Monograph
L01DB03 - Epirubicin |
Propably not porphyrinogenic |
PNP |
Rationale
Possible CYP substrate. No observations of interference with CYP-metabolism of other drugs. Not listed as CYP-inducer or inhibitor. Side effects such as nausea, anorexia and vomiting may be potentially porphyrinogenic through reduction in caloric intake.
Chemical description
Epirubicin is the 4-epimer of doxorubicin, and is an anthracycline glycoside antineoplastic antibiotic.
Therapeutic characteristics
Epirubicin is used, alone or in combination with other antineoplastics, in the treatment of acute leukaemias, lymphomas, multiple myeloma, and in solid tumours including Wilms tumour, cancer of the bladder, breast, and stomach. Usually administered as an intravenous injection or infusion, but may also be given as an intravescical installation. Common adverse reactions of epirubicin that can be confused with an acute porphyric attack are nausea and vomiting. Side effects such as nausea and vomiting may be potentially porphyrinogenic through reduction in caloric intake.
Metabolism and pharmacokinetics
Epirubicin is extensively and rapidly metabolized in the liver. Baumhakel (2001) found no inhibitory effect on CYP 3A4, and states that
Published experience
Used uneventfully in the treatment of breast cancer in a 42 year old AIP woman (Kristiansen, 2006).
IPNet drug reports
Uneventful use reported in 1 patient with acute porphyria.
References
| # | Citation details | PMID |
|---|---|---|
| * | Scientific articles | |
| 1. | Rendic, S. Summery of information on human CYP enzymes: human P450 metabolism. Drug metabolism reviews 2002; 34(1&2), 83-448.
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| 2. | Screening for inhibitory effects of antineoplastic agents on CYP3A4 in human liver microsomes.
Baumhäkel M, Kasel D, et al. Int J Clin Pharmacol Ther. 2001;39(12):517-28. |
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| 3. | Treatment and treatment considerations in a patient with advanced breast cancer and acute intermittent porphyria.
Kristiansen C, Langkjer ST. Acta Oncol. 2006;45(3):337-9. |
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| * | Drug reference publications | |
| 4. | McEvoy GK, editor. Epirubicin. The AHFS Drug Information 2008. Bethesda, MD: American Society of Health-System Pharmacists; 2009. Electronic version (06.05.10).
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| 5. | Sweetman SC, editor. Martindale: The complete drug reference. Epirubicin. Pharmaceutical Press 2009.
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