EPISUP SENIOR AUTO-INJECTOR

Indications

• Breast cancer
• Gastric cancer
• Lung cancer
• Ovarian cancer
• Soft tissue sarcomas
• Bladder cancer

Dosage

Children: Refer to the BNF for Children for pediatric dosing guidelines.

Adults: Refer to the BNF for specific dosing based on cancer type and treatment regimen.

Mechanism of action

Epirubicin intercalates into DNA, disrupting the structure and function of the DNA molecule. This action inhibits the enzyme topoisomerase II, which is crucial for DNA replication. By preventing the proper unwinding of DNA, epirubicin induces double-strand breaks and ultimately leads to cell death, particularly in rapidly dividing cancer cells.

Pharmacodynamics

The pharmacodynamics of epirubicin involve its ability to induce apoptosis in malignant cells. The drug's action is concentration-dependent, and its effectiveness can be influenced by the cell cycle phase, with the most significant effects occurring during the S and G2 phases. Epirubicin also has immunosuppressive properties, which can affect the response to cancer therapy and the patient’s overall immune status.

Pharmacokinetics

Epirubicin is administered intravenously and has a volume of distribution of approximately 50 L/m². It is metabolized primarily in the liver, undergoing extensive hepatic metabolism, with its active metabolites contributing to its overall antitumor activity. The elimination half-life is approximately 30 to 36 hours, and it is primarily excreted in urine as metabolites. Renal impairment may affect the clearance of the drug, necessitating dose adjustments in patients with compromised renal function.

Contra-indications

• Hypersensitivity to epirubicin or any of its components
• Severe myelosuppression
• Active infections
• Pregnancy
• Severe liver impairment

Adverse effects

• Nausea and vomiting
• Myelosuppression
• Cardiotoxicity
• Alopecia
• Mucositis
• Extravasation reactions
• Diarrhea
• Fatigue

Interactions

• CYP3A4 inhibitors and inducers may affect epirubicin metabolism
• Other cardiotoxic agents may increase the risk of cardiac side effects
• Live vaccines can pose a risk in patients receiving immunosuppressive chemotherapy

Precautions

• Monitor cardiac function due to potential cardiotoxicity
• Use caution in patients with pre-existing liver disease
• Regular blood counts are necessary to monitor for myelosuppression
• Avoid live vaccines during treatment

Pregnancy

Epirubicin is contraindicated in pregnancy due to potential teratogenic effects.

Breast-feeding

Breastfeeding is not recommended during treatment with epirubicin due to potential excretion in breast milk.

Storage

Store in a cool, dry place away from light. Protect from freezing.

Formulations

• Injection solution