Adult Dosing
Primary breast cancer involving axillary node tumor
- 100-120 mg/m2 IV on day 1 of cycle repeated q3-4 wks
- Alt: 50-60 mg/m2 IV given on day 1 and 8 of each cycle
Pre-existing bone marrow depression
- Start with lower dose 75-90 mg/m2 IV on day 1 of cycle repeated q3-4 wks
- Alt: 32.5-45 mg/m2 IV on day 1 and 8 of each cycle
Note:
- Administer prophylactic antibiotic therapy in patients receiving 120 mg/m2 of epirubicin
- See package insert for toxicity related dose adjustments
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on serum creatinine)
- Severe renal impairment (serum creatinine >5 mg/dL): Reduce dose, amount not defined
Hepatic Dose Adjustment
- Bilirubin 1.2-3 mg/dL or AST 2-4 x ULN: Reduce starting dose by 50%
- Bilirubin > 3 mg/dL or AST > 4 x ULN: Reduce starting dose by 75%
- Severe hepatic impairment: Contraindicated
- Administer epirubicin only under the supervision of a qualified physician experienced in the use of cytotoxic therapy [US Black Box Warning]
- Before starting the epirubicin treatment, patient should recover from acute toxicities of prior cytotoxic treatment such as stomatitis, neutropenia, thrombocytopenia, and generalized infections
- Carefully evaluate baseline blood counts; serum levels of total bilirubin, AST, and creatinine; and cardiac function as measured by left ventricular ejection function (LVEF), before initiating epirubicin treatment
- Monitor patient carefully for possible clinical complications due to myelosuppression and cardiotoxicity. Provide necessary supportive care for the treatment of severe neutropenia and severe infectious complication
- Leukopenia and/or neutropenia are the predominant manifestations of epirubicin associated hematologic toxicity and are dose dependent and reversible, reaching nadir 10 to 14 days after treatment with recovery usually occurring by the 21st day
- Myelosuppression has been reported with epirubicin; severe myelosuppression results in fever, infections, sepsis/septicemia, septic shock, hemorrhage, tissue hypoxia, or death. Measure total and differential WBC, red blood cell (RBC), and platelet counts before and during each cycle of therapy and provide appropriate supportive measures if myelosuppressive complications occurs
- Cardiotoxicity, manifested by early or late events has been reported with anthracycline treatment. The risk of serious cardiac impairment can be decreased through regular monitoring of LVEF measured by multi-gated radionuclide angiography (MUGA) or echocardiography (ECHO), during the course of treatment. Discontinue epirubicin immediately at the first sign of impaired function [US Black Box Warning]
- Secondary AML or MDS has been reported with chemotherapy regimens containing anthracyclines (including epirubicin) and DNA-damaging antineoplastic agents, in combination with radiotherapy [US Black Box Warning]
- As epirubicin is metabolized and excreted predominantly by the hepatobiliary route, toxicity is enhanced by hepatic impairment. Hence evaluate hepatic function using conventional laboratory tests such as SGOT, SGPT, alkaline phosphatase, and bilirubin prior to individual dosing
- Epirubicin can cause fetal harm when administered to a pregnant woman, therefore use during pregnancy should be avoided. Women of childbearing age should be advised to avoid becoming pregnant and if the patient becomes pregnant during therapy, the patient should be apprised of the potential hazard to the fetus
- Injection into a small vessel or from repeated injections into the same vein can result in venous sclerosis. Follow the recommended administration procedures to minimize the risk of phlebitis/thrombophlebitis at the injection site
- Epirubicin associated extravasation causes local pain, severe tissue lesions (vesication, severe cellulitis) and necrosis. It is recommended to administer epirubicin slowly into the tubing of a freely running intravenous infusion
- Epirubicin is emetigenic hence use prophylactic antiemetics before administering
Cautions: Use cautiously in
- Severe renal impairment
- Hepatic impairment
- Cardiovascular diseases
- Concomitant hepatotoxic agent
- History of cardiovascular diseases
- Concomitant use of cardiotoxic agent
- Concomitant myelosuppressive agents
- Concomitant radiotherapy
- Pre-existing Myelosuppression
- Women of childbearing age
Pregnancy Category:D
Breastfeeding: Epirubicin is excreted in the milk of rats; it is unknown whether it is excreted in human milk. As many drugs, including other anthracyclines, are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants, manufacturer advises to discontinue nursing prior to taking this drug.