Description: Antineoplastic Agent, Topoisomerase II Inhibitor
“Alert: Black Box Warning
Including acute left ventricular failure, can occur with Epirubicin, Ellence. Assess left ventricular ejection fraction before and regularly during and after treatment with Epirubicin, Ellence.
Secondary acute myeloid leukemia and myelodysplastic syndrome occur at a higher incidence in patients treated with anthracyclines, including Epirubicin, Ellence.
Extravasation and Tissue Necrosis
Extravasation of Epirubicin, Ellence may result in severe local tissue injury and necrosis requiring wide excision of the affected area and skin grafting.
Bone marrow suppression
Severe myelosuppression resulting in serious infection, septic shock, requirement for transfusions, hospitalization, and death may occur.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
Epirubicin, Ellence is an anthracycline antineoplastic agent; known to inhibit DNA and RNA synthesis by steric obstruction after intercalating between DNA base pairs; active throughout entire cell cycle. Intercalation triggers DNA cleavage by topoisomerase II, resulting in cytocidal activity.
Indications For Use
Before starting Epirubicin, Ellence make sure your physician is aware of any allergies or medications you currently take. Epirubicin, Ellence can cause bone marrow suppression (i.e. severe myelosuppression, leukopenia, thrombocytopenia, anemia), cardiac toxicity including left ventricular failure, gastrointestinal toxicity and secondary malignancy (i.e. acute myelogenous leukemia, myelodysplastic
syndrome), tumor lysis syndrome. Epirubicin, Ellence should be used with caution with patients who pre-existing hepatic and/or renal
Intravenous: Dosed according to mg/m2 per treatment cycle.
Pharmacist Tips On Using
How to Take:
Intravenous: Infuse over 15 to 20 minutes or slow IV push; if lower doses due to dose reduction are administered, may reduce infusion time proportionally. Do not infuse over <3 minutes. Infuse into a free-flowing IV solution (NS or D5W). Avoid the use of veins over joints or in extremities with compromised venous or lymphatic drainage. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate antidote (dexrazoxane or dimethyl sulfate [DMSO]). Apply dry cold compresses for 20 minutes 4 times daily for 1 to 2 days.
The frequency of side effects has not been defined but are reported as part of combination chemotherapy regimens and include the following:
Decreased left ventricular ejection fraction, cardiac failure, atrioventricular block, bradycardia, bundle branch block, cardiac arrhythmia, cardiomyopathy, ECG abnormality, myocarditis, non-specific T wave on ECG, sinus tachycardia, ST segment changes on ECG, tachyarrhythmia, thromboembolism, ventricular premature contractions, ventricular tachycardia, lethargy, alopecia, skin rash, amenorrhea, hot flash, nausea, vomiting, mucositis, diarrhea, anorexia, abdominal pain, esophagitis, neutropenic enterocolitis, stomatitis, toxic megacolon, menopause (premature or early), neutropenia, leukopenia, thrombocytopenia, ascites, injection site reaction, conjunctivitis, dyspnea, pulmonary edema, fever.
Note this is not a complete list of side effects for Epirubicin, Ellence only common ones.
Frequently Asked Questions
Why would my physician prescribe a medication with such serious side effects?
Your physician takes the most recent clinical guidelines to make evidence-based decisions on what medication is appropriate in which situations. Your current medications, your allergies, age, cost of medication, comorbid conditions and many other factors will further complicate or limit which medications are appropriate. This medication is used for certain forms of cancer and your physician has determined the benefits outweigh the risks. Furthermore, they will be monitoring your bloodwork and symptoms closely to avoid many of the serious side effects and will keep you on the lowest effective dosage for the shortest amount of time possible.