 3-Glycoloyl-1,2,3,4,6,11-hexahydro-3,5,12-trihydroxy-10-methoxy-6,11-dioxo-1-naphthacenyl-3-amino-2,3,6-trideoxy-alpha-L-arabino-hexopyranoside, Epi DX, 4'-epi DX, Epirubicin [Chemical/Ingredient], (8S-cis)-10-((3-Amino-2,3,6-trideoxy-beta-L-arabino-hexopyranosyl)oxy)-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-5,12-naphthacenedione, EPIRUBICIN, epirubicin, Epirubicin (product), EPI, 4'-epiadriamycin, 4'-epidoxorubicin, epi-ADR, Epirubicin, Epirubicin (substance)
Swedish Epirubicin
Czech epirubicin
Finnish Epirubisiini
Russian EPIRUBITSIN, 4'-EPIADRIAMITSIN, 4'-EPIDOKSORUBITSIN, 4'-ЭПИАДРИАМИЦИН, 4'-ЭПИДОКСОРУБИЦИН, ЭПИРУБИЦИН
Japanese 4'-エピドキソルビシン, ファルモルビシン, 4'-エピアドリアマイシン, エピルビシン
Spanish Epirrubicina, epirubicina, epirrubicina (sustancia), epirubicina (sustancia), epirrubicina, epirrubicina (producto), epirubicina (producto), 4'-Epiadriamicina, 4'-Epidoxorrubicina
German EPIDOXORUBICIN 04, EPIADRIAMYCIN 04, 4'-Epiadriamycin, 4'-Epidoxorubicin, Epirubicin
Polish Farmorubicyna, Epirubicyna
Croatian Epirubicin
French Épirubicine
Italian Epirubicina
Portuguese 4'-Epiadriamicina, Epidoxorubicina, Epirubicina