Do not administer epirubicin in combination with other cardiotoxic agents unless the patient’s cardiac function is closely monitored. Patients receiving epirubicin after stopping treatment with other cardiotoxic agents, especially those with long half-lives such as trastuzumab, may also be at an increased risk of developing cardiotoxicity. Avoid epirubicin-based therapy for up to 24 weeks after stopping trastuzumab when possible. If epirubicin is used before this time, monitor cardiac function carefully [see Dosage and Administration (
) and Warnings and Precautions (
Concomitant use of epirubicin hydrochloride injection with other cardioactive compounds that could cause heart failure (e.g., calcium channel blockers), requires close monitoring of cardiac function throughout treatment.
Cimetidine increases the exposure to epirubicin [see Clinical Pharmacology (
12.3 )]. Stop Cimetidine during treatment with epirubicin hydrochloride injection.
Other Cytotoxic Drugs
Epirubicin hydrochloride injection used in combination with other cytotoxic drugs may show on-treatment additive toxicity, especially hematologic and gastrointestinal effects.
The administration of epirubicin immediately prior to or after paclitaxel increased the systemic exposure of epirubicin, epirubicinol and 7-deoxydoxorubicin aglycone [see Clinical Pharmacology (
The administration of epirubicin immediately prior to or after docetaxel did not have an effect on the systemic exposure of epirubicin, but increased the systemic exposure of epirubicinol and 7-deoxydoxorubicin aglycone [see Clinical Pharmacology (
There are few data regarding the coadministration of radiation therapy and epirubicin hydrochloride injection. In adjuvant trials of epirubicin hydrochloride injection-containing CEF-120 or FEC-100 chemotherapies, breast irradiation was delayed until after chemotherapy was completed. This practice resulted in no apparent increase in local breast cancer recurrence relative to published accounts in the literature. A small number of patients received epirubicin hydrochloride injection-based chemotherapy concomitantly with radiation therapy but had chemotherapy interrupted in order to avoid potential overlapping toxicities. It is likely that use of epirubicin hydrochloride injection with radiotherapy may sensitize tissues to the cytotoxic actions of irradiation. Administration of epirubicin hydrochloride injection after previous radiation therapy may induce an inflammatory recall reaction at the site of the irradiation.
Concomitant Therapies-Hepatic Function
Epirubicin is extensively metabolized by the liver. Changes in hepatic function induced by concomitant therapies may affect epirubicin metabolism, pharmacokinetics, therapeutic efficacy, and/or toxicity.
Drug/Laboratory Test Interactions
There are no known interactions between epirubicin hydrochloride injection and laboratory tests.