Last update March 24, 2019

Epirubucin

Very High Risk

Very unsafe. Contraindicated. Use of an alternative or cessation of breastfeeding. Read the Comment.

Epirubicin is an antineoplastic from the anthracycline family, with actions similar to doxorubicin but with fewer toxic effects.

Since the last update we have not found published data on its excretion in breast milk.

Although it has a high volume of distribution, the remaining pharmacokinetic data (not very high molecular weight and protein binding, high pKa and long half-life) make it probable that it will pass into breast milk in quantities that could be significant, as has been seen in another drug from the same therapeutic group, Doxorubicin.

Given its serious side effects (cardiotoxicity and myelotoxicity) (Tjuljandin 1990) it is prudent to discontinue breastfeeding during the period in which the drug is still in the mother's body.

When possible, detection in the milk of each patient to determine the total elimination of the drug would be the best indicator for resuming breastfeeding between two rounds of chemotherapy.

It is known via Pharmacokinetics that after 3 elimination half-lives (T½) 87.5% of the drug is eliminated from the body; after 4 T½ 94%, after 5 T½ 96.9%, after 6 T½ 98.4% and after 7 T½ 99%. Plasma drug concentrations in the body are negligible after 7 T½. In general, a period of at least five half-lives may be considered a safe waiting period to return to breastfeeding (Anderson 2016).

Expert authors recommend waiting 7 to 10 days (between 5 and 7 T½) after the last dose to restart breastfeeding. Meanwhile, express and discard breast milk regularly (Hale 2017 p.330).

There may be an increase in the mean half-life in patients with impaired hepatic function (Twelves 1992) or in co-administration with other medication such as paclitaxel (Danesi 2002), docetaxel or dexverapamil (AEMPS 2017, BC Cancer 2017). In these cases, the safety time of interruption of breastfeeding would be increased.

Some chemotherapeutics with antibiotic effects may alter the composition of the microbiota (combination of bacteria or bacterial flora) of the milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs briefly with later recovery, with no harmful effects being reported in breastfed infants.

Given the strong evidence that exists on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother that wishes to continue with breastfeeding (Koren 2013).


See below the information of this related product:

  • Doxorubicin ( Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.)

Alternatives

We do not have alternatives for Epirubucin.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Epirubucin is also known as


Epirubucin in other languages or writings:

Group

Epirubucin belongs to this group or family:

Pharmacokinetics

Variable Value Unit
Molecular weight 580 daltons
Protein Binding 77 %
VD 21 - 27 l/Kg
pKa 9.53 -
Tmax 0.1 - 0.9 hours
33 (30 - 40) hours

References

  1. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  2. AEMPS. Epirubicina. Ficha técnica. 2017 Full text (in our servers)
  3. BC Cancer. Epirubicin. Drug Summary. 2017 Full text (in our servers)
  4. Anderson PO. Cancer Chemotherapy. Breastfeed Med. 2016 May;11:164-5. Abstract Full text (link to original source) Full text (in our servers)
  5. Urbaniak C, McMillan A, Angelini M, Gloor GB, Sumarah M, Burton JP, Reid G. Effect of chemotherapy on the microbiota and metabolome of human milk, a case report. Microbiome. 2014 Jul 11;2:24. Abstract Full text (link to original source) Full text (in our servers)
  6. Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V; Society of Obstetricians and Gynaecologists of Canada. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013 Mar;35(3):263-278. Abstract Full text (link to original source) Full text (in our servers)
  7. Gentilini O, Masullo M, Rotmensz N, Peccatori F, Mazzarol G, Smeets A, Simsek S, De Dosso S, Veronesi P, Intra M, Zurrida S, Viale G, Goldhirsch A, Veronesi U. Breast cancer diagnosed during pregnancy and lactation: biological features and treatment options. Eur J Surg Oncol. 2005 Abstract
  8. Danesi R, Innocenti F, Fogli S, Gennari A, Baldini E, Di Paolo A, Salvadori B, Bocci G, Conte PF, Del Tacca M. Pharmacokinetics and pharmacodynamics of combination chemotherapy with paclitaxel and epirubicin in breast cancer patients. Br J Clin Pharmacol. 2002 Abstract Full text (link to original source) Full text (in our servers)
  9. Saunders C, Ives A, Puckridge P, Semmens J. Delays in diagnosing breast cancer--the impact of concurrent pregnancy and lactation. Aust N Z J Obstet Gynaecol. 2002 Abstract
  10. Brunetti L, Orlando G, Michelotto B, Recinella L, Ragazzoni E, Vacca M. A possible prolactin-related adverse effect of certain antineoplastic anthracyclines. Toxicol Lett. 2000 Abstract
  11. Robert J. Clinical pharmacokinetics of epirubicin. Clin Pharmacokinet. 1994 Abstract
  12. Twelves CJ, Dobbs NA, Michael Y, Summers LA, Gregory W, Harper PG, Rubens RD, Richards MA. Clinical pharmacokinetics of epirubicin: the importance of liver biochemistry tests. Br J Cancer. 1992 Abstract Full text (link to original source) Full text (in our servers)
  13. Tjuljandin SA, Doig RG, Sobol MM, Watson DM, Sheridan WP, Morstyn G, Mihaly G, Green MD. Pharmacokinetics and toxicity of two schedules of high dose epirubicin. Cancer Res. 1990 Abstract Full text (link to original source) Full text (in our servers)

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