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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.