Epirubicin Side Effects

Medically reviewed by Drugs.com. Last updated on Apr 14, 2025.

Applies to epirubicin: intravenous solution.

Precautions

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. If you are a woman who can bear children, your doctor may give you a pregnancy test before starting this medicine to make sure you are not pregnant. Female patients should use effective birth control during treatment with this medicine and for at least 6 months after the last dose. Male patients who have female partners should use effective birth control during treatment with this medicine and for at least 3 months after the last dose. Male patients with pregnant partners should use condoms during treatment and for at least 7 days after the last dose. If you think you have become pregnant while using this medicine, tell your doctor right away.

Your doctor may monitor your heart before you start receiving epirubicin and while you are getting treatments with this medicine. Call your doctor right away if you have any chest pain, increased coughing, trouble breathing, a sudden difficulty with breathing at night, rapid weight gain, or abnormal swelling in your ankles or legs. These could be symptoms of serious heart problems.

This medicine should not be used within 24 weeks of stopping trastuzumab (Herceptin) unless your doctor has determined that it is the best treatment.

This medicine can rarely cause leukemia (cancer of the blood). Talk with your doctor if you have concerns about this.

While you are being treated with epirubicin, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Epirubicin may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them, and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

Epirubicin can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

If epirubicin accidentally leaks out of the vein into which it is injected, it may damage some tissues and may cause scarring. Tell the doctor right away if you notice redness, pain, or swelling at the injection site.

This medicine may cause a serious type of reaction called tumor lysis syndrome. Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

This medicine may increase your risk of developing blood clots. If you have chest pain, trouble breathing, or pain, redness, or swelling in your arms or legs while using this medicine, call your doctor right away.

This medicine may turn your urine red for 1 or 2 days after your treatment. This is normal and is nothing to worry about. You may want to protect your clothing from being stained.

This medicine often causes a temporary and total loss of hair. After treatment with epirubicin has ended, normal hair growth should return.

Cancer medicines can cause nausea and vomiting, in most people, sometimes even after receiving medicines to prevent it. Ask your doctor or nurse about other ways to control these unwanted effects if you still have nausea or vomiting after receiving the medicine.

If you plan to have children, talk with your doctor before using this medicine. Some men and women using this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects of epirubicin

Along with its needed effects, epirubicin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking epirubicin:

Get emergency help immediately if any of the following symptoms of overdose occur while taking epirubicin:

Symptoms of overdose

• abdominal or stomach swelling or tenderness
• high fever
• stomach pain
• swelling of the lining of the mouth, nose, or throat
• vomiting

Other side effects of epirubicin

Some side effects of epirubicin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to epirubicin: intravenous powder for injection, intravenous solution.

Hematologic adverse events

• Very common (10% or more): Leukopenia (80%), neutropenia (80%), anemia (72%), thrombocytopenia (49%)
• Frequency not reported: Myelosuppression, febrile neutropenia, pancytopenia^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea/vomiting (92%), mucositis (59%), diarrhea (25%), stomatitis
• Common (1% to 10%): GI pain, GI erosion, GI ulcer
• Uncommon (0.1% to 1%): GI hemorrhage
• Frequency not reported: Abdominal discomfort, esophagitis
• Postmarketing reports: Ulceration, pain or burning sensation, bleeding, hyperpigmentation of the oral mucosa^[Ref]

Immunologic

• Very common (10% or more): Infection (22%)
• Frequency not reported: Secondary infection
• Postmarketing reports: Sepsis, pneumonia^[Ref]

Ocular

• Very common (10% or more): Conjunctivitis/keratitis (15%)^[Ref]

Dermatologic

• Very common (10% or more): Alopecia (96%), skin toxicity
• Common (1% to 10%): Rash, itching, skin changes, pruritus, nail pigmentation, skin disorder, skin/nail hyperpigmentation
• Uncommon (0.1% to 1%): Erythema, urticaria
• Frequency not reported: Tissue hypoxia
• Postmarketing reports: Flushes, photosensitivity reaction, hypersensitivity to irradiated skin (radiation-recall reaction)^[Ref]

Cardiovascular

• Very common (10% or more): Hot flashes (39%)
• Common (1% to 10%): Asymptomatic drops in left ventricular ejection fraction (LVEF), cardiac heart failure (CHF), ventricular tachycardia, atrioventricular block, bundle branch block, bradycardia, congestive heart failure
• Frequency not reported: Transient ECG changes (including low QRS voltage), arrhythmia, T wave flattening, ST depression, T inversion, cardiomyopathy, venous sclerosis
• Postmarketing reports: Shock, hemorrhage, embolism arterial, thrombophlebitis, phlebitis^[Ref]

Respiratory

• Postmarketing reports: Pulmonary embolism^[Ref]

Hypersensitivity

• Postmarketing reports: Anaphylaxis^[Ref]

Metabolic

• Postmarketing reports: Dehydration, hyperuricemia^[Ref]

Genitourinary

• Very common (10% or more): Amenorrhea (72%), chromaturia (red coloration of urine for 1 to 2 days after administration)
• Frequency not reported: Azoospermia
• Postmarketing reports: Chemical cystitis (following intravesical administration)^[Ref]

Local

• Very common (10% or more): Local toxicity (20%)
• Frequency not reported: Erythematous streaking along the infused vein^[Ref]

Psychiatric

• Frequency not reported: Confusion, depression^[Ref]

Hepatic

• Very common (10% or more): Transaminases abnormal^[Ref]

Oncologic

• Uncommon (0.1% to 1%): Acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL)^[Ref]

Other

• Very common (10% or more): Lethargy (46%), malaise, pyrexia
• Common (1% to 10%): Fever
• Frequency not reported: Weakness
• Postmarketing reports: Chills^[Ref]

See also:

Further information

Epirubicin side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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