Epirubicin hydrochloride

How it works

It intercalates into DNA and inhibits topoisomerase II, disrupting DNA and RNA synthesis in dividing cells; as an epimer of doxorubicin it has a comparable mechanism with a somewhat different toxicity profile.

Prescribing in practice

• Cumulative dose-related cardiotoxicity is the defining hazard, so lifetime cumulative exposure must be tracked and cardiac function assessed before and during treatment.
• It is a vesicant and extravasation causes severe tissue damage, so secure intravenous access and experienced administration are essential.
• Dose modification is required in hepatic impairment as it is predominantly cleared by the liver.

Monitoring

Monitor full blood count, cardiac function (including ejection fraction) and liver function, and record the cumulative anthracycline dose.

Counselling the patient

• Your urine may turn red for a short time after treatment, which is harmless.
• Report breathlessness or ankle swelling, and tell the team at once if you feel pain or burning at the infusion site.

Evidence & guidelines

Epirubicin is an established anthracycline used in standard regimens such as adjuvant breast cancer chemotherapy, with cumulative cardiotoxicity well characterised.