drug-infosheet

EPIrubicin

Cancer Type

Gastrointestinal, Gastric Stomach, Esophagus, Breast, Sarcoma, Soft Tissue, Hematologic, Lymphoma - Non-Hodgkin's Intermediate Grade, Lymphoma - Non-Hodgkin's High Grade, Unknown Primary, Genitourinary, Prostate, Neuroendocrine (GI), Lung, Neuroendocrine (Lung)

Other Names

Generic brand(s) available

Appearance

Red solution; may be mixed into larger bags of fluids

EPIrubicin

Pronunciation:

e-pee-ROO-bi-sin

Other Name(s):

Generic brand(s) available

Appearance:

Red solution; may be mixed into larger bags of fluids

This handout gives general information about this cancer medication.

You will learn:

who to contact for help
what the medication is
how it is given
what to expect while on medication

This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.

Who do I contact if I have questions or need help?

My cancer health care provider is: _____________________________________________

During the day I should contact: _______________________________________________

Evenings, weekends and holidays: _____________________________________________

This page gives general information about this cancer medication.

You will learn:

who to contact for help
what the medication is
how it is given
what to expect while on this medication

This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.

What is this treatment for?

For treating breast, lung, stomach, ovarian and other cancers, as well as blood cancers such as lymphomas.

What should I do before I start this treatment?

Tell your health care team if you have or had significant medical condition(s), such as:

heart, liver or kidney problems, or
any allergies.

Tell your health care team if you had prior chemotherapy and/or radiation treatment.

Remember To:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.

How is this treatment given?

This drug is given by injection into a vein.
Talk to your health care team about your treatment schedule.
If you missed your treatment appointment, talk to your health care team to find out what to do.

DO this while on treatment		DO NOT do this while on treatment
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures. DO tell your health care team if your urine (pee) stays red for more than 2 days. It is normal for your pee to be red for up to 2 days after your treatment.		DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs or substances, or natural health products without checking with your health care team. DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic products, without checking with your health care team. DO NOT use tobacco products (such as smoking cigarettes or vaping) or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

DO this while on treatment

DO NOT do this while on treatment

Check Mark Icon

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO tell your health care team if your urine (pee) stays red for more than 2 days. It is normal for your pee to be red for up to 2 days after your treatment.

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DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs or substances, or natural health products without checking with your health care team.

DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic products, without checking with your health care team.

DO NOT use tobacco products (such as smoking cigarettes or vaping) or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

DO this while on treatment

Check Mark Icon

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO tell your health care team if your urine (pee) stays red for more than 2 days. It is normal for your pee to be red for up to 2 days after your treatment.

DO NOT do this while on treatment

Stop Icon

DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs or substances, or natural health products without checking with your health care team.

DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic products, without checking with your health care team.

DO NOT use tobacco products (such as smoking cigarettes or vaping) or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

Will this treatment interact with other medications or natural health products?

Yes, this medication can interact with other medications, vitamins, foods, traditional medicines and natural health products. Interactions can make this medication not work as well or cause severe side effects.

Tell your health care team about all of your:

prescription and over-the-counter (non-prescription) medications
other drugs and substances, such as cannabis/marijuana (medical or recreational)
natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements, or traditional medicines

Check with your health care team before starting or stopping any of them.

Talk to your health care team BEFORE taking or using these :

Anti-inflammatory medications such as ibuprofen (Advil^® or Motrin^®), naproxen (Aleve^®) or Aspirin^®.
Over-the-counter products such as dimenhydrinate (Gravol^®)
Natural health products such as St. John’s Wort
Traditional medicines
Supplements such as vitamin C
Grapefruit juice
Alcoholic drinks
Tobacco
All other drugs or substances, such as marijuana or cannabis (medical or recreational)

What to do if you feel unwell, have pain, a headache or a fever

Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol^®) or ibuprofen (Advil^®)).
- Fever can be a sign of infection that may need treatment right away.
- If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

You have a fever if your temperature taken in your mouth (oral temperature) is:
- 38.3°C (100.9°F) or higher at any time
OR
- 38.0°C (100.4°F) or higher for at least one hour.

If you do have a fever:

Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
Ask your health care team for the Fever pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your health care team about the right medication for you. Acetaminophen (Tylenol^®) is a safe choice for most people.

Talk to your health care team before you start taking ibuprofen (Advil^®, Motrin^®), naproxen (Aleve^®) or ASA (Aspirin^®), as they may increase your chance of bleeding or interact with your cancer treatment.

Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

How will this treatment affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

How this treatment may affect your sexual health
Changes to your menstrual cycle (periods), if this applies to you
Symptoms of menopause such as hot flashes, vaginal dryness or changes in your mood, if this applies to you
How this treatment may affect your ability to have a baby, if this applies to you

This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until at least 6 months (general recommendation) after your last treatment dose. Talk to your health care team about which birth control options are best for you.

Do not breastfeed while on this treatment.

What are the side effects of this treatment?

The following table lists side effects that you may have when getting epirubicin. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Keep this paper during your treatment so that you can refer to it if you need to.

Side effects and what to do	When to contact health care team
Very Common Side Effects (50 or more out of 100 people)

Hair thinning or loss

(May be severe)

What to look for?

Your hair may begin to become thin or fall out during or after treatment.
In most cases, your hair will grow back after treatment, but the texture or colour may change.
In very rare cases, hair loss may be permanent.

What to do?

Use a gentle soft brush and avoid hair sprays, bleaches, dyes and perms.

Talk to your health care team if this bothers you.

Nausea and vomiting

What to look for?

Nausea is feeling like you need to throw up, you may also feel light-headed.
May feel nausea within hours to days after your treatment.

What to do?

