From the hemopoietic system: leukopenia, neutropenia. anemia, thrombocytopenia.
From the cardiovascular system: manifestations of early (acute) cardiotoxicity of epirubicin are mainly sinus tachycardia and / or anomalies on the ECG (nonspecific changes in ST-T waves).There may also be tachyarrhythmias (including ventricular extrasystole and ventricular tachycardia), bradycardia, atrioventricular blockade, and blockade of the bundle's legs. These effects are not always a prognostic factor in the development of subsequently delayed cardiotoxicity, are rarely clinically significant, and usually do not require withdrawal of drug therapy. Late (deferred) cardiotoxicity is manifested by a decrease left ventricular ejection fraction (LVEF) and / or symptoms of congestive heart failure (CHF), such as dyspnea, pulmonary edema, orthostatic edema, cardiomegaly and hepatomegaly, oliguria, ascites, exudative pleurisy, gallop rhythma. There may also be subacute phenomena, such as pericarditis / myocarditis. The most severe form of anthracycline-induced cardiomyopathy is the life-threatening CHF, which is a toxicity that limits the cumulative dose of the drug.
In addition, there may be thromboembolic complications, including pulmonary embolism (in some cases fatal), hot flashes to the face.
From the side of the digestive system: anorexia, nausea, vomiting, stomatitis, hyperpigmentation of the oral mucosa, esophagitis, pain or burning sensation in thebabdominal cavity, erosion of the stomach, bleeding from the gastrointestinal tract, diarrhea, colitis; increased levels of total bilirubin and transaminases in serum.
From the urinary system: staining the urine in red for 1-2 days after the administration of EPIRUBICINE. Possible the appearance of hyperuricemia due to rapid lysis of tumor cells.
On the part of the organs of vision: conjunctivitis, keratitis.
From the skin and skin appendages: alopecia, rash, itching, sudden reddening of the skin, hyperpigmentation of the skin and nails, photosensitivity, irritated skin hypersensitivity (anamnestic reaction to irradiation), urticaria.
On the part of the endocrine system: amenorrhea (at the end of therapy, ovulation recovers, but premature menopause may occur); oligospermia, azoospermia (in a number of cases the number of spermatozoa is restored to normal level, this can happen several years after the end of therapy).
Local reactions.Often, erythematous, striated along the vein into which the infusion was produced, then local-phlebitis or thrombophlebitis may occur. Also, phlebosclerosis may develop, especially if EPIRUBICINE is reentered into a small vein. In the event of a drug falling into the surrounding tissues, local soreness, severe inflammation of the subcutaneous tissue and necrosis of the tissues may occur.
With intra-arterial administration in addition to systemic toxicity, ulcers of the stomach and duodenum (possibly due to reflux of the drug in the gastric artery) and narrowing of the bile ducts due to drug-induced sclerosing cholangitis can be observed, as well as widespread necrosis of the perfused tissue.
Intravesical application of epirubicin can lead to the appearance of symptoms of chemical cystitis (dysuria, polyuria, nocturia, painful urination, hematuria, discomfort in the bladder, necrosis of the bladder wall) and constriction of the bladder.
Other: malaise, asthenia, fever, chills, attachment of secondary infections, anaphylaxis, dehydration, development of acute lymphocytic leukemia or myeloid leukemia.