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.

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