To help prevent nausea:

It is easier to prevent nausea than to treat it once it happens.
Take your preventative anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
Drink clear liquids and have small meals. Get fresh air and rest.
Do not eat spicy, fried foods or foods with a strong smell.
Limit caffeine (like coffee, tea) and avoid alcohol.

If you have nausea or vomiting:

Take your rescue (as-needed) anti-nausea medication(s) as prescribed.
Ask your health care tam for the Nausea & Vomiting pamphlet for more information.
Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe.

Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or severe.

Low platelets in the blood

(May be severe)

When platelets are low you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information.

What to look for?

Watch for signs of bleeding:
- bleeding from your gums
- unusual or heavy nosebleeds
- bruising easily or more than normal
- black coloured stools (poo) or blood in your stools
- red or brown coloured mucus when you cough
- dizziness, constant headache or changes in your vision
- heavy vaginal bleeding
- red or pink coloured urine (pee), except for the 2 days after your EPIrubicin treatment

What to do?

If you have low platelets

Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
Check with your healthcare team before you go to the dentist.
Try to prevent cuts and bruises.
Ask your health care team what activities are safe for you.
Low platelets may delay your treatment. Your health care team may recommend blood transfusion.

If you have signs of bleeding

If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.
If you have bleeding that doesn’t stop or is severe, you must get emergency medical help right away.

Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency help right away.

Hot flashes, feeling or wave of warmth

You may sweat more or have trouble sleeping because of this.

To help prevent hot flashes :

Avoid triggers such as spicy food, alcohol and caffeine (tea, coffee, and soft drinks),
Exercise regularly. Ask your health care team what exercises are appropriate for you before you start any new exercise.
Quitting smoking may also help.

If you have hot flashes :

Keep cool; dress lightly or in layers that you can easily remove and drink plenty of liquids unless you have been told otherwise.

Hot flashes may improve over time. Talk to your health care team if this is bothersome for you.

Other symptoms of having low testosterone levels

Decreased sexual function or desire to have sex
Breast swelling or tenderness
Low energy
Mood changes, depression
Thinning of the bones and higher risk of fracture
High cholesterol and effects on your heart

Other symptoms of having low estrogen levels

Vaginal dryness (possibly with discharge or bleeding)
Memory loss
Mood changes, depression
Thinning of the bones and increased risk of fracture

Contact your health care team if these feelings bother you.

Talk to your health care team if it does not improve or if it is severe.

Mouth sores

What to look for?

Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
In more severe cases they may make it hard to swallow, eat or brush your teeth.
They may last for 3 days or longer.

What to do?

To help prevent mouth sores:

Take care of your mouth by gently brushing and flossing regularly.
Rinse your mouth often with a homemade mouthwash.
To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth.

If you have mouth sores:

Avoid hot, spicy, acidic, hard or crunchy foods.
Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection.
Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information.

Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Side effects and what to do	When to contact health care team
Common Side Effects (25 to 49 out of 100 people)

Fatigue

What to look for?

Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.

What to do?

Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
Check with your health care team before starting any new exercise.
Pace yourself, do not rush. Put off less important activities. Rest when you need to.
Ask family or friends to help you with things like housework, shopping, and child or pet care.
Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less).
Avoid driving or using machinery if you are feeling tired.

Ask your health care team for the Fatigue pamphlet for more information.

Talk to your health care team if it does not improve or if it is severe.

Diarrhea

What to look for?

Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.

What to do?

If you have diarrhea:

Take anti-diarrhea medication if your health care team prescribed it or told you to take it.
Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol, until your diarrhea has stopped.
Eat many small meals and snacks instead of 2 or 3 large meals.
Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less.
Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day.

Ask your health care team for the Diarrhea pamphlet for more information.

Talk to you health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day).

Side effects and what to do	When to contact health care team
Less Common Side Effects (10 to 24 out of 100 people)

Reactions at the injection site

What to look for?

Your skin may become red, itchy, bruised, and/or swollen where the injection was given.
Site reactions are usually mild and go away within one to three days.

What to do?

Tell your nurse right away if there is any burning, stinging or other pain while epirubicin is being injected into your vein.
You may need to apply hot compresses or ice/cold compresses if you have mild redness or discomfort. This depends on which medication caused the reaction in your treatment.
Talk to your health care team to find out which treatment is right for you.

Talk to your health care team as soon as possible.

Eye problems

What to look for?

Your eyes may feel dry, irritated, or painful.
They may look red and have a lot of tears.
They may feel sensitive to light and your vision may be blurry.

What to do?

Avoid wearing contact lenses.
Wear sunglasses with UV protection.
Use protective eyewear (goggles or helmet with face mask) when playing sports, mowing the lawn or doing anything that may get particles or fumes in your eyes.
You may try artificial tears (eye drops) or ointment.

Talk to your health care team as soon as possible.

Other rare, but serious side effects are possible with this treatment.

If you have any of the following, talk to your cancer health care team or get emergency medical help right away:

Second or new cancers (your doctor will discuss and monitor this with you)
Sudden loss of vision, speech, or the use of your arm(s) and/or leg(s)
Pain or swelling or hardening of a vein in your arm(s) or leg(s)
Increased cough, breathing problems, or coughing blood
Chest pain or shortness of breath, swelling in your legs, ankle or belly
Redness/rash in areas where you’ve previously received radiation
Stomach pain, vomit blood or what looks like coffee-grounds or pass poo with bright red blood. Your poo could also look black/tarry coloured.
Severe rash, itchiness, flushing, dizziness, chest or throat tightness (during or shortly after epirubicin is given)
Lower back pain, pee less than usual
Severe muscle spasms, cramping, weakness, or twitching, seizures, confusion

Notes

June 2026 Updated/revised information sheet

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

Last Updated: July 21, 2026

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