DurgicalDurgical
EN
Open the app

Pharmacology · Antitumour antibiotics

Epirubicin !

An anthracycline closely related to doxorubicin, used in adjuvant chemotherapy for breast cancer. Same cautions: heart, marrow and veins.

Updated 2026-11-01

The figure shows doxorubicin intercalated in DNA; epirubicin differs only in the orientation of one sugar hydroxyl group and occupies the same site. No epirubicin structure is available.

Target in 3D: Topoisomerase IIα (and DNA, by intercalation). PDB structure 1D12 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Like doxorubicin, epirubicin intercalates in DNA, traps topoisomerase II on cut DNA and generates free radicals. It is extensively metabolised by the liver.

  1. Intercalates in DNA
  2. Topoisomerase II trapped: double-strand breaks
  3. Free radicals; breast cancer cells die

Pharmacokinetics

Absorption
Intravenous only.
Metabolism
Extensive liver metabolism; doses are reduced in hepatic impairment.

Indications

  • Adjuvant therapy after resection of breast cancer with axillary node involvement. Breast cancer →

Adverse effects

Common

  • Nausea, vomiting, diarrhoea and mouth sores
  • Hair loss
  • Neutropenia

Contraindications

  • Low baseline neutrophil count
  • Severe myocardial insufficiency, recent myocardial infarction or severe arrhythmias
  • Previous anthracycline treatment up to the maximum cumulative dose
  • Hypersensitivity to epirubicin, other anthracyclines or anthracenediones; severe hepatic dysfunction

Key interactions

Other cytotoxic drugs
Additive blood and gastrointestinal toxicity.
Cardioactive drugs that can cause heart failure (e.g. calcium channel blockers)
Cardiac function is monitored closely throughout treatment.
Paclitaxel or docetaxel
The order of administration changes exposure to epirubicin and its metabolites.

What is monitored

  • Ejection fraction (echocardiogram or MUGA) before, during and after treatment, by the same method each time.
  • Neutrophil count before each cycle
  • Bilirubin and liver tests

Administration and safety

  • Vesicant: given only into a free-flowing intravenous line, never intramuscularly or subcutaneously; the site is checked before and during the dose.
  • Suspected extravasation (burning, stinging, swelling): stop the drug, try to aspirate without flushing, apply ice intermittently, elevate the limb and notify; dexrazoxane may be used in adults.
  • Look-alike risk with doxorubicin and other anthracyclines: the full name and the cumulative dose are checked.
  • Hazardous drug: prepared and given following hazardous-drug handling procedures (impervious gloves, no skin contact) and disposed of as cytotoxic waste.

Nursing care

  • Independent double check of drug, patient, route and cycle before giving it (high-alert medicine).
  • Blood count before each cycle; fever with neutropenia is treated as an emergency.
  • Teaching: report shortness of breath, swelling of the legs, palpitations or fast weight gain, even months after treatment.
  • Teaching: report vomiting with dehydration, fever, or pain at the injection site.

Pregnancy and breastfeeding

May cause fetal harm; pregnancy is avoided during treatment.

Test yourself

Think of the answer, then tap the question to see it.

What is epirubicin's main indication?

Adjuvant chemotherapy for breast cancer with axillary node involvement.

Which prior treatment is a contraindication to epirubicin?

Previous anthracyclines up to the maximum cumulative dose, because cardiotoxicity adds up.

When can epirubicin heart failure appear?

During treatment or months to years after it ends.

Add to my cards (3)

← Back to the class: Antitumour antibiotics

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - epirubicin hydrochloride- epirubicin hydrochloride injection, solution (DailyMed (U.S. National Library of Medicine), 2008); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.