Patient Medication Information: uses, side effects, how to take - Epirubicin Hydrochloride Injection (Strides Pharma Canada)

ABOUT THIS MEDICATION

Epirubicin Hydrochloride Injection and cancer treatment:

What is Epirubicin Hydrochloride Injection used for:

Epirubicin Hydrochloride Injection alone or in combination with other anticancer drugs is used in the treatment of:

Metastatic breast cancer
Small cell lung cancer, advanced non-small cell lung cancer
Stage III and IV ovarian cancer
Metastatic and locally unresectable gastric carcinoma

Epirubicin Hydrochloride Injection in combination with other anticancer drugs is also used in the adjuvant treatment of early stage of breast cancer for pre- and peri-menopausal women.

What it does:

Epirubicin Hydrochloride Injection is a chemotherapy drug, often used in combination with other drugs to kill cancer cells. Most chemotherapy agents (including Epirubicin Hydrochloride Injection) work by killing rapidly dividing cells, such as cancer cells. This action can affect normal cells as well.

In breast cancer, it can be used following surgery and/or radiation as adjuvant or additional therapy. Here, it is used to kill cancer cells that have ‘escaped’ the tumour and could spread to other parts of the body (like the bones, liver, or lungs), where the cancer can grow again and recur. If breast cancer has spread to the lymph nodes in the axilla (armpit), there is higher chance of recurrence if no treatment is given. (The axillary lymph nodes normally drain fluid from the breast and arm.) The extent of the cancer cell spreading may be a factor when a chemotherapy regimen is chosen.

BEFORE STARTING TREATMENT YOU AND YOUR DOCTOR SHOULD DISCUSS TREATMENT OPTIONS BEST SUITED TO YOU, TAKING INTO CONSIDERATION YOUR CONDITION AND OTHER HEALTH CONCERNS THAT YOU MAY HAVE.

In other cancers, chemotherapy can be used to reduce tumour size, or stop them from growing. Understand why your doctor has chosen the particular chemotherapy regimen to be used, and know all the risk and benefits before starting therapy.

When it should not be used:

Do not use the drugs if you:

are allergic to epirubicin or any of the ingredients of the drug or its container (see What is in your medication),
are allergic to other anthracyclines or anthracediones such as doxorubicin, daunorubicin, mitoxanthrone or mitomycin C.
have persistent low blood count (myelosuppression)
have severe liver impairment
have severe heart disease
have had a recent heart attack
have irregular heartbeat
have a history of severe cardiac disease
have been treated with a maximum cumulative dose of epirubicin and/or other anthracyclines and anthracenediones

What the medicinal ingredient is:

Epirubicin hydrochloride.

What the non-medicinal ingredients are:

Sodium chloride, hydrochloric acid, and water for injection

What dosage form it comes in:

Epirubicin Hydrochloride Injection 2 mg/mL is available in

25 mL and 100 mL glass vials.

WARNINGS AND PRECAUTIONS

Severe local tissue degradation caused by fluid leakage from the veins to the surrounding tissues during administration

Cardiac toxicity, manifested in its most severe form by potentially fatal heart failure

A severe decrease in the ability of the bone marrow to produce blood cells

Epirubicin Hydrochloride Injection should be given under the supervision of a doctor experienced with the use of anticancer drugs.

Epirubicin Hydrochloride Injection should not be given to patients with the following conditions:

A low blood count (bone marrow suppression induced by previous drug therapy or radiotherapy);
A heart disease and/or previous treatment with anthracyclines (cardiotoxic drugs)

IMPORTANT: PLEASE READ

Before using Epirubicin Hydrochloride Injection, tell your doctor if any of the following applies to you:

if you have or have experienced a sensitivity or allergic reaction to epirubicin or any other component of the product (see what is in your medication), other anthracyclines or anthracenediones such as doxorubicin hydrochloride, daunorubicin hydrochloride, mitoxantrone or mitomycin C.
if you have low blood cell counts due to a decreased ability of the bone marrow to produce blood cells
if you have severe liver disease
if you have a heart disease, recent heart attack or irregular heartbeat
if you are taking other drugs (including calcium channel blockers) or have been previously treated with Epirubicin Hydrochloride Injection or other anti-cancer drugs, including anthracyclines (cardiotoxic drugs).

As Epirubicin Hydrochloride Injection may be harmful to an unborn child, women should be advised to avoid becoming pregnant. Effective contraceptive methods should be used.

Tell your doctor right away if you become pregnant during treatment. If you have been nursing, you should stop before starting treatment with Epirubicin Hydrochloride Injection. Ask your baby’s doctor to recommend a formula that would be best for your baby.

INTERACTIONS WITH THIS MEDICATION

Administration of live vaccines to immunosuppressed patients including those undergoing cytotoxic chemotherapy should be avoided.

PROPER USE OF THIS MEDICATION

How is Epirubicin Hydrochloride Injection given?

Some patients may receive Epirubicin Hydrochloride Injection through a vein in the arm (“intravenously” or “IV”) by their doctor or nurse, usually in the hospital, outpatient department or clinic.

If you are getting many injections over several weeks or months, for your convenience, your doctor may insert a catheter (thin tube) or port into a large vein in your body that is placed there as long as it is needed. Medicines get injected through the catheter or port rather than directly into a vein.

