Epirubicin Hydrochloride

Epirubicin Hydrochloride is used in the treatment of various types of cancers of blood, breast, stomach, lung, ovaries and soft tissues. It also helps to prevent the recurrence of bladder cancer after surgery. It is given as a drip or infusion vein with extreme caution by a qualified medical professional. It can be used alone, or sometimes given together with certain other medicines as part of combination chemotherapy. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. It makes contraceptive pills less effective, so it advised to both male and female to use reliable contraception during the treatment. The most common side effects of this medicine include nausea, low blood platelets, hair loss, absence of menstrual periods, fever and rash. It is known to reduce the number of blood cells in your blood thereby, increasing the susceptibility to infections. Infections can sometimes be life threatening. Regular blood tests are required to monitor your blood cells along with kidney, liver and heart function during treatment with this medicine. Before taking this medicine, tell your doctor if you have liver disease, or have heart problem. Your doctor should also know about all other medicines you are taking as many of these may make this medicine less effective or change the way it works. Inform your doctor if you are pregnant or breastfeeding. Epirubicin Hydrochloride is an anti-cancer medication. It works by suppressing the activity of an enzyme (topoisomerase II) involved in DNA multiplication of the breast cancer cells. It also forms harmful chemicals (free radicals) which cause DNA damage. This slows the growth of breast cancer cells and eventually kills them.

• Cancer

Epirubicin, an anthracycline with cytotoxic properties. It inhibits DNA and RNA synthesis by steric obstruction after intercalating between DNA base pairs that triggers DNA cleavage by by topoisomerase II. It also inhibits DNA helicase and generates cytotoxic free radicals.

Adult Dose: Adjuvant Breast Cancer Treatment Option 1 (Day 1 dose schedule) Day 1: Epirubicin 100 mg/m² IV, AND 5-fluorouracil 500 mg/m² IV, AND cyclophosphamide 500 mg/m² IV Repeat q21Days x 6 cycles Option 2 (Divided dose schedule) First dose divided equally between days 1 & 8: Epirubicin 60 mg/m² IV, AND 5-fluorouracil 500 mg/m² IV, AND Days 1-14: Cyclophosphamide 75 mg/m² PO Repeat q28Days x 6 cycles Intravenous Lymphoma; Multiple myeloma; Solid tumours; Acute leukaemias Adult: As a single agent: 60-90 mg/m2 every 3-4 wk. May divide dose over 2-3 days if desired. May admin as an inj over 3-5 minutes or as an infusion over up to 30 minutes. Max (total cumulative dose limit): 0.9-1 g/m2. For palliative care: 12.5-25 mg/m2 once wkly. Hepatic Impairment Billirubin 3 mg/dL or AST > 4 x ULN: 25% of recommended starting dose (ie, decrease starting dose by 75%) Severe hepatic impairment: Not recommended Child Dose: Safety & efficacy not established Renal Dose: Renal Impairment SCr >5 mg/dL [>442 micromoles/L]: Decrease dose by 50%; test cardiac ejection fraction via MUGA before starting treatment

Your doctor or nurse will give you this medicine. Kindly do not self administer.

Common: • Low blood platelets • Nausea • Hair loss • Absence of menstrual periods • Fever • Anemia (low number of red blood cells) • Diarrhea • Weight loss • Decreased white blood cell count (neutrophils) • Hot flashes • Gastrointestinal inflammation • Rash • Low energy • Eye disorder

[UNSAFE] Epirubicin Hydrochloride may cause side effects which could affect your ability to drive. Epirubicin Hydrochloride may cause episodes of nausea and vomiting, which can temporarily lead to an impairment of the ability to drive. Epirubicin Hydrochloride is used alone or in combination with other medicines for the treatment of various types of cancers. It is given through a drip into a vein (intravenous infusion) by a doctor or nurse. It may make you feel tired or sleepy. Do not drive or do anything that requires mental focus until you know how it affects you. Use a reliable contraceptive method to prevent pregnancy while you are taking this medicine and for 6 months after stopping treatment. Your doctor may get regular blood tests done to monitor your blood cells, liver, and heart function during treatment with this medicine. Inform your doctor immediately if you notice any signs of infection such as fever, sore throat or rash.

Cardiac impairment, severe or recent MI; previous full cumulative doses of anthracyclines. Hypersensitivity; severe hepatic dysfunction. Not for intravesical use where invasive tumours have penetrated the bladder wall; urinary infections, bladder inflammation or catheterisation problems. Pregnancy, lactation.

Paclitaxel and other anthracyclines. Cimetidine, heparin. Antineoplastic drugs, cardiotoxic drugs, radiation, hepatoactive drugs.

[UNSAFE] It is unsafe to consume alcohol with Epirubicin Hydrochloride.

[CONSULT YOUR DOCTOR] Epirubicin Hydrochloride is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[UNSAFE] Epirubicin Hydrochloride is unsafe to use during breastfeeding. Data suggests that the drug may cause toxicity to the baby.

[SAFE IF PRESCRIBED] Epirubicin Hydrochloride is probably safe to use in patients with kidney disease. Limited data available suggests that dose adjustment of Epirubicin Hydrochloride may not be needed in these patients. Please consult your doctor. Lower doses may be considered in patients with serum creatinine > 5 mg/dL. [CAUTION] Epirubicin Hydrochloride should be used with caution in patients with liver disease. Dose adjustment of Epirubicin Hydrochloride may be needed. Please consult your doctor. Use of Epirubicin Hydrochloride is not recommended in patients with severe liver disease.

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