Epirubicin (Ellence)

Class of Drugs: Anthracycline/Antineoplastic

Manufacturer: Pharmacia & Upjohn

Information on Patient Assistance program: Prescription Medication Assistance Program, Self-Administered products: (800) 242-7014; Non Self-Administered products: (800) 366-5570

Description: Epirubicin is intended for intravenous administration. If epirubicin accidentally leaks out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the doctor or nurse right away if you notice redness, pain, or swelling at the place of injection .

Ingredient: Epirubicin is the 4'-epimer of doxorubicin

Use: It has been widely used as adjuvant therapy for early breast cancer and in metastatic breast cancer. Recently, the US Food and Drug Administration (FDA) approved epirubicin for use as a component of adjuvant therapy in women with early stage, node-positive breast cancer.

The antineoplastic effect of epirubicin are that it inhibits DNA, RNA, and protein synthesis, it produces cytocidal activity and it interferes with replication and transcription.

Warnings:

Before taking epirubicin it is especially important that you inform your health care professional know if you are taking any of the following:

Concurrent use of these agents with epirubicin may increase risk of liver problems:
Acetaminophen (e.g., Tylenol) (with long-term, high-dose use); Amiodarone (e.g., Cordarone); Anabolic steroids, nandrolone [e.g., Anabolin], oxandrolone [e.g., Anawar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]); Androgens (male hormones); Carmustine (e.g., BiCNU); Chloroquine (e.g., Aralen); Dantrolene (e.g., Dantrium); Disulfiram (e.g., Antabuse); Divalproex (e.g., Depakote); Estrogens (female hormones); Etretinate (e.g., Tegison); Hydroxychloroquine (e.g., Plaquenil); Methyldopa (e.g., Aldomet); Maltrexone (e.g., Trexan) (with long-term, high-dose use); Oral contraceptives (birth control pills) containing estrogen; Phenothiazines (acetophenazine [e.g., Tindal], chlorpromazine [e.g., Thorazine], fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil], perphenazine [e.g., Trilafon], prochlorperazine [e.g., Compazine], promazine [e.g., Sparine], promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril], trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin], trimeprazine [e.g., Temaril]); Phenytoin (e.g., Dilantin); Valproic acid (e.g., Depakene).

Concurrent use of these agents with epirubicin may cause blood disorders:
Acyclovir (e.g., Zovirax); Anticonvulsants (seizure medicine); Antidiabetics, oral (diabetes medicine taken by mouth); Antipsychotics (medicine for mental illness); Captopril (e.g., Capoten); Enalapril (e.g., Vasotec); Flecainide (e.g., Tambocor); Imipenem; Inflammation or pain medicine, except narcotics; Lisinopril (e.g., Prinivil, Zestril); Maprotiline (e.g., Ludiomil); Penicillamine (e.g., Cuprimine); Pimozide (e.g., Orap); Procainamide (e.g., Pronestyl); Promethazine (e.g., Phenergan); Ramipril (e.g., Altace); Sulfasalazine (e.g., Azulfidine); Tiopronin (e.g., Thiola); Tocainide (e.g., Tonocard); Tricyclic antidepressants (medicine for depression); Trimeprazine (e.g., Temaril).

Concurrent use of these agents with epirubicin increases the risk of infection:
Amphotericin B, injection (e.g., Fungizone); Antineoplastics, other (cancer medicine); Azathioprine (e.g., Imuran); Chloramphenicol (e.g., Chloromycetin); Colchicine; Cyclophosphamide (e.g. Cytoxan); Flucytosine (e.g. Ancoban);
Ganciclovir (e.g., Cytovene); Interferon (e.g., Intron A, Roferon-A); Zidovudine (e.g., AZT, Retrovir).

Concurrent use with epirubicin may cause blood disorders and increase risk of liver problems:
Anti-infectives, by mouth or injection (medicine for infection); Carbamazepine (e.g., Tegretol); Gold salts (medicine for arthritis).

Concurrent use with epirubicin increases the risk of infection and may increase the risk of liver problems:
Antithyroid agents (medicine for overactive thyroid); Mercaptopurine (e.g., Purinethol); Methotrexate (e.g., Rheumatrex);
Plicamycin (e.g., Mithracin).