How much time does it take to get a treatment with

Epirubicin Hydrochloride Injection?

It usually takes about 5 minutes to inject Epirubicin Hydrochloride Injection. However, you may get other medicines before or after Epirubicin Hydrochloride Injection, so your entire treatment may last an hour or longer.

How long will I need treatment?

Your doctor will determine the length of your treatment based on your treatment goals, the medicines you receive, and how your body responds to those medicines. Adjuvant chemotherapy for breast cancer usually lasts 3-6 months, however.

Chemotherapy is usually given in cycles that include rest periods between treatments. The rest periods give your body a chance to build healthy new cells and regain your strength before your next treatment. Epirubicin Hydrochloride Injection is given in treatment cycles of 21 days or 28 days. You may receive one dose of Epirubicin Hydrochloride Injection every three or four weeks (on Day 1 of the cycle). Or, you may receive Epirubicin Hydrochloride Injection in two doses - one dose on Day 1 of the cycle, and another dose on Day 8.

Your treatment cycle will depend on your medical condition and the other chemotherapy medicines you are getting.

Will I be able to work?

Some people work full time, while others work part time or wait until their chemotherapy treatments are finished. It depends on the type of job you have and the side effects you experience.

Is it okay to become pregnant or nurse a baby?

No. Epirubicin Hydrochloride Injection can be harmful to an unborn child. If there is any possibility that you may become pregnant, ask your doctor about using birth control to prevent pregnancy during your treatment with Epirubicin Hydrochloride Injection. Tell your doctor right away if you become pregnant during treatment. If you have been nursing, you should stop before starting treatment with Epirubicin Hydrochloride Injection. Ask your baby’s doctor to recommend a formula that would be best for your baby.

What should men consider when taking Epirubicin Hydrochloride Injection?

Men undergoing treatment with epirubicin should use effective contraceptive methods.

What happens after treatment?

After you have completed all your chemotherapy treatments, your doctor will check you regularly to make sure the cancer has not returned.

Overdose:

Missed Dose:

If you miss your scheduled treatment with the drug, contact your doctor as soon as possible to schedule your next treatment.

If you think you, or a person you are caring for, have taken too much Epirubicin Hydrochloride Injection, contact a healthcare professional, hospital emergency department, or regional poison control centre immediately, even if there are no symptoms

IMPORTANT: PLEASE READ

SIDE EFFECTS AND WHAT TO DO ABOUT THEM

Like all medicines, Epirubicin Hydrochloride Injection may cause side effects. Everyone reacts differently to chemotherapy and not all people will experience every side effect.

Common side effects include:

hair loss, which is temporary and usually starts to grow back within 2 or 3 months after you have finished your treatments.
increased risk of infection, as a result of low white blood cell count. The signs of infection include fever over 38°C (100°F), chills or sweating, sore throat or coughing, redness or swelling around a cut, wound or a catheter site, a burning feeling when you urinate, unusual vaginal itching or discharge.
nausea and vomiting.
fatigue, or feeling tired.
mouth sores.
Epirubicin Hydrochloride Injection is a red-orange coloured liquid and will make your urine turn red for a few days after treatment.

The kinds of side effects, how often they occur, and how bad they may be could be related to the dose of chemotherapy, or the regimen used.

Rare side effects include:

Damage to the heart muscle, which can cause symptoms such as shortness of breath, swelling in the ankles, and fluid retention. If you have these symptoms, call your doctor right away. There are medicines to treat this condition.
Secondary leukemia (less than 1% of patients) up to 5 years after treatment with Epirubicin Hydrochloride Injection.

The chances of developing heart damage or leukemia appear to be related to either how much chemotherapy you have received, or the dose of Epirubicin Hydrochloride Injection used. Be sure you discuss the risks and benefits of various chemotherapy options with your doctor, and understand the side-effects both immediate and long-term that you could have from your treatment before you start therapy.

SERIOUS SIDE EFFECTS AND WHAT TO DO ABOUT THEM

Symptom / effect

Talk to your healthcare professional

Only if severe

In all cases

Low white blood cell count and symptoms such as increased infection, fever > 38°C, chills or sweating, sore throat, mouth sores, burning feeling when urinating, unusual vaginal itching or discharge
Anemia (reduced red blood cell) and symptoms such as feeling weak, dizzy, shortness of breath
Injection site reactions such as pain, sores, burning
Increased bleeding with symptoms such as dark urine or dark/bloody stool, unexplained bruising
Cardiovascular problems with symptoms such as irregular heartbeat, chest pain, swelling of the ankle, shortness of breath / cardiac problems
Bowel inflammation (colitis) or, digestive tract bleeding and symptoms such as bloody stools, bloody vomit

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This is not a complete list of side effects. For any unexpected effects while taking Epirubicin Hydrochloride Injection, contact your doctor or pharmacist.

REPORTING SIDE EFFECTS

You can report any suspected side effects associated with the use of health products to Health Canada by:

Visiting the Web page on Adverse Reaction Reporting (https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/adverse-reaction-reporting.html) for information on how to report online, by mail or by fax; or
Calling toll-free at 1-866-234-2345.

NOTE: Contact your health professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.