Epirube

Epirube - Uses | Precautions | Dosage

Epirube contains an active substance called epirubicin and belongs to the class of drugs called antineoplastic agents. It is chemically classified into the anthracycline class. The exact mechanism of cytotoxic action is not fully known, although it is assumed that it is based on intercalation of DNA (reversible insertion / introduction of one or a group of molecules between two or more molecules). Epirubicin is inserted between the nucleotide base pair of the DNA of the cancer cells which causes its death.

Researches suggest that this drug interferes / prevents DNA replication, which also results in the death of cancer cells.

Unfortunately, Epirube does not specifically bind to cancer cells and this relates to its high potential for toxicity.

Uses

Epirube is used for the treatment of

  • Breast cancer
  • Ovarian cancer
  • Stomach cancer
  • Small-cell lung cancer
  • Papillary transitional cell bladder cancer

Precautions

Epirube can cause fatal congestive heart failure that may have a fatal outcome. The risk of cardiotoxicity increases with the high doses. In clinical studies, 0.9% of patients who received 550 mg / m2 developed this side effect, while patients receiving 900 mg / m2 had a higher incidence (3.3%). Cardiotoxicity can occur at the very beginning of the therapy, but also months and years after stopping therapy.

For this reason, its use is contraindicated in patients who have cardiomyopathy, unstable angina, heart failure, recent heart attack, or severe arrhythmias.

Epirube is intended for intravenous administration only. Intramuscular or subcutaneous administration leads to severe necrosis of the tissue.

Acute myelogenous leukemia can occur, and patients receiving other antineoplastic drugs have a higher risk of developing this side effect. The risk of the occurrence of this side effect increases with duration of use (0.27% of patients who received epirubicin for 3 years developed myelogenous leukemia and 0.55% of patients who received epirubicin for 8 years, respectively).

The use of Epirube in patients with known severe myelosuppression is contraindicated. The number of leukocytes in the blood should be determined prior starting therapy and should be monitored regularly during therapy.

Epirube can be used only within secondary and tertiary health facilities, and only by doctors - oncology specialists.

Epirube, Pregnancy and Breastfeeding

The use of this medication during pregnancy leads to retardation of fetal growth and death, which is why this medicine is contraindicated during pregnancy.

Because of possible adverse effects on infants, breastfeeding is contraindicated during Epirube therapy.

Dosage

Epirube exists in the form of injection and is usually mixed with saline (0.9% sodium chloride solution) so it can be used in the form of intravenous infusion for 3-5 minutes.

The usual starting dose is 100-120 mg / m2 every 3-4 weeks.

Patients receiving 120 mg / m2 should also receive antibiotics, such as Bactrim (sulfamethoxazole / trimethoprim) or fluoroquinolone antibacterial.

The application of a total cumulative dose greater than 900 mg / m2 increases the risk of cardiotoxicity.

Note: Epirube can be used only in stationary health care facilities and only by an experienced oncologist.

Interactions

Simultaneous administration of Epirube with the following drugs is contraindicated:

  • Adalimumab. Simultaneous administration increases the risk of severe myelosuppression which leads to a decrease in the number of leukocytes and weakened immune system resulting in the appearance of serious, life-threatening infections.
  • Teriflunomide and leflunomide. Simultaneous administration increases the risk of serious infections.
  • Clozapine (antipsychotic). Simultaneous administration increases the risk of a severe adverse effect known as agranulocytosis.
  • Cimetidine (a medicine used to treat heartburn and stomach ulcer). Simultaneous administration increases the risk of bleeding.
  • Trastuzumab. Simultaneous administration increases the risk of cardiotoxicity.

Simultaneous administration with the following medicines increases the risk of serious arrhythmias that can be life-threatening:

  • Pimozide (a medicine used to treat schizophrenia).
  • Methadone - a narcotic painkiller.
  • Efavirenz - used to treat AIDS.
  • Droperidol (antiemetic and antipsychotic).
  • Dolasetron - a medicine used to treat chest pain induced by chemotherapy.
  • Antidepressants, such as: citalopram and escitalopram.
  • Antiarrhythmic drugs, such as: dronedarone, amiodarone, sotalol, quinidine and ibutylide.
  • Moxifloxacin, gatifloxacin and grepafloxacin.

Side effects

Epirube may cause the following side effects:

  • Thrombocytopenia
  • Acute myelogenous leukemia
  • Agranulocytosis
  • Neutropenia
  • Anorexia
  • Congestive heart failure
  • Thromboembolism
  • Nausea
  • Alopecia
  • Azoospermia
  • Asthenia
  • Conjunctivitis
  • Febrile neutropenia
  • Amenorrhea
  • Hot flushes
  • Lethargy
  • Local tissue necrosis
  • Ulcerations
  • Bleeding
  • Infections
  • Dehydration

References

  1. FDA
  2. PIL