Epirubicin
4'-Epi-doxorubicin
Also known as: Pharmorubicin · 4'-Epi-doxorubicin · Epirubicinum
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
This dose is based on body surface area (mg/m²). Convert body weight to body surface area before dosing.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Lymphoma, splenic haemangiosarcoma, histiocytic sarcoma, and other sarcomas/carcinomas | 30 mg/m2 (In dogs weighing <10 kg a dose of 1 mg/kg should be used) | IV | q3wk | Maximum total dose not to exceed 240 mg/m2 | 🌍 EU |
- Lymphoma, splenic haemangiosarcoma, histiocytic sarcoma, and other sarcomas/carcinomas: Administer over a minimum period of 10 minutes into the side port of a freely running IV infusion of 0.9% NaCl.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Feline injection site sarcoma | 25 mg/m2 or 1 mg/kg | IV | q3wk | — | 🌍 EU |
- Feline injection site sarcoma: Administer over a minimum period of 10 minutes into the side port of a freely running IV infusion of 0.9% NaCl.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Epirubicin is a semisynthetic stereoisomer of doxorubicin used in veterinary oncology. It is a cytotoxic anthracycline glycoside antibiotic that demonstrates efficacy against several neoplasms, including lymphoma, splenic haemangiosarcoma, and histiocytic sarcoma.
Clinical Warning: Epirubicin is a potent vesicant. Extravasation will cause severe tissue necrosis. It must be administered via a perfectly placed and taped indwelling IV catheter.
Mechanism of action
Epirubicin enters the cell where its intracellular metabolism results in the production of cytotoxic free radicals. It also binds irreversibly to DNA → prevents DNA replication and alters cell membrane functions, ultimately leading to cell death.
Safety & warnings
Contraindications
- No specific absolute contraindications listed, but use with extreme caution in patients with pre-existing cardiac disease or the ABCB1 (MDR1) mutation.
Adverse effects
- Acute anaphylaxis
- Dose-dependent cumulative cardiotoxicity (cardiomyopathy, congestive heart failure)
- Tachycardia and arrhythmias (during administration)
- Anorexia
- Vomiting
- Pancreatitis
- Severe leucopenia
- Thrombocytopenia
- Haemorrhagic gastroenteritis
- Nephrotoxicity
- Severe tissue necrosis (if extravasated)
Precautions
Extravasation Risk: Severe tissue necrosis will occur if extravasated. Use of an indwelling catheter taped in place is essential. Administer into the side port of a freely running IV infusion of 0.9% NaCl over a minimum of 10 minutes. Cardiotoxicity: May cause dose-dependent cumulative cardiotoxicity, though possibly at a lower incidence than doxorubicin. Caution in patients with pre-existing cardiac disease. Myelosuppression: Suspend treatment if neutrophils drop below 2.5 × 10^9/L or platelets below 50 × 10^9/L. Reduce dose by 10-25% if haematological or GI toxicity is recurrent. Genetics: Dogs with the ABCB1 (MDR1) mutation may be at higher risk of toxicity.
Clinical Pearl: Premedication with IV chlorphenamine or dexamethasone is recommended to prevent acute anaphylactic reactions.
Drug interactions
Incompatible; a precipitate will form if mixed.
Increased risk of myelosuppression when used in combination.
Increases the area under the dose curve (AUC) of epirubicin by 50%; should not be used concurrently.
Monitoring
- Complete Blood Count (CBC) and platelet count prior to every dose
- Physical examination and auscultation
- Electrocardiogram (ECG)
- Echocardiogram (especially in breeds predisposed to cardiac disease)
- Renal parameters
- Gastrointestinal signs
Pharmacokinetics
Absorption
Administered intravenously, resulting in 100% bioavailability.
Distribution
Rapidly distributed into tissues. Does not cross the blood-brain barrier effectively.
Metabolism
Extensively metabolized in the liver.
Elimination
Primarily eliminated via biliary excretion, with a smaller portion excreted in the urine.
Overdose
Overdosage increases the risk of severe myelosuppression, severe gastrointestinal toxicity (haemorrhagic gastroenteritis), and acute cardiotoxicity. Treatment is supportive and symptomatic, including aggressive fluid therapy, broad-spectrum antibiotics (if neutropenic), and antiemetics.
Available products
Formulations
- 10 mg powder for reconstitution
- 20 mg powder for reconstitution
- 50 mg powder for reconstitution
- 2 mg/ml solution
Human-labeled
- Pharmorubicin
- Epirubicin 10 mg, 20 mg, 50 mg powder for reconstitution
- Epirubicin 2 mg/ml solution
Regulatory status
Human authorized products used off-label under the cascade.
Human authorized products used off-label under the cascade.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
After reconstitution, the drug is stable for 24 hours at room temperature. Store under refrigeration up to 28 days. Protection from light is not necessary.
Client information
Epirubicin is a potent chemotherapy drug used to treat various cancers in pets.
- Handling: Chemotherapy drugs can be hazardous. Follow your veterinarian's instructions for handling your pet's waste (urine/feces) for a few days after treatment.
- Side Effects: Watch for loss of appetite, vomiting, or diarrhea. Contact your vet immediately if these occur.
- Heart Health: This drug can occasionally affect the heart, so your vet may recommend heart monitoring (like an ECG or ultrasound) before and during treatment.
- Infection Risk: Your pet's white blood cell count may drop, making them more susceptible to infections. Keep them away from sick animals.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.