Concurrent use of these agents with epirubicin may contribute to heart damage and failure:
Bepridil (e.g., Vascor); Diltiazem (e.g., Cardizem); Flunarizine (e.g., Sibelium); Isradipine (e.g., DynaCirc); Nicardipine (e.g., Cardene); Nifedipine (e.g., Procardia); Nimodipine (e.g., Nimotop); Verapamil (e.g., Calan); other heart medicines.

Concurrent use of maximum cumulative doses of other anthracyclines with epirubicin may increase risk of heart damage, secondary leukemia, and stomach and blood problems.

Concurrent use may increase risk of liver problems.
Cimetidine (e.g., Tagamet)--Cimetidine increases the amount of time epirubicin stays in the body.
Daunorubicin (e.g., Cerubidine); Doxorubicin (e.g., Adriamycin); Idarubicin (e.g., Idamycin); Mitoxantrone (e.g., Novantrone).

If you have ever been treated with radiation or cancer medicines -- Epirubicin may increase the effects of these medicines or radiation therapy on the blood

If you have ever been treated with radiation to your chest -- Risk of heart problems caused by epirubicin may be increased

Epirubicin  may cause fetal harm when administered to a pregnant woman.

There is increased risk of a second leukemia associated with the use of this drug.

Side Effects:

The major adverse effects of epirubicin are acute dose-limiting haematological toxicity and cumulative dose-related cardiac toxicity. These effects are less severe after epirubicin administration than after equimolar doses of doxorubicin.

Before initiating therapy with epirubicin, you should be informed that there is a risk of irreversible damage to the heart muscle associated with the drug. For women who receive epirubicin as adjuvant therapy, there is a slightly increased risk of treatment-related leukemia. Epirubicin may cause harm to the fetus if you are pregnant when taking it. The drug may also cause premature menopause. Men undergoing treatment with epirubicin should be advised to use effective contraceptive methods because therapy with the drug can induce chromosomal damage in sperm.

Other adverse effects associated with the use of this drug include nausea, vomiting, diarrhea, stomatitis and hair loss.

Check with your doctor or nurse immediately if any of the following side effects occur: bleeding, redness, or ulcers in mouth or throat; cough or hoarseness; fever or chills; lower back or side pain; painful or difficult urination; pain or burning in mouth or throat; sores in mouth or on lips; black, tarry stools; blood in urine or stools; pinpoint red spots on skin; redness or discharge of the eye, eyelid, or lining of the eyelid; red streaks along injected vein; unusual bleeding or bruising; darkening or redness of skin at place of irradiation; fast or irregular heartbeat; joint pain; pain, redness, or warmth at place of injection; skin rash or itching; swelling of abdomen, lower legs, and feet; swelling or tenderness of lymph nodes, abdomen, side or lower back; wheezing, difficulty breathing or shortness of breath

The dosage of this drug is very specific. If you notice abdominal swelling or tenderness, black stools, blood in your stools, if you have difficulty in urination, fast or irregular heartbeat, high fever, shortness of breath, stomach pain, swelling of the lining of your mouth, nose or throat or severe vomiting these may be signs of an overdose and you should contact your doctor immediately.

Other side that effects may appear and then diminish during the treatment are lack of menstrual periods, nausea and vomiting; diarrhea, hot flashes, darkening of soles, palms, or nails and loss of appetite or weight loss.

After you stop receiving epirubicin, you may notice some side effects that need attention. Check with your health care professional  immediately if you notice fast or irregular heartbeat, shortness of breath or swelling of abdomen, feet, and lower legs.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Epirubicin causes the urine to turn reddish in color, which may stain clothes. This is not blood. It should only lasts for 1 or 2 days after each dose is given.

This drug may cause a temporary and total loss of all body hair (reversible alopecia). After your treatment has ended, normal hair growth should return.

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This information is intended as reference and not as medical advice. All treatment decisions should be made with your team of medical professionals and prescriptions must be given by your doctor. See TERMS AND CONDITIONS.