Epirubicin

• What epirubicin is
• How you have treatment
• Common side effects
• Occasional side effects
• High dose side effects
• Important points to remember
• Immunisations and chemotherapy

Epirubicin is a chemotherapy drug used to treat various types of cancer, including breast cancer, ovarian cancer, stomach cancer and bowel cancer. It used to be called by its brand name Pharmorubicin. One way in which epirubicin works is by binding to the cancer cells’ DNA (the genetic code). This makes the DNA get tangled up and the cancer cell cannot divide or grow.

Epirubicin is a red liquid that you have as an injection or drip (infusion) into a vein (intravenously) through a fine tube (cannula) put into the vein. To find out more about the ways of giving chemotherapy look at the section on how chemotherapy is given.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for epirubicin depends on which cancer you have. To find out more about planning chemotherapy look at our chemotherapy section.

The side effects associated with epirubicin are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, please see our cancer drug side effects section or click on search at the top of the page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• Fatigue during and after treatment - most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick can be severe with epirubicin but is usually well controlled with anti-sickness injections or tablets - if sickness happens, it usually starts a few hours after each treatment and lasts for about a day. Tell your doctor if your sickness is not controlled, as you may be able to have other anti-sickness drugs that work better for you.
• Hair loss occurs in everyone who has epirubicin and includes all head and body hair. The hair grows back after treatment. A cold cap may help to stop you losing your hair, but you need to talk to your doctor about how advisable this is with your type of cancer.
• Inflammation in the mouth and throat can happen about 2 to 3 days after each treatment. You may have reddening of the skin in your mouth, mouth ulcers, a burning feeling and bleeding. This is usually gone within 3 weeks of treatment.
• Damage to heart muscle is usually temporary but for a small number of people it may be permanent - your doctor will check your heart before and after your treatment
• Your urine may become a pink or red colour for about one day after treatment - this is nothing to worry about
• Reddening of the skin in areas where you have had radiotherapy in the past, and the skin in the area may get dry and flaky and feel sore and hot - this goes away on its own
• Sensitivity to sunlight - don’t sit out in the sun, and cover up or use sun block on exposed skin
• Epirubicin may have a harmful effect on a developing baby - do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

Some people may have one or more of the following effects

• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility - we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you
• Inflammation around the drip site - if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Allergic reactions can happen while the drug is going into your bloodstream and your nurse will monitor you for signs of allergic reaction - tell your nurse if you have skin rashes and itching, a temperature, shivering, redness of the face, a feeling of dizziness, headaches, breathlessness, anxiety or a need to pass urine
• Diarrhoea may occur - drink plenty of fluids, and if your diarrhoea is severe or continues tell your doctor or nurse
• Loss of appetite
• Nails may become darker and may have white lines on them
• Sore eyes (conjunctivitis) - your doctor or nurse can prescribe eyedrops

There is a small risk that you may get a second cancer some years after high doses, or many doses, of epirubicin.

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.