Anthracycline (specialist)
Epirubicin hydrochloride
Brand names: Pharmorubicin
Adult dose
Dose: 60–90mg/m² IV q21d (per protocol); intravesical formulation for superficial bladder cancer
Route: IV / Intravesical
Frequency: q21d (IV) or per regimen
Clinical pearls
- Component of FEC, EC regimens for breast cancer
- Less cardiotoxic than equivalent doxorubicin doses
- ESMO/UKONS extravasation guidance
- Echo/MUGA at baseline; LVEF threshold for discontinuation
Contraindications
- Severe myocardial impairment
- Recent MI
- Severe hepatic impairment
- Severe myelosuppression
- Cumulative anthracycline dose limit reached
- Pregnancy/breastfeeding
Side effects
- Cardiotoxicity (acute and chronic, dose-related — cumulative limit ~900mg/m²)
- Myelosuppression
- Mucositis
- Alopecia
- Nausea/vomiting
- Vesicant — extravasation injury
- Red-coloured urine
- Secondary leukaemia (rare)
Interactions
- Other cardiotoxic drugs (trastuzumab — sequence carefully)
- Live vaccines
Monitoring
- FBC
- LFTs
- Echo/MUGA (LVEF)
- Cumulative dose
- Extravasation
Reference: BNF; ESMO breast cancer guidelines; UKONS extravasation; SmPC; https://bnf.nice.org.uk/drugs/epirubicin-hydrochloride-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs