EPIRUBICIN HYDROCHLORIDE

EPIRUBICIN HYDROCHLORIDE
(e-pi-roo'bi-sin)
Ellence
Classifications: antineoplastic; antibiotic;
Therapeutic:antineoplastic
Prototype: Doxorubicin HCl
Pregnancy Category: D

Availability

2 mg/mL

Action

Cytotoxic antibiotic with wide spectrum of antitumor activity and strong immunosuppressive properties. Less myelotoxic than doxorubicin. Complexes with DNA causing the DNA helix to change shape, thus blocking effective DNA and RNA transcription.

Therapeutic Effect

Highly destructive to rapidly proliferating cells. Effectiveness indicated by tumor regression.

Uses

Adjunctive therapy for axillary node-positive breast cancer.

Contraindications

Hypersensitivity to epirubicin and other related drugs; marked myelosuppression, severely impaired cardiac function, severe cardiac arrhythmias, recent MI; severe hepatic disease, jaundice; previous treatment with maximum doses of epirubicin, doxorubicin, or daunorubicin; pregnancy (category D), lactation.

Cautious Use

Arrhythmias; mild or moderate liver dysfunction; severe renal insufficiency or renal failure.

Route & Dosage

Breast Cancer
Adult: IV 100–120 mg/m² infused on day 1 of a 3–4 wk cycle or 50–60 mg/m² on day 1 and 8 of a 3–4 wk cycle (max cumulative dose: 900 mg/m²)

Hepatic Impairment
Bilirubin 1.2–3 mg/dL: give 50% of dose; bilirubin over 3 mg/dL: give 25% of dose; bilirubin >5 mg/dL: skip dose

Administration

Intravenous

Note: Pregnant women should NOT prepare or administer this drug. Wear protective goggles, gowns and disposable gloves and masks when handling this drug. Discard ALL equipment used in preparation of this drug in high-risk, waste-disposal bags for incineration. Treat accidental contact with skin or eyes by rinsing with copious amounts of water followed by prompt medical attention.
Note: Reduce dosages when serum creatinine >5 mg/dL or AST 2–4 times the upper limit of normal.

PREPARE: IV Infusion: Epirubicin is manufactured as a preservative-free ready-to-use solution. The contents of a vial must be used within 24 h of first penetrating the rubber stopper. Discard unused solution.

ADMINISTER: IV Infusion: Measure ordered dose and inject into a port of a freely flowing IV solution of D5W or NS over 3–20 min. DO NOT give by direct IV push into a vein. Avoid IV sites that enter small veins or repeated injections into the same vein. Monitor IV site closely for S&S of extravasation and if suspected, notify physician immediately.

INCOMPATIBILITIES Solution/additive: alkaline solutions (including sodium bicarbonate), fluorouracil, ifosfamide, heparin, fluorouracil.

Store between 2°–8° C (36°–46° F). Protect from light.

Adverse Effects (≥1%)

Body as a Whole: Lethargy, fever. CV: Asymptomatic decrease in LVEF, CHF. GI: Nausea, vomiting, mucositis, diarrhea, anorexia. Hematologic: Leukopenia, neutropenia, anemia, thrombocytopenia, AML. Skin: Alopecia, injection site reaction, rash, itching, skin changes. Other: Amenorrhea, hot flashes, infection, conjunctivitis/keratitis, secondary acute myelogenous leukemia (related to cumulative dose).

Interactions

Drug: Cimetidine increases epirubicin levels; concomitant use with cardioactive drugs (e.g., calcium channel blockers) may affect cardiac function.

Pharmacokinetics

Distribution: Widely distributed, 77% protein bound, concentrated in red blood cells. Metabolism: Extensively metabolized in liver, blood and other organs. Clearance is reduced in patients with hepatic impairment. Elimination: Primarily excreted in bile, some urinary excretion; clearance decreases in older adult female patients. Half-Life: 33 h.

Nursing Implications

Assessment & Drug Effects

Withhold drug and notify physician of any of the following: neutrophil count <1500 cells/mm³, recent MI, suspicion of severe myocardial insufficiency.
Obtain baseline and periodic (before each cycle of therapy) cardiac evaluation: left ventricular ejection fraction, ECG and ECHO (tests are recommended especially in the presence of risk factors of cardiac toxicity).
Monitor cardiac status closely throughout therapy as the risk of developing severe CHF increases rapidly when cumulative doses approach 900 mg/m². Report significant ECG changes immediately. Report immediately S&S of the following: tachycardia, gallop rhythm, pleural effusion, pulmonary edema, dependent edema, ascites, or hepatomegaly.
Lab tests: Baseline and periodic (before each cycle of therapy) CBC with differential, platelet count, serum total bilirubin, AST, serum creatinine.

Patient & Family Education

Review all literature regarding the adverse effects of epirubicin therapy carefully.
Report any of the following to physician immediately: Pain at the site of IV infusion, chest pain, palpitations, shortness of breath or difficulty breathing, sudden weight gain, swelling of hands, feet or legs, or any unexplained bleeding.
Be aware that your urine may turn red for 1–2 d after receiving this drug. This change is expected and harmless.
Do not take OTC cimetidine or any other OTC drug without consulting physician.
Use effective means of contraception (both men and women) while on epirubicin therapy.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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