Epirubicin (Systemic)

Brand Names : Ellence, Pharmorubicin PFS

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For epirubicin, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to daunorubicin, doxorubicin, epirubicin, idarubicin, or mitoxantrone.

Pregnancy - There is a chance that this medicine may cause birth defects if either the male or female is receiving it at the time of conception or if it is taken by the mother during pregnancy. Studies in rats and rabbits have shown that epirubicin causes birth defects in the fetus and other problems (including miscarriage). In addition, many cancer medicines may cause sterility, which could be permanent. Although sterility has been reported in animals and humans with this medicine, this is less likely to occur in humans than in animals.

Be sure that you have discussed these possible effects with your doctor before receiving this medicine. Before receiving epirubicin make sure your doctor knows if you are pregnant or if you may become pregnant. It is best to use some kind of birth control while you are receiving epirubicin. Tell your doctor right away if you think you have become pregnant while receiving epirubicin.

Breast-feeding - It is not known whether epirubicin passes into breast milk. However, epirubicin is not recommended during breast-feeding, because it may cause unwanted effects in nursing babies.

Children - Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of epirubicin in children with use in other age groups. Heart problems are more likely to occur in children younger than 2 years of age.

Older adults - Heart problems are more likely to occur in the elderly, who may have existing heart disease. The elderly may also be more likely to have blood problems. Also, elderly patients may not be able to metabolize the medication as quickly as younger patients, which may put them at risk for added toxicity.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When receiving epirubicin it is especially important that your health care professional know if you are taking any of the following:

• Acetaminophen (e.g., Tylenol) (with long-term, high-dose use) or
• Amiodarone (e.g., Cordarone) or
• Anabolic steroids, nandrolone [e.g., Anabolin], oxandrolone [e.g., Anawar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
• Androgens (male hormones) or
• Carmustine (e.g., BiCNU) or
• Chloroquine (e.g., Aralen) or
• Dantrolene (e.g., Dantrium) or
• Disulfiram (e.g., Antabuse) or
• Divalproex (e.g., Depakote) or
• Estrogens (female hormones) or
• Etretinate (e.g., Tegison) or
• Hydroxychloroquine (e.g., Plaquenil) or
• Methyldopa (e.g., Aldomet) or
• Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
• Oral contraceptives (birth control pills) containing estrogen or
• 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]) or
• Phenytoin (e.g., Dilantin) or
• Valproic acid (e.g., Depakene) - Concurrent use of these agents with epirubicin may increase risk of liver problems
• Acyclovir (e.g., Zovirax) or
• Anticonvulsants (seizure medicine) or
• Antidiabetics, oral (diabetes medicine taken by mouth) or
• Antipsychotics (medicine for mental illness) or
• Captopril (e.g., Capoten) or
• Enalapril (e.g., Vasotec) or
• Flecainide (e.g., Tambocor) or
• Imipenem or
• Inflammation or pain medicine, except narcotics or
• Lisinopril (e.g., Prinivil, Zestril) or
• Maprotiline (e.g., Ludiomil) or
• Penicillamine (e.g., Cuprimine) or
• Pimozide (e.g., Orap) or
• Procainamide (e.g., Pronestyl) or
• Promethazine (e.g., Phenergan) or
• Ramipril (e.g., Altace) or
• Sulfasalazine (e.g., Azulfidine) or
• Tiopronin (e.g., Thiola) or
• Tocainide (e.g., Tonocard) or
• Tricyclic antidepressants (medicine for depression) or
• Trimeprazine (e.g., Temaril) - Concurrent use of these agents with epirubicin may cause blood disorders
• Amphotericin B, injection (e.g., Fungizone) or
• Antineoplastics, other (cancer medicine) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Cyclophosphamide (e.g. Cytoxan) or
• Flucytosine (e.g. Ancoban) or
• Ganciclovir (e.g., Cytovene) or
• Interferon (e.g., Intron A, Roferon-A) or
• Zidovudine (e.g., AZT, Retrovir) - Concurrent use of these agents with epirubicin increases the risk of infection
• Anti-infectives, by mouth or injection (medicine for infection) or
• Carbamazepine (e.g., Tegretol) or
• Gold salts (medicine for arthritis) - Concurrent use with epirubicin may cause blood disorders and increase risk of liver problems
• Antithyroid agents (medicine for overactive thyroid) or
• Mercaptopurine (e.g., Purinethol) or
• Methotrexate (e.g., Rheumatrex) or
• Plicamycin (e.g., Mithracin) - Concurrent use with epirubicin increases the risk of infection and may increase the risk of liver problems
• Bepridil (e.g., Vascor) or
• Diltiazem (e.g., Cardizem) or
• Flunarizine (e.g., Sibelium) or
• Isradipine (e.g., DynaCirc) or
• Nicardipine (e.g., Cardene)
• Nifedipine (e.g., Procardia) or
• Nimodipine (e.g., Nimotop) or
• Verapamil (e.g., Calan) or
• other heart medicines - Concurrent use of these agents with epirubicin may contribute to heart damage and failure
• Cimetidine (e.g., Tagamet) - Cimetidine increases the amount of time epirubicin stays in the body.
• Daunorubicin (e.g., Cerubidine) or
• Doxorubicin (e.g., Adriamycin) or
• Idarubicin (e.g., Idamycin) or
• Mitoxantrone (e.g., Novantrone) - 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.
• 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

Other medical problems - The presence of other medical problems may affect the use of epirubicin. Make sure you tell your doctor if you have any other medical problems, especially:

• Bone marrow depression or
• Viral, fungal, or bacterial infection - There may be an increased risk of infections or worsening infections because of the body's reduced ability to fight them

• Heart disease - Risk of heart problems caused by epirubicin may be increased

• Kidney disease or

• Liver disease - Effects of epirubicin may be increased because of its slower removal from the body

• Tumor cell infiltration of bone marrow - Increased susceptibility for cancer to spread to bone marrow