Home Drug Guide Epirubicin Hydrochloride

Drug Guide

Generic Name

Epirubicin Hydrochloride

Brand Names Ellence

Classification

Therapeutic: Antineoplastic Agent

Pharmacological: Anthracycline Antibiotic

FDA Approved Indications

Breast cancer (adjuvant and metastatic)
Gastric cancer

Mechanism of Action

Epirubicin intercalates into DNA, inhibiting topoisomerase II, leading to DNA strand breaks, and generating free radicals, which result in cytotoxic effects on rapidly dividing cells.

Dosage and Administration

Adult: Dose varies based on regimen, typically 90-133 mg/m² IV every 3 weeks.

Pediatric: Use not established.

Geriatric: Dose adjustments may be necessary based on renal, hepatic function, and overall health.

Renal Impairment: Reduce dose cautiously in renal impairment.

Hepatic Impairment: Adjust dose as hepatic metabolism is significant; consult specific guidelines.

Pharmacokinetics

Absorption: Administered intravenously; not orally absorbed.

Distribution: Wide distribution including into tissues and fluids; penetrates tumor tissue.

Metabolism: Hepatic metabolism via reduction and conjugation pathways.

Excretion: Primarily in bile; some renal excretion.

Half Life: Approximately 24-47 hours, varying with tissue and plasma distribution.

Contraindications

Known hypersensitivity to epirubicin or other anthracyclines.
Severe bone marrow suppression.
Active infections.

Precautions

Use with caution in patients with hepatic impairment, cardiac dysfunction, or previous cardiotoxicity.
Monitor cardiac function regularly (LVEF) during therapy.
Patients with a history of chest radiation or other cardiotoxic therapies should be carefully evaluated before use.

Adverse Reactions - Common

Nausea and vomiting (Very common)
Mucositis (Common)
Anorexia (Common)
Myelosuppression (Common)

Adverse Reactions - Serious

Cardiotoxicity (including cardiomyopathy) (Serious but unpredictable; monitor cardiac function)
Myocardial infarction (Rare)
Secondary leukemia (Rare)
Hepatotoxicity (Less common)

Drug-Drug Interactions

Other cardiotoxic agents (e.g., trastuzumab, cyclophosphamide) increases risk of cardiotoxicity.
Myelosuppressive agents may enhance marrow suppression.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess baseline cardiac function (ECHO or MUGA scans), complete blood counts, liver function tests.

Diagnoses:

Risk for bleeding related to myelosuppression.
Risk for cardiotoxicity.

Implementation: Administer IV as per schedule; monitor cardiac function, CBC, hepatic function.

Evaluation: Monitor for signs of cardiotoxicity, infection, and other side effects; evaluate blood counts and liver function periodically.

Patient/Family Teaching

Report symptoms of infection, fatigue, or unusual bleeding.
Avoid live vaccines during therapy.
Limit alcohol intake and avoid exposure to infections.

Special Considerations

Black Box Warnings:

Potential for cardiotoxicity; cumulative dose limits to reduce risk.
Secondary malignancies (e.g., leukemia).

Genetic Factors: Pharmacogenetic variations may affect metabolism and toxicity.

Lab Test Interference: May cause transient elevations or reductions in liver enzymes and hematologic parameters.

Overdose Management

Signs/Symptoms: Severe myelosuppression, cardiotoxicity, extravasation,

Treatment: Supportive care; manage extravasation with local measures; consult toxicology for specific antidotes (though none specific for overdose).

Storage and Handling

Storage: Store at room temperature, protected from light.

Stability: Stable under ideal storage conditions for the duration specified in the package insert.