[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antitumour antibiotics](https://durgical.com/en/pharmacology/classes/antitumour-antibiotics/) › Epirubicin [Pharmacology](https://durgical.com/en/pharmacology/) · [Antitumour antibiotics](https://durgical.com/en/pharmacology/classes/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 - Class: [Antitumour antibiotics](https://durgical.com/en/pharmacology/classes/antitumour-antibiotics/) - Enzyme: Topoisomerase IIα (and DNA, by intercalation) - ATC code: L01DB03 ## ⚠ High-alert medication An error with this medicine can cause serious harm: double checks and protocols are used. ✂**Topoisomerase IIα (and DNA, by intercalation)**Epirubicin ⓘ 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](https://www.rcsb.org/structure/1D12) · Drag to rotate · pinch to zoom ## 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. - Intercalates in DNA - Topoisomerase II trapped: double-strand breaks - 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 →](https://durgical.com/en/conditions/breast-cancer/) ## Adverse effects ### Common - Nausea, vomiting, diarrhoea and mouth sores - Hair loss - Neutropenia ### Serious (rare, important) - Heart failure during therapy or months to years later - Severe tissue necrosis after extravasation - Secondary acute myeloid leukaemia - Severe myelosuppression ## 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. ## Memory aid EPIrubicin is doxorubicin's mirror twin (an EPImer): same heart rules, same vein rules, mainly for breast cancer. ## 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)](https://durgical.app/estudiar/?add=/en/pharmacology/epirubicin/) ## Related drugs - [Doxorubicin](https://durgical.com/en/pharmacology/doxorubicin/) - [Daunorubicin](https://durgical.com/en/pharmacology/daunorubicin/) - [Idarubicin](https://durgical.com/en/pharmacology/idarubicin/) ## Related conditions - [Breast cancer](https://durgical.com/en/conditions/breast-cancer/) [← Back to the class: Antitumour antibiotics](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f7ec5ec1-fb05-4c78-b821-9aea638cf144) (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](https://atcddd.fhi.no/atc_ddd_index/?code=L01DB03) (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. --- Source: https://durgical.com/en/pharmacology/epirubicin/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/epirubicin/