Parenteral Manual

Epirubicin (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
PHARMORUBICIN
Classification: 
Antineoplastic antibiotic (anthracycline) - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Experimentally in resistant leukemia, lymphoma, sarcoma

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as a 2 mg/mL solution which is red in color
  • Refrigerate
  • Diluted solutions stable 24 hours at room temperature and 7 days refrigerated
  • 2 mg/mL solution is stable in syringe for 7 days refrigerated
  • Protect from light
Compatibility: 

- Solutions Compatible: D5W, NS

- Very limited compatibility information available

- Incompatible: heparin, fluorouracil, mesna

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Push

YES, doses <30 mg/mONLY

 

Usual dilution: into running IV

Infusion time: > 5 minutes

Flush: > 20 mL of IV fluid to clear line        

IV Intermittent Infusion YES
Usual dilution: dilute in 50-100 mL D5W or NS
Infusion time: 30-60 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 75 - 90 mg/m2 q 3 weeks
  • 25 - 30 mg/m2 x 2-3 days, q 3 weeks

Use ideal body weight for dosage calculations ( ie if patient is obese or has ascites). Total cumulative lifetime dose should generally not exceed 650 mg/m2, or 450 mg/m2 with concomitant use of radiation to the mediastinum. Children < 0.5 mg/m2 or <2 years of age should be doses on a mg/kg basis.  (To obtain mg/kg dose, divide mg/m2 dose by 30.)

** Dosage may differ according to protocol

Dosage adjustment in hepatic impairment:

Serum Bilirubin

Dose

25-50 micromol/L

50% of usual dose

51-85 micromol/L

25% of usual dose

>85 micromol/L

Contraindicated

Potential hazards of parenteral administration: 

Immediate (within minutes to hours):

  • Nausea and vomiting (moderately low to moderately high emetogenic potential; dose dependent)
  • Erythematous streaking along vein (likely a flare reaction, not extravasation; may respond to antihistamines or slowing of infusion rate).
  • Transient arrhythmias, hypotension.
  • VESICANT:  will cause severe pain and tissue necrosis, if extravasated, usual first sign is pain.  Refer to policy for administration of vesicant chemotherapy and Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines.   

Delayed (within days to months):

  • Alopecia
  • Mucositis, diarrhea
  • Myocardial toxicity (cumulative, additive with other cardiotoxic drugs), congestive heart failure, cardiomyopathy
  • Myelosuppression; nadir 10 - 14 days
  • Red discoloration of urine for 1-2 days after dose (this is not hematuria)

 - Treatment for unusual side effects are available through he study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor cardiac function (eg: ECG, echocardiogram) at onset of therapy, and prior to each dose (particularly after cumulative doses of 650 mg/m2 have been reached)
  • Monitor hematologic status
  • Serious irreversible myocardial toxicity can occur as total cumulative dose approaches 1000 mg/m2
  • Cardiotoxicity is enhanced by mediastinal irradiation, and previous anthracycline therapy
  • Anthracycline equivalent is 0.6 for cardiotoxicity

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