provider image
Welcome! You’re in GoodRx for healthcare professionals. Now, you’ll enjoy a streamlined experience created specifically for healthcare professionals.
Skip to main content

epirubicin

Generic Ellence
Used for Breast Cancer
Used for Breast Cancer

Epirubicin (Ellence) is a type of chemotherapy used along with other anticancer medications to get rid of remaining cancer in the armpit region after the breast cancer tumor has been removed by surgery. Epirubicin (Ellence) is given as an injection through your veins, typically once during every 3- or 4-week treatment cycle. This medication commonly causes hair loss, nausea, and vomiting.

Last reviewed on December 19, 2022
basics-icon

What is Epirubicin (Ellence)?

What is Epirubicin (Ellence) used for?

  • Remaining cancer in the armpit region (axillary node tumor) after removal of primary breast cancer tumor

How Epirubicin (Ellence) works

Epirubicin (Ellence) is a type of chemotherapy. Specifically, it’s called a topoisomerase II inhibitor. It works by blocking your cells from repairing and making copies of its genetic material. This prevents the cancer cells from growing and causes them to die.

Are you looking for information on Halaven (eribulin) instead?

Drug Facts

Common BrandsEllence
Drug ClassAnticancer agent
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Epirubicin (Ellence)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Hair loss (up to 96%)
  • Nausea/vomiting (up to 92%)
  • Low blood cell counts (up to 80%)
  • Missing menstrual cycles (amenorrhea) (up to 72%)
  • Painful sores inside of mouth and throat (up to 59%)
  • Lower energy levels (up to 46%)
  • Hot flashes (up to 39%)
  • Diarrhea (up to 25%)
  • Infection (up to 22%)
Please note: These side effects were reported by people in clinical trials who took epirubicin (Ellence) with cyclophosphamide (Cytoxan) and fluorouracil.

Other Side Effects

  • Pink eye or eye inflammation
  • Rash, itchy skin, or other changes in your skin
  • Fever with or without low white blood cell counts
  • Loss of appetite

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Blood clot in lungs: difficulty breathing, chest pain, coughing up blood
  • Heart problems: chest pain, changes in heartbeat, sudden weight gain, trouble breathing, dizziness, feeling light-headed
  • Tumor lysis syndrome: nausea, vomiting, feeling tired, pounding heart, muscle cramps, feeling numb, not feeling hungry, seizures, seeing things that aren’t really there

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Black, tarry stools

bleeding, redness, or ulcers in the mouth or throat

chest pain

cough or hoarseness

fever or chills

lower back or side pain

pain or burning in the mouth or throat

painful or difficult urination

sore throat

sores, ulcers, or white spots in the mouth or on the lips

swollen glands

trouble breathing

unusual bleeding or bruising

unusual tiredness or weakness

Less common

Blood in the urine or stools

pinpoint red spots on the skin

red streaks along the injected vein

Rare

Darkening or redness of the skin at the place of irradiation

fast