Consumer medicine information

Pharmorubicin RD

Epirubicin hydrochloride

BRAND INFORMATION

Brand name

Pharmorubicin

Active ingredient

Epirubicin hydrochloride

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Pharmorubicin RD.

What is in this leaflet

This leaflet answers some common questions about Pharmorubicin RD.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of using Pharmorubicin RD against the benefits it is expected to have for you.

If you have any concerns about this medicine, ask your doctor or pharmacist.

Keep this leaflet. You may need to read it again.

What Pharmorubicin RD is used for

Pharmorubicin RD is used in the treatment of various types of cancer. It may be used alone or with other medicines.

Ask your doctor if you have any questions about why Pharmorubicin RD has been prescribed for you. Your doctor may have prescribed it for another purpose.

Pharmorubicin RD is only available with a doctor's prescription. It is not addictive.

Before you are given Pharmorubicin RD

When you must not be given it

Do not use Pharmorubicin RD if you have ever had an allergic reaction to epirubicin (the active ingredient in Pharmorubicin RD), other medicines to treat cancer or any of the ingredients listed at the end of this leaflet. Symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body; rash, itching or hives on the skin.

Do not use the medicine for injection into a vein if you have:

  • a low number of red blood cells, white blood cells or platelets in your blood
  • sore, red mouth from previous treatment or radiation therapy
  • an infection
  • severe liver problems
  • heart problems or have ever had heart problems
  • already received the highest dose allowed for medicines such as mitozantrone, mitomycin C, doxorubicin or daunorubicin.

Do not use the medicine for injection into the bladder if you have:

  • cancer that has gone into the bladder wall
  • kidney or urinary tract infection
  • swollen or inflamed bladder
  • problems with a catheter (a tube in your bladder)
  • blood in the urine.

Do not use Pharmorubicin RD if you are pregnant. Pharmorubicin RD may harm the unborn child.

Do not use Pharmorubicin RD if you are breastfeeding. You should not breastfeed while taking Pharmorubicin RD.

Do not use this medicine after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering.

Before you are given it

You must tell your doctor if you:

  • have heart problems or have ever had heart problems
  • have liver problems
  • have kidney problems
  • have had radiation therapy previously or are having radiation therapy
  • have been treated previously with medicines to treat cancer
  • you are going to be vaccinated (have an injection to prevent a certain disease)
  • are planning to have children
    Pharmorubicin RD may decrease the fertility of men and women.

If you have not told your doctor about any of the above, tell your doctor before you start using Pharmorubicin RD.

Taking other medicines

Tell your doctor if you are taking any other medicines, including medicines that you buy without a prescription from a pharmacy, supermarket or health food shop.

Some medicines and Pharmorubicin RD may interfere with each other. These include:

  • medicines used to treatment cancer such as:
    - 5-fluorouracil
    - cyclophosphamide
    - cisplatin
    - paclitaxel
    - docetaxel
    - trastuzumab
    - other medicines to treat cancer.
  • medicines used to treat angina or high blood pressure such as:
    - nifedipine
    - verapamil
    - diltiazem
    - felodipine
    - amlodipine
    - lercanidipine
    - propranolol.
  • cimetidine ( a medicine used to treat heartburn or stomach ulcers).

You may need to take different amounts of your medicines or you may need to use different medicines. Your doctor will advise you.

How Pharmorubicin RD is given

Treatment will normally take place in a hospital. Pharmorubicin RD is usually given as a slow injection or a drip (infusion) into a vein. It might also be injected into the bladder.

Do not drink fluids for 12 hours before treatment if Pharmorubicin RD is to be used in the bladder.

Pharmorubicin RD may be given alone or in combination with other medicines.

Your doctor will decide the dose of Pharmorubicin RD to be given. Treatment is usually given every 3 to 4 weeks, in cycles of therapy. However, your doctor may give Pharmorubicin RD more or less frequently.

Treatment will not be repeated until your blood counts have returned to acceptable levels and any unwanted effects have been controlled.

Your doctor may change your dose during treatment.

Your doctor will let you know how many cycles of treatment you will need.

Ask your doctor if you have any questions about the dose of Pharmorubicin RD and how it is given.

If you are given too much (overdose)

As Pharmorubicin RD is likely to be given to you in hospital under the supervision of a doctor, it is unlikely that you will receive too much.

