Adults

Dosage varies significantly based on cancer type, treatment regimen, and patient factors (e.g., body surface area, hepatic function). Typical IV doses range from 60-120 mg/m² administered every 3-4 weeks. Intravesical doses for bladder cancer are typically 50 mg in 25-50 mL saline.

Elderly

Dose adjustments may be required, particularly in elderly patients with pre-existing impaired cardiac or hepatic function. Close monitoring is recommended.

Renal_impairment

No major dose adjustments are generally required for mild to moderate renal impairment, but caution is advised in severe cases. Hepatic impairment is a more critical factor for dose reduction.

Onset

Rapid.

Excretion

Primarily via bile and feces (60-80%); a smaller amount (10-15%) is excreted via urine.

Half life

Biphasic or triphasic elimination with a terminal half-life typically ranging from 30 to 40 hours.

Absorption

Administered intravenously, thus immediate and complete bioavailability.

Metabolism

Extensively metabolized in the liver and other tissues (e.g., erythrocytes) to its main active metabolite, epirubicinol, and various glucuronide conjugates.

Cimetidine

Increases epirubicin plasma levels by reducing hepatic metabolism.

Paclitaxel

Concurrent administration may increase epirubicin concentrations and enhance myelotoxicity.

Dexrazoxane

Used to reduce epirubicin-induced cardiotoxicity, but may alter epirubicin pharmacokinetics.

Live vaccines

Avoid live vaccines due to immunosuppression caused by epirubicin.

Phenobarbital

May increase epirubicin clearance.

Other myelosuppressive agents

Concomitant use with other bone marrow suppressants or radiation therapy may lead to increased hematologic toxicity.