Caelyx 20 mg/ 10 ml concentrate for solution for infusion vials|
1 vialP£ 360. 23
Powder for solution for injection
▶Doxorubin(medac UK)
Doxorubicin hydrochloride 50 mgDoxorubin 50 mg powder for
solution for injection vials| 10 vialP£ 914. 00
Powder and solvent for suspension for infusion
ELECTROLYTES:May contain Sodium
▶Myocet(Teva UK Ltd)
Doxorubicin hydrochloride 50 mgMyocet 50 mg powder and
solvent for suspension for infusion vials| 2 vialP£ 912. 26
(Hospital only)Epirubicin hydrochloride
lINDICATIONS AND DOSE
Recurrent acute lymphoblastic leukaemia|
Rhabdomyosarcoma|Other soft-tissue tumours of
childhood
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSMyocardiopathy.previous
treatment with maximum cumulative doses of epirubicin
or other anthracycline.recent myocardial infarction.
severe arrhythmia.severe myocardial insufficiency.
unstable angina
CONTRA-INDICATIONS, FURTHER INFORMATION
Anthracycline antibiotics should not normally be used in
children with left ventricular dysfunction.
lCAUTIONSCaution in handling—irritant to tissues
lINTERACTIONS→Appendix 1 : anthracyclines
lSIDE-EFFECTS
▶Common or very commonAlopecia.anaemia.appetite
decreased.bone marrow depression.dehydration.
diarrhoea.increased risk of infection.leucopenia.
mucositis.nausea.neutropenia.oesophagitis.
paraesthesia.stomatitis.urinary frequency increased.
urine red.vasodilation.vomiting
▶UncommonEmbolism and thrombosis.thrombocytopenia
▶Rare or very rareAmenorrhoea.arrhythmias.ascites.
asthenia.azoospermia.cardiac conduction disorders.
cardiomyopathy.cardiotoxicity.chills.congestive heart
failure.dizziness.dyspnoea.fever.hepatomegaly.
hyperuricaemia.malaise.neoplasms.oedema.pleural
effusion.pulmonary oedema.skin reactions
▶Frequency not knownEye inflammation.haemorrhage.
hypoxia.nail discolouration.photosensitivity reaction.
radiation injuries.sepsis.shock
SIDE-EFFECTS, FURTHER INFORMATION
CardiotoxicityAll anthracycline antibiotics have been
associated with varying degrees of cardiac toxicity—this
may be idiosyncratic and reversible, but is commonly
related to total cumulative dose and is irreversible.
Cumulative doses of other anthracyclineEpirubicin is
considered less toxic than other anthracyline antibiotics,
and may be suitable for children who have received high
cumulative doses of other anthracyclines.
lCONCEPTION AND CONTRACEPTIONContraceptive advice
required, seePregnancy and reproductive functionin
Cytotoxic drugs p. 531.
lPREGNANCYAvoid (carcinogenic inanimalstudies). See
alsoPregnancy and reproductive functionin Cytotoxic drugs
p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lHEPATIC IMPAIRMENTAvoid in severe impairment.
Dose adjustmentsReduce dose according to bilirubin
concentration—consult local treatment protocol for
details.lRENAL IMPAIRMENT
Dose adjustmentsDose reduction may be necessary in
severe impairment.
lMONITORING REQUIREMENTS
▶Cardiac toxicityCardiac function should be monitored
before and at regular intervals throughout treatment and
afterwards.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection, solution for
infusion
Solution for injection
▶Epirubicin hydrochloride (Non-proprietary)
Epirubicin hydrochloride 2 mg per 1 mlEpirubicin 50 mg/ 25 ml
solution for injection vials| 1 vialP£ 86. 89 – £ 100. 88
Epirubicin 10 mg/ 5 ml solution for injection vials| 1 vialP£ 17. 38 –
£ 20. 18
▶Pharmorubicin(Pfizer Ltd)
Epirubicin hydrochloride 2 mg per 1 mlPharmorubicin 50 mg/ 25 ml
solution for injection Cytosafe vials| 1 vialP£ 106. 19 (Hospital
only)
Pharmorubicin 10 mg/ 5 ml solution for injection Cytosafe vials|
1 vialP£ 21. 24 (Hospital only)
Solution for infusion
▶Epirubicin hydrochloride (Non-proprietary)
Epirubicin hydrochloride 2 mg per 1 mlEpirubicin 200 mg/ 100 ml
solution for infusion vials| 1 vialP£ 306. 20 – £ 366. 85
Epirubicin 100 mg/ 50 ml solution for infusion vials| 1 vialP
£ 201. 76
▶Pharmorubicin(Pfizer Ltd)
Epirubicin hydrochloride 2 mg per 1 mlPharmorubicin
200 mg/ 100 ml solution for infusion Cytosafe vials| 1 vialP
£ 386. 16 (Hospital only)Mitoxantrone
(Mitozantrone)
lINDICATIONS AND DOSE
Acute myeloid leukaemia|Recurrent acute lymphoblastic
leukaemia
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONS
CONTRA-INDICATIONS, FURTHER INFORMATION
Anthracycline antibiotics should not normally be used in
children with left ventricular dysfunction.
lINTERACTIONS→Appendix 1 : anthracyclines
lSIDE-EFFECTSAbdominal pain.acute leukaemia.alopecia
.amenorrhoea.anxiety.appetite decreased.arrhythmia.
asthenia.bone marrow depression.confusion.
constipation.diarrhoea.drowsiness.dyspnoea.fever.
gastrointestinal haemorrhage.heart failure.mucositis.
nail discolouration.nail dystrophy.nausea.neurological
effects.paraesthesia.scleral discolouration.skin
discolouration.stomatitis.thrombocytopenia.urine blue
.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONAll anthracycline
antibiotics have been associated with varying degrees of
cardiac toxicity—this may be idiosyncratic and reversible,
but is commonly related to total cumulative dose and is
irreversible.
lCONCEPTION AND CONTRACEPTIONManufacturer advises
effective contraception during and for at least 6 months
after treatment in men or women.
lPREGNANCYAvoid. See alsoPregnancy and reproductive
functionin Cytotoxic drugs p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.540 Cytotoxic responsive malignancy BNFC 2018 – 2019
Immune system and malignant disease8