No specific drug–drug interactions were provided in the reference document. However, as epirubicin is metabolized extensively in the liver and eliminated via biliary excretion, caution should be taken with drugs affecting hepatic metabolism or excretion.

The recommended starting dose is 100 to 120 mg/m². Reduce the dose in patients with hepatic impairment. Consider lower doses in patients with severe renal impairment.

Patients should not be treated with epirubicin injection if they have any of the following conditions: baseline neutrophil count <1500 cells/mm³; severe myocardial insufficiency, recent myocardial infarction, severe arrhythmias; previous treatment with anthracyclines up to the maximum cumulative dose; hypersensitivity to epirubicin, other anthracyclines, or anthracenediones; or severe hepatic dysfunction.

General side effects include neutropenia, anemia, fatigue, and nausea. Rare side effects include decreased left ventricular ejection fraction (LVEF) and congestive heart failure (CHF).

Pregnancy Category D. Epirubicin may cause fetal harm when administered to a pregnant woman. Nursing should be discontinued prior to taking epirubicin.

Cardiotoxicity is a known risk of anthracycline treatment and may be manifested by early (acute) or late (delayed) events. Serum total bilirubin and AST levels should be evaluated before and during treatment. Serum creatinine should be assessed before and during therapy. Care should be taken in monitoring toxicity when epirubicin is administered to female patients ≥70 years of age.

Experience with epirubicin overdose is limited. Possible complications may include severe myelosuppression, gastrointestinal toxicity, and acute cardiac complications. Symptomatic treatment and supportive measures should be initiated.

Store refrigerated between 2ºC and 8ºC. Do not freeze. Protect from light.