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Epirubicin (Pharmorubicin)

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This page tells you about the chemotherapy drug epirubicin and its possible side effects. There is information about

 

What epirubicin is

Epirubicin is a chemotherapy drug and its brand name is Pharmorubicin (pronounced farm-oh-roo-bis-in). It is used to treat various types of cancer, including

Epirubicin may be given into the bladder for early bladder cancer. The side effects are then different from those on this page. We have specific information about chemotherapy into the bladder in our chemotherapy for bladder cancer section. 

Epirubicin may also be used to treat other types of cancer in clinical trials.

 

How epirubicin works

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 cells can't divide or grow.

 

How you have epirubicin

Epirubicin is a red liquid that you have as an injection into a vein (intravenously) through a fine tube (cannula) put into the vein. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for epirubicin depends on which type of cancer you have. We have a page about planning chemotherapy.

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.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An 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, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Tiredness and weakness (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 or nurse if your sickness is not controlled. You may be able to have other anti sickness medicines 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
  • Your urine may become a pink or red colour for about one day after treatment – this won't harm you
  • Reddening of the skin in areas where you have had radiotherapy in the past. The skin in the area may also 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 do cover up or use sun block on exposed skin
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these effects.

  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
  • 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 ending
  • Inflammation around the drip siteif you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
  • Allergic reactions can happen while the drug is going into your bloodstream – your nurse will monitor you for signs of an allergic reaction. Tell them straight away 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 – your doctor or nurse can prescribe eye drops
  • Hot flushes and sweats
  • Damage to heart muscle is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment. Tell your doctor or nurse if you have any chest pain, breathlessness or swollen ankles
 

Rare side effects

Fewer than 1 in 100 people have these effects.

  • 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)
  • Blood clots – there is a slightly increased risk of developing a blood clot (thrombosis) when you are taking epirubicin. If you’ve had a blood clot in the past tell your doctor. Let your doctor or nurse know straight away if you have a red, hot, swollen area on your leg or if you suddenly develop a cough, breathlessness or chest pain
  • Acute leukaemia or a second cancer may occur up to 3 years after treatment
  • Dizziness
  • Raised uric acid levels in the blood – you will have regular blood tests to check the levels
  • Liver changes that are mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • A skin rash – let your doctor or nurse know if you have this
 

Important points to remember

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

Coping with side effects

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

Other medicines

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

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drug may come through in the breast milk.

 

Immunisations and chemotherapy

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, yellow fever and Zostavax (shingles vaccine).

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 safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about epirubicin

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 15 August 2014