However, immediately tell your doctor or telephone the Poisons Information Centre on 13 11 26 for advice, or go to Accident and Emergency at your nearest hospital if you have side effects after being given Pharmorubicin RD. You may need urgent medical attention.

Symptoms of overdose with Pharmorubicin RD include the side effects below in the 'Side Effects' section, but they are usually of a more severe nature.

While you are using Pharmorubicin RD

Things you must do

Tell your doctor or nurse immediately if the injection stings or hurts while it is being given. The injection may need to be stopped and injected into a different vein.

Make sure you follow your doctor's instructions and keep all appointments. Your doctor will regularly check the function of your heart, liver and kidneys. You will also need to have blood tests.

Use contraception (birth control) to prevent pregnancy while you or your partner are being treated with Pharmorubicin RD. Pharmorubicin RD may cause birth defects if either the male or female is being treated with Pharmorubicin RD. Men being treated with Pharmorubicin RD must use effective contraceptive methods during treatment and for at least 3.5 months after treatment. Women being treated with Pharmorubicin RD must use effective contraceptive methods during treatment with Pharmorubicin RD and at least 6.5 months after treatment.

Tell your doctor immediately if you become pregnant while taking Pharmorubicin RD.

Tell your doctor if you have an infection or fever. Pharmorubicin RD lowers your ability to fight infection.

Tell your doctor if you would like to take medicine to prevent or treat nausea (feeling sick) or vomiting. Pharmorubicin RD may cause nausea and vomiting,

Tell any doctor, dentist or pharmacist who treats you that you are being treated with Pharmorubicin RD.

If you are about to be started on any new medicine, tell your doctor and pharmacist that you are being treated with Pharmorubicin RD.

Things to be careful of

Be careful driving, operating machinery or doing jobs that require you to be alert, until you know how Pharmorubicin RD affects you.

PHARMORUBICIN RD may make some people feel tired or dizzy.

Side effects

Tell your doctor as soon as possible if you do not feel well while you are being treated with Pharmorubicin RD. All medicines can have unwanted side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects. Medicines can affect people in different ways.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

  • nausea (feeling sick) or vomiting
  • diarrhoea
  • sore mouth or tongue, mouth ulcers, redness of mouth, sore vagina or rectum
  • redness of the skin or vein at the site of the injection
  • hair loss, beard stops growing
  • dehydration (thirsty, dry mouth, dry skin, loss of body fluid)
  • sore oesophagus (food pipe), pain on swallowing or difficulty with swallowing
  • stomach pain or burning feeling in stomach
  • skin rash, itchy skin, hives, sensitive skin, blisters
  • change in colour of skin or nails
  • increased sensitivity to the sun
  • itchy eye, crusty eyelid, sore red eye, blurred vision, conjunctivitis
  • loss of appetite
  • absence of menstrual bleeding (temporary loss of periods)
  • hot flushes
  • weakness, tiredness, dizziness, confusion, depression
  • tingling or numbness of hands or feet; pins and needles
  • gout
  • red coloured urine.
    Pharmorubicin RD is red and may cause the urine to be a red colour for one or two days after treatment. There is no cause for alarm.

Tell your doctor immediately if you get any of the following side effects:

  • stinging, swelling or pain at the site of injection
  • flushing of face while the injection is being given
  • an infection or chills, fever, sore throat, swollen glands, shock
  • heart problems, fast or irregular heartbeat, shortness of breath
  • swelling of ankles, feet, legs or hands
  • bleeding or bruising under the skin
  • cough, difficulty breathing, chest pain, coughing up blood
  • swelling, pain, tenderness and redness of the leg.

The above side effects may be serious. You may need urgent medical attention.

Tell your doctor if you notice anything else that is making you feel unwell. Other side effects not listed above, such as leukaemia, may also occur in some patients.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

After using Pharmorubicin RD

Tell your doctor immediately if you notice any of the following side effects, even if they occur several months or years after stopping treatment with Pharmorubicin RD:

  • heart problems, fast or irregular heartbeat, shortness of breath
  • swelling of ankles, feet, legs or hands, swelling in the stomach
  • fever or other signs of infection.

Leukaemia may occur after treatment with Pharmorubicin RD and other medicines to treat cancer. It is rare.

Storage

This medicine will be stored in the hospital pharmacy and will be looked after by your doctor or pharmacist.

Pharmorubicin RD should be stored below 25°C.

Product description

What it looks like

Pharmorubicin RD is a powder that is dissolved in a solution before injection.

