Epirubicin

Epirubicin is used in the treatment of a variety of cancers including breast, ovarian, stomach and bowel. 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 are being treated for. To find out more about the way chemotherapy treatment is planned, look at the section on 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 chemotherapy side effects section or click on search at the top of the page.


Common side effects of Epirubicin

Many people have one or more of the following side effects with epirubicin


Fatigue - for many people this is the most troublesome side effect of all. Tiredness often carries on after treatment has ended. Most people find their energy levels are back to normal from 6 months to a year after their treatment finishes.
Temporary effect on the bone marrow. The bone marrow makes blood cells and a drop in its function can cause

- An increased risk of getting infections. This is due to a temporary drop in the number of white blood cells produced by the bone marrow. Having a low white blood count means that you are less able to fight infections and can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. Infections can sometimes be life threatening. You should contact your hospital urgently if you think you have an infection.

- Tiredness and breathlessness. This is due to a drop in the number of red blood cells made by your bone marrow which is called anaemia. You may need a blood transfusion to treat anaemia.

- Getting bruises more easily. This is due to a drop in the number of platelets produced by your bone marrow. You may have nosebleeds or notice your gums bleed when you brush your teeth. You may have lots of tiny red spots or bruises on your arms or legs. Contact your hospital urgently if you have this effect.

Feeling or being sick. This can be severe with epirubicin. It 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. If your sickness is not controlled, tell your doctor. You may be able to have other anti-sickness drugs that work better for you.
Hair loss. Everyone treated with epirubicin has complete head and body hair loss. Remember - this is only temporary. 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. This can happen about 2-3 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.
Effects on the heart. Epirubicin can cause temporary damage to the muscles of the heart, which may change the rhythm of the heart beat. In most cases this will go back to normal after the treatment is completed. Your heart will be checked before you start treatment.
Your urine may become a pink/red colour for about one day after treatment
Changes to your skin. You may have skin rashes (which may be itchy), darkening of your skin, sensitivity to light, and redness or soreness in areas of skin previously treated with radiotherapy
Epirubicin may have a harmful effect on a developing baby. It is not advisable to become pregnant or father a child whilst taking this drug. You should discuss contraception with your doctor before treatment starts.
Occasional side effects of Epirubicin

Loss of fertility - it's not known exactly what effect this drug could have on your fertility. It is important to talk to your doctor before starting treatment. Women may stop having periods (amenorrhoea). This may only be temporary.
While you are actually having the chemotherapy treatment, epirubicin can leak into the tissues around the cannula site and cause damage in that area. It is important to tell your nurse or doctor if you have any

- Stinging or burning around the cannula site
- Leakage of fluid
- Redness or swelling around the cannula site after treatment has finished

Allergic reactions can happen while the drug is going into your bloodstream. While you are having the epirubicin treatment you will be monitored 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. Drink plenty of fluids, and if your diarrhoea is severe or persistent tell your doctor or nurse.
Loss of appetite
Nails may become darker and may have white lines on them
Sore eyes (Conjunctivitis)
Side effects with high doses of Epirubicin

With high doses of epirubicin or many treatments with epirubicin there is a small chance of

Permanent damage to the heart
Developing another cancer at some time in the future
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

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.

Immunisations

You should not have immunisations with live vaccines while you are having chemotherapy or for 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.

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