Chemotherapy of breast cancer, stomach cancer, ovarian cancer, non-Hodgkin's lymphoma and lung cancer (small- and non-small cell lung cancer). Epirubicin is also used in the treatment of colon and rectum cancer, head and neck cancer, soft tissue cancers, leukemias and bladder cancer, including in the prophylaxis of local recurrence of bladder cancer.
A drug with anticancer activity. The mechanism of antitumor action of epirubicin has not been fully investigated. It is believed that anthracyclines bind to the DNA chain through bonds between DNA strands, thereby inhibiting replication and transcription. As a result of the reduction to free semichinone radicals, DNA, lipids of the cell membrane and mitochondria are damaged. After rapid intravenous administration, epirubicin undergoes three-phase elimination from plasma. Epirubicin is characterized by a fast initial (α) distribution phase (T0,5α = 1.8-4.8 minutes) followed by the central phase (β) (T0,5β = 0.5-2.6 h), and finally much slower terminal (γ) elimination phase (T0,5γ = 15-45 h). Epirubicin is extensively distributed to tissues. After intravenous administration, epirubicin is rapidly metabolised to glucuronides, epirubicinol and aglycones. It is excreted primarily in the urine, in unchanged form and in the form of metabolites. In patients with moderate or severe hepatic impairment, decreased clearance of epirubicin and increased blood levels were observed.
Contraindications:
Hypersensitivity to the drug or other ingredients of the preparation. Bone marrow suppression caused by previous cytostatic treatment or radiotherapy. Use of the maximum, acceptable dose of epirubicin or other anthracyclines. Cardioactive or active myocardial dysfunction. Hepatic dysfunction.
Precautions:
Exceeding the total dose of epirubicin (900-1000 mg / m2 pc.) significantly increases the risk of congestive heart failure. The red urine may appear 1-2 days after the medicine.
Pregnancy and lactation:
Do not use during pregnancy and breast-feeding.
Side effects:
Myelotoxicity: transient leukopenia and neutropenia (nadir 10-14 days after administration of the drug). Thrombocytopenia, thrombocytopenia. Cardiotoxicity: after exceeding the maximum cumulative dose of the drug, the risk of congestive heart failure increases. The risk of heart damage increases in patients who underwent radiotherapy in the mediastinal area at the same time or earlier. ECG changes: usually transient and reversible flattening or inversion of the T wave, lowering the S-T segment, arrhythmias. Postoperragenic cardiomyopathy characterized by a decrease in the size of QRS and reduction of the ejection fraction of the heart. Alopecia (usually reversible) occurring in 60-90% of patients. Mucositis usually occurring after 5-10 days from the start of treatment and usually involving the oral mucosa (painful erosions located mainly along the edges of the tongue and sublingually). Gastrointestinal disorders: nausea, vomiting, diarrhea. Increase in body temperature, fever. Rarely: chills, urticaria, anaphylactic reaction, induration of veins. Extravasation causes tissue damage and necrosis. Possibility of secondary development, acute myeloid leukemia with or without phase of leukaemias in the case of simultaneous use of DNA damaging cytostatics. During intravesical administration due to minimal absorption, systemic side effects are rare, with more frequent drug-induced cystitis, sometimes hemorrhagic.
Dosage:
The preparation should be administered only under the supervision of a doctor who has experience in cancer chemotherapy. It is only administered intravenously via an intravenous set, infused with physiological NaCl solution, 5% Glucose or a mixture of NaCl and Glucose, after ensuring that the needle is well positioned in the vein. Monotherapy: the recommended dose in adults is 60-90 mg / m2 pc. 3-5-minute infusion.The peripheral blood count and bone marrow function should be considered when determining the dose. Subsequent doses should be given within 21 days. In the bladder: the standard dose is 50 mg / 50 ml in NaCl solution or distilled water. The solution should remain in the bladder for 1 hour. If a local toxicity reaction occurs, a dose reduction to 30 mg / ml is recommended.
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