Epirubicin Side Effects

Medically reviewed by Drugs.com. Last updated on Nov 19, 2024.

Applies to epirubicin: intravenous solution.

Important warnings This medicine can cause some serious health issues

Intravenous route (solution)

Myocardial damage, including acute left ventricular failure, can occur with epirubicin.

The risk of cardiomyopathy is proportional to the cumulative exposure with incidence rates from 0.9% at a cumulative dose of 550 mg/m(2), 1.6% at 700 mg/m(2), and 3.3% at 900 mg/m(2) and is further increased with concomitant cardiotoxic therapy.

Assess left ventricular ejection fraction (LVEF) before and regularly during and after treatment with epirubicin.

Secondary acute myelogenous leukemia and myelodysplastic syndrome occur at a higher incidence in patients treated with anthracyclines, including epirubicin. Extravasation of epirubicin can result in severe local tissue injury and necrosis requiring wide excision of the affected area and skin grafting.

Immediately terminate the drug and apply ice to the affected area.

Severe myelosuppression resulting in serious infection, septic shock, requirement for transfusions, hospitalization, and death may occur.

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:

More common side effects

• black, tarry stools
• bleeding, redness, or ulcers in the mouth or throat
• chest pain
• cough or hoarseness
• fever or chills
• lower back or side pain
• pain or burning in the mouth or throat
• painful or difficult urination
• sore throat
• sores, ulcers, or white spots in the mouth or on the lips
• swollen glands
• trouble breathing
• unusual bleeding or bruising
• unusual tiredness or weakness

Less common side effects

• blood in the urine or stools
• pinpoint red spots on the skin
• red streaks along the injected vein

Rare side effects

• darkening or redness of the skin at the place of irradiation
• fast or irregular heartbeat
• joint pain
• pain, redness, or warmth at the injection site
• skin rash or itching
• swelling of the abdomen or stomach, lower legs, and feet
• swelling or tenderness of the lymph nodes, abdomen, side or lower back

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:

More common side effects

• absent, missed, or irregular menstrual periods
• burning, dry, or itching eyes
• diarrhea
• discharge or excessive tearing
• feeling of warmth
• hair loss or thinning of the hair
• nausea
• redness of the face, neck, arms, and occasionally, upper chest
• redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
• stopping of menstrual bleeding
• sudden sweating
• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Less common side effects

• changes in the skin
• loss of appetite
• weight loss

Rare side effects

• darkening of the soles, palms, or nails

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]

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.

Medical Disclaimer