II. Indications
- FDA Approved
- Breast Cancer (primary cancer, adjuvant therapy)
- Off-Label
III. Mechanism
- See Antibiotic Chemotherapy
- Epirubicin is an Anthracycline aminoglycoside Antineoplastic Agent
- Epirubicin is the 4'-epi-isomer of Doxorubicin
- Epirubicin (like Doxorubicin) inserts between adjacent DNA base pairs
- Blocks DNA Transcription by RNA Polymerase
- Epirubicin (like Doxorubicin) also inhibits Topoisomerase 2
- Inhibits normal Nucleotide strand ligation during DNA Replication
- Epirubicin (like Doxorubicin) also induces free radical formation with several secondary effects
- Lipid peroxidation of cell membrane lipids (cytotoxic effects)
- Toxic effects (esp. cardiovascular adverse effects)
IV. Medications
- Epirubicin IV solution: 2 mg/ml in 100 ml vial
V. Dosing
- See other references for disease specific dosing protocols
VI. Adverse Effects
- Severe skin and soft tissue necrosis on extravasation
- Carcinogenic
- Risk of secondary malignancy (esp. Acute Myelogenous Leukemia)
- Cardiotoxicity (esp. children)
- Risk of Congestive Heart Failure (esp. with multiple doses)
- Myelosuppression
- Hyperuricemia
- Alopecia
- Impaired future fertility
- Urine Discoloration (transient red coloration)
VII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring
- Complete Blood Count
- Liver Function Tests
- Renal Function Tests
- Serum Uric Acid
- Echocardiogram with ejection fraction
VIII. Drug Interactions
-
Cimetidine
- Increases Epirubicin levels
IX. Resources
- Epirubicin Injection Solution (DailyMed)
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia