Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041WARNING Blood related problems: Epirubicin may cause serious decreases in red blood cell, white blood cell and platelet levels which can cause infections, anemia, bruising and bleeding (see Precautions To Be Aware Of Before Taking This Medication). Heart related problems: Epirubicin can cause heart problems, including congestive heart failure. The risk of developing this problem increases as the total amount of epirubicin used over time increases (see Who Should Not Take This Medication and Precautions To Be Aware Of Before Taking This Medication). Infusion related problems: Epirubicin is given by injection into a vein (IV) and can cause serious skin and tissue problems if it leaks out of the vein while being given. Your doctor or healthcare provider will monitor you carefully during the administration of epirubicin to make sure that this does not happen. Liver related problems: If you have any liver problems before starting this medication, make sure that you tell your doctor or healthcare provider (see Who Should Not Take This Medication and Precautions To Be Aware Of Before Taking This Medication). Secondary cancers: The development of leukemia (acute myelogenous leukemia; AML) or myelodysplastic syndrome (MDS), a precursor to leukemia, has been reported in patients receiving epirubicin. The risk of developing leukemia is higher in patients 1) who are receiving other chemotherapy medications in combination with epirubicin, 2) who have received a lot of previous chemotherapy, 3) who are receiving a high dose of epirubicin, or 4) exposure to radiation therapy in combination with chemotherapy.
Uses For This Medication
- Epirubicin is used alone or in combination with other chemotherapy medications to treat adults with breast cancer.
- Epirubicin is being studied for the treatment of other tumors and blood-based cancers, including endometrial cancer, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, certain types of leukemia (chronic lymphocytic leukemia), lung cancer, esophageal cancer, stomach cancer, soft tissue sarcoma, and liver cancer.
- This medication may also be given for other conditions as determined by your doctor.
How This Medication WorksEpirubicin is a chemotherapy medication that doesn’t allow cancer cells, also known as tumor cells, to divide and grow normally, which leads to tumor cell death.
Benefits of This MedicationWhen surgery is done to remove a tumor in the breast, some cancer cells may remain in the body. Studies have shown that epirubicin can help to get rid of these cancer cells and lower the risk of the breast cancer returning. Who Should Not Take This Medication You should not take this medication if you:
- Are allergic to epirubicin, any of its components, or other medications that are similar to epirubicin, including doxorubicin, daunorubicin, idarubicin, or mitoxantrone
- Have very low white blood cell levels. Your doctor or healthcare provider will check your blood before starting epirubicin to make sure that it is safe to start this medication.
- Have a serious heart condition including abnormal heart rhythm or a recent heart attack
- Have serious liver problems
- Have already received a complete course of chemotherapy with any of the following medications: doxorubicin, daunorubicin, epirubicin, idarubicin, or mitoxantrone. Make sure that your doctor or healthcare provider has a complete record of any chemotherapy medications that you have received in the past so that he or she can determine whether it is safe for you to receive further treatment with epirubicin.
Precautions to be Aware of Before Taking This Medication
Blood related precautions:
- This medication may temporarily reduce the number of platelets in your blood. This can increase your risk of bleeding. Contact your doctor or healthcare provider if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. If your platelet levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a platelet transfusion, and/or that you take medication to help increase the number of platelets in your blood. To lower your chance of bleeding, do not use aspirin, aspirin-containing medications, or aspirin-like medications (e.g., ibuprofen, naproxen). Use caution with sharp objects like razors and nail cutters, and avoid activities that can cause cuts, bumps and bruises.
- This medication may temporarily reduce the number of germ fighting white blood cells in your blood. This can increase your risk of infection. Contact your doctor or healthcare provider promptly if you develop any signs of an infection such as fever, painful urination, chills or a sore throat that doesn’t go away. If your white blood cell levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed and/or you receive medication to increase the number of white cells in your blood. To lower your risk of infection, stay away from crowds and people with colds or other illnesses, wash your hands with soap and water well and often, and brush and floss your teeth daily.
- This medication may temporarily lower the number of red cells in your blood. This can increase your risk of anemia. If your red blood cell level becomes low, you may feel tired and weak. If your red blood cell level becomes too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a red blood cell transfusion, and/or you receive a medication to help increase the red cells in your blood.
Gastrointestinal related precautions
- This medication may cause two types of nausea and/or vomiting, acute and delayed. Acute nausea and/or vomiting occurs within the first 24 hours following chemotherapy treatment. Delayed nausea and/or vomiting usually starts 24 hours after treatment and can last for up to 3 to 7 days. Eat small frequent meals and bland foods (for example bananas, rice, apples, toast). If you are having moderate or severe vomiting, tell your doctor or healthcare provider. Nausea and vomiting can be treated with medications.
- This medication may cause diarrhea, which can lead to dehydration. If diarrhea occurs, contact your doctor or healthcare provider. Drink plenty of water and fluids that contain electrolytes (e.g. Gatorade, Pedialyte) to avoid dehydration.
- This medication may cause redness or sores in your mouth, throat or on your lips.This usually occurs 5-10 days after receiving this medication. Talk with your doctor or healthcare provider about proper mouth and throat care (for example brushing and flossing). Avoid foods and drinks that may irritate your mouth such as citrus fruits and juices, tobacco, and spicy foods. Using a salt and baking soda mouthwash (1 teaspoon salt & 1 teaspoon baking soda dissolved in 1 quart of water) four times a day may be soothing.
Organ related precautions
- Rarely, this medication can cause heart problems, including congestive heart failure. The risk of developing this problem increases as the total amount of epirubicin used over time increases. Heart problems can occur either during treatment or months to years after treatment is completed. Your doctor or healthcare provider will check your heart regularly while you are receiving epirubicin to make sure that your heart is working properly.
- Make sure you tell your doctor or healthcare provider if:
- You already have heart related problems
- You have already received chemotherapy with a medication similar to epirubicin, including doxorubicin, mitoxantrone, daunorubicin, idarubicin
- You are also receiving trastuzumab (Herceptin®)
- You have received radiation therapy to your chest area
- This medication is broken down by enzymes (chemicals) in the liver and cleared from the body. In patients with severe liver disease, epirubicin may not break down normally which can lead to high levels of this medication in the body and a greater chance of side effects. If you have any liver problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
- Epirubicin can cause the urine to become red in color for one to two days following treatment. This change in urine color is not harmful.
- Rarely, in patients who have had radiation therapy in the past, the skin or tissue damage from radiation therapy can become red and appear damaged again after receiving epirubicin. Contact your doctor or healthcare provider if your skin gets red in areas where radiation was given.
- This medication can cause tumor lysis syndrome (TLS). This occurs when chemotherapy medications rapidly kill large numbers of cancer cells and cause abnormal changes in your blood. Your doctor or healthcare provider will check your blood regularly through blood tests. In addition, if you experience symptoms such as muscle weakness, tingling on the lips, arms or legs, anxiety, cough, wheezing, chest tightness (shortness of breath), fatigue, increased nausea and/or vomiting, joint-pain, or a feeling of general discomfort, you should contact your doctor or healthcare provider.
- Do not receive any immunizations (vaccinations) while on this medication without your doctor or healthcare provider’s approval. This medication can increase your risk of infection. For certain immunizations, you may develop the infection that the immunization is intended to prevent.
Patient specific precautions
- It is not known if this medication is safe and effective in children however it has been used in the treatment of childhood cancers.
Pregnancy and breastfeeding precautions
- This medication may cause fetal harm. When taking this medication, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant.
- It is not known whether this medication is found or excreted in breast milk. Since many medications are excreted in breast milk and because this medication can cause serious harmful reactions in infants, breastfeeding should be avoided.
- Many anti-cancer therapies can cause sterility. Notify your doctor or healthcare provider if you want to have children in the future.
Medication and Food InteractionsBefore using this medication, tell your doctor or healthcare provider of all prescription or over-the-counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval. Possible interactions can occur with epirubicin and the following foods or medications:
- Cimetidine (Tagamet®)
- Grapefruit or grapefruit juice
- Trastuzumab (Herceptin®)
- All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
- You should contact your doctor or healthcare provider if you experience any side effect(s) which don’t go away, worsen, are serious in nature, or are worrisome to you.
- Side effects can occur when epirubicin is given alone or together with other chemotherapy medications. The side effects listed below are those reported in patients who were treated with epirubicin in combination with other chemotherapy medications.
More common side effects
- Decreased platelet, red blood cell, and/or white blood cell levels (see Precautions To Be Aware Of Before Taking This Medication)
- Tiredness (fatigue)
- Nausea, vomiting, diarrhea, sores in the mouth (see Precautions To Be Aware Of Before Taking This Medication)
- Stopping of menstrual periods in women
- Hair loss
- Hot flashes
Less common side effects
- Infection (see Precautions To Be Aware Of Before Taking This Medication)
- Irritation of the eyes (conjunctivitis)
- Cellulitis (inflammation and swelling under the skin)
- Photosensitivity (sensitivity to light)
- Allergic reactions, fever, chills
Rare side effectsThis is not a complete list of the rare side effects reported with epirubicin. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert.
- Loss of appetite
- Facial flushing, darkening of nails and skin, skin irritation or rash on areas exposed to past radiation treatments (see Precautions To Be Aware Of Before Taking This Medication)
- Development of a secondary leukemia (acute myelogenous leukemia; AML) or myelodysplastic syndrome (MDS) (see Warning)
- Heart damage with congestive heart failure (see Precautions To Be Aware Of Before Taking This Medication)
How To Take This Medication
- This medication may only be given by injection into a vein (IV) by a healthcare professional. This medication can be given in different doses depending on your weight, your type of condition and whether epirubicin is being given with other chemotherapy medications
- Antiemetics, which are medications to help prevent and control nausea and vomiting, may be given before epirubicin either by mouth (orally) or by injection into a vein (IV). Following treatment, your doctor or healthcare provider may prescribe additional antiemetics which you may need to take for several days after treatment to prevent and control nausea and/or vomiting.
- In the unlikely event of an overdose of this medication contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
- It is unlikely that you will need to store this medication. However, in the event that you do, the unopened containers should be stored at controlled room temperature. Keep in original package to protect from light.
- Keep this medication out of the reach of children or pets.
- Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.