Epirubicin (Pharmorubicin)

Epirubicin is a type of chemotherapy. It is also known as Pharmorubicin. 

You pronounce epirubicin as eh-pee-roo-bih-sin.

It is a treatment for a number of different cancer types. 

How does epirubicin work?

Epirubicin belongs to a group of chemotherapy drugs called anthracyclines. They damage the DNA (genetic code) in cancer cells. This stops the cancer cells from dividing or growing.

How do you have epirubicin?

For most types of cancer you have epirubicin into your bloodstream (intravenously). For bladder cancer, you might have it given directly into the bladder. Epirubicin is a red liquid.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

Into your bladder

You can have epirubicin directly into your bladder (intravesical chemotherapy). It’s used to treat some types of early bladder cancer.

Your doctor or specialist nurse puts the epirubicin through a flexible tube called a catheter, which goes into your bladder. They then remove the catheter. Avoid passing urine for the next 1 to 2 hours. This gives the chemotherapy time to be in contact with the lining of your bladder.

How often do you have epirubicin?

You have epirubicin as cycles of treatment. This means that you have the drug then a break to allow your body to recover.

When you have epirubicin depends on your cancer type. You might have it weekly or every 3 weeks. It is sometimes given in combination with other cancer drugs.

It can take up to 30 minutes if you have it on its own but it might take longer if you have it with other drugs.

For bladder cancer, you might have epirubicin every week, for up to 8 weeks.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You might also have tests to check how well your heart is working. Epirubicin can weaken the heart. This isn’t very common, but doctors need to know how well your heart is working before you start.

What are the side effects of epirubicin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Breathlessness and looking pale 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Red or pink urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Eye problems

You might have eye problems, including watery eyes and redness (conjunctivitis).

Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Periods stopping

Women might stop having periods (amenorrhoea) but this may be temporary.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Hot flushes

We have some tips for coping with hot flushes in women and hot flushes in men. This information also includes some of the possible treatments. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe some medicines to help.

Inflammation around the drip or injection site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Skin changes

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after taking this drug.

Inflammation of the bladder

Inflammation of the bladder causes a burning feeling when passing urine and the need to pass urine often. This can happen if you have epirubicin into the bladder. Tell your doctor or nurse if you have this and try to drink plenty of fluids.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• changes in the way your heart works - you may have changes to your heart beat, feel dizzy, have shortness of breath or chest pain, contact your advice line if you have this
• indigestion or heartburn - your doctor or pharmacist can give you medicines to help these symptoms
• loss of appetite and weight loss - you might not feel like eating and may lose weight, eating several small meals and snacks throughout the day can be easier to manage
• redness (flushing) of the skin or changes to skin colour
• pain in your tummy (abdomen)
• nail changes - your nails may become brittle, dry, change colour or develop ridges
• chills
• dehydration
• bleeding

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• allergic reaction - some people can have a severe allergic reaction, with swelling of the face, lips, tongue and throat - this may cause difficulty breathing - tell your nurse straight away if you have difficulty breathing
• an increase in the level of uric acid in your blood this can cause gout - you have blood tests to check for this
• lung infection (pneumonia)
• a whole body infection (sepsis) which can be life threatening if not treated rapidly
• a second cancer - there is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you
• tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up
• a blood clot in the deep veins of your body (deep vein thrombosis, DVT) that could possibly travel to your lungs (pulmonary embolism)- this could be life threatening if not treated quickly

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Pregnancy and contraception 

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.