Epirubicin Disease Interactions

The use of epirubicin is contraindicated in patients with severe myocardial insufficiency, recent myocardial infarction, and severe arrhythmias. Myocardial toxicity, manifested in its most severe form by potentially fatal congestive heart failure (CHF), may occur either during therapy with epirubicin or months to years after termination of therapy. Risk factors may increase the risk of cardiac toxicity. Cardiac toxicity with epirubicin may occur at lower cumulative doses whether or not cardiac risk factors are present, so extreme caution is advised. Initial treatment with epirubicin should be preceded by a careful baseline assessment of cardiac function as measured by left ventricular ejection function (LVEF). Close cardiac monitoring during treatment is suggested.

Patients with severe hepatic dysfunction should not be treated with epirubicin. The major route of elimination of epirubicin is the hepatobiliary system. Serum total bilirubin and AST levels should be evaluated before and during treatment with epirubicin. Patients with elevated bilirubin or AST may experience slower clearance of drug with an increase in overall toxicity. Lower doses are recommended in these patients.

Patients should not be treated with epirubicin if they have a baseline neutrophil count < 1500 cells/mm3. A dose-dependent, reversible leukopenia and/or neutropenia is the predominant manifestation of hematologic toxicity associated with epirubicin and represents the most common acute dose-limiting toxicity of this drug. Myelosuppression requires careful monitoring. Total and differential WBC, red blood cell (RBC), and platelet counts should be assessed before and during each cycle of therapy with epirubicin.

Before beginning treatment with epirubicin, patients should recover from any acute toxicities, such as stomatitis, neutropenia, thrombocytopenia, and generalized infections, of prior cytotoxic treatment.

Serum creatinine should be assessed before and during therapy with epirubicin. Dosage adjustment is necessary in patients with serum creatinine >5 mg/dL. Patients undergoing dialysis have not been studied.