Ingredients

The active ingredient in Pharmorubicin RD is epirubicin hydrochloride. It also contains lactose and methyl hydroxybenzoate.

Supplier

Pharmorubicin RD is supplied by:

Pfizer Australia Pty Ltd
Sydney, NSW.
Toll Free Number 1800-675 229.
www.pfizer.com.au .

Australian Registration Numbers

Pharmorubicin RD:
50 mg: AUST R 40220.

Date of preparation

This leaflet was revised in May 2021.

© Pfizer Australia Pty Ltd.

® Registered trademark.

Published by MIMS June 2021

BRAND INFORMATION

Brand name

Pharmorubicin

Active ingredient

Epirubicin hydrochloride

Schedule

S4

 

1 Name of Medicine

Epirubicin hydrochloride.

2 Qualitative and Quantitative Composition

Pharmorubicin RD Powder for Injection is supplied in vials containing 50 mg of epirubicin hydrochloride as a red lyophilised powder for reconstitution before use.
Pharmorubicin Injection is supplied in vials containing 50 mg and 200 mg of epirubicin hydrochloride (strength 2 mg/mL) as a ready-to-use solution.
Pharmorubicin is a red orange, almost odourless, hygroscopic powder, sparingly soluble in water and dilute alcohol.
Excipient(s) with known effect. Methyl hydroxybenzoate.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Powder for injection, Solution for injection.
Pharmorubicin (epirubicin hydrochloride) is supplied in two presentations: as a lyophilised powder with a rapid dissolution formulation (Pharmorubicin RD Powder for Injection) and as a ready-to-use solution (Pharmorubicin Injection).

4 Clinical Particulars

4.9 Overdose

A 36 year old man with non-Hodgkin's lymphoma received a daily 95 mg/m2 dose of epirubicin injection for five consecutive days. Five days later, he developed bone marrow aplasia, grade 4 mucositis and gastrointestinal bleeding. No signs of acute cardiac toxicity were observed. He was treated with antibiotics, colony stimulating factors and antifungal agents and recovered completely. A 63 year old woman with breast cancer and liver metastasis received a single 320 mg/m2 dose of epirubicin, which resulted in hyperthermia, multiple organ failure (respiratory and renal), lactic acidosis, increased lactate dehydrogenase and anuria, and death within 24 hours of administration.
Additional instances of administration of doses higher than recommended have been reported at doses ranging from 150 to 250 mg/m2. The observed adverse events in these patients were qualitatively similar to known toxicities of epirubicin. Most of the patients recovered with appropriate supportive care.
Very high single doses of Pharmorubicin may be expected to cause acute myocardial degeneration within 24 hours and severe myelosuppression (mainly leucopenia and thrombocytopenia) within 10 to 14 days and also gastrointestinal toxic effects (mainly mucositis).
If an overdose occurs, supportive treatment (including antibiotic therapy, blood and platelet transfusions, colony stimulating factors and intensive care as needed) should be provided until the recovery of toxicities. Delayed cardiac failure may occur up to six months after the overdose. Patients should be observed carefully and should, if signs of cardiac failure arise, be treated along conventional lines.
Epirubicin cannot be removed by dialysis.
For information on the management of overdose, contact the Poisons Information Centre on 131 126 (Australia).

5 Pharmacological Properties

5.3 Preclinical Safety Data

Genotoxicity and carcinogenicity. Like most other antitumour and immunosuppressant agents, Pharmorubicin, under experimental conditions, has mutagenic properties and is carcinogenic in laboratory animals (see Section 4.6 Fertility, Pregnancy and Lactation, Use in pregnancy).

6 Pharmaceutical Particulars

6.7 Physicochemical Properties

Structurally, Pharmorubicin differs from Adriamycin (doxorubicin hydrochloride) only in the orientation of the hydroxyl group at the 4 position on the aminoglycoside ring.
The chemical name of epirubicin hydrochloride is (8S, 10S)-10-(3-amino-2,3,6-trideoxy-α-L-arabino-hexopyranosyloxy)-8-glycolloyl-7,8,9,10-tetrahydro-6,8,11-trihydroxy-1-methoxynaphthacene-5,12-dione hydrochloride.
Chemical structure.
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSEPIHYD.gif CAS number. 56390-09-1.

7 Medicine Schedule (Poisons Standard)

S4.

Summary Table of Changes

https://stagingapi.mims.com/au/public/v2/images/fulltablegif/PHRMRBST.gif