Epirubicin hydrochloride is given by intravenous injection of a solution in sodium chloride 0.9% or Water for Injections into a fast-running infusion of sodium chloride 0.9% or glucose 5% over 3 to 5 minutes, or by infusion over up to 30 minutes. It is given as a single agent in usual doses of 60 to 90 mg/m2 as a single dose every 3 weeks; this dose may be divided over 2 or 3 days if desired. A regimen of 12.5 to 25 mg/m2 once a week has also been tried in palliative care. High-dose regimens, of 120 mg/m2 or more every 3 weeks, or 45 mg/m2 for 3 consecutive days every 3 weeks have been used.
Doses may need to be reduced if epirubicin is given with other antineoplastics. Doses should also be reduced in patients with liver impairment and in those whose bone-marrow function is impaired by age or previous chemotherapy or radiotherapy.
A total cumulative dose of 0.9 to 1 g/m2 should not generally be exceeded, because of the risk of cardiotoxicity.
Epirubicin has also been given by intravesical instillation in the local treatment of bladder cancer. Instillation of 50 mg weekly as a 0.1% solution (in sodium chloride 0.9% or sterile water) for 8 weeks has been suggested, reduced to 30 mg in 50 mL weekly if chemical cystitis develops; for carcinoma in-situ, the dose may be increased, if tolerated, to 80 mg in 50 mL weekly. For the prophylaxis of recurrence in patients who have undergone transurethral resection, 50 mg weekly for 4 weeks, followed by 50 mg instilled once a month for 11 months is the suggested regimen. The solution should be retained in the bladder for 1 hour.
Blood counts should be made routinely during treatment with epirubicin, and cardiac function should be carefully monitored. Liver function should be assessed before and if possible during therapy.
Increased exposure to epirubicin, and a consequent increase in myelotoxicity, has been reported in patients given epirubicin immediately after paclitaxel, compared with patients who received epirubicin before paclitaxel.1 Similar interactions have been seen when paclitaxel was given before other anthracyclines.2 These and other studies3,4 have suggested that paclitaxel given in this way is associated with a reduced conversion of epirubicin to the less myelotoxic metabolite, epirubicinol, although the interaction is complex, and may involve both disposition and pharmacodynamics.
Licensed product information states that epirubicin hydrochloride is incompatible with heparin or fluorouracil, resulting in precipitation, and that it is hydrolysed in alkaline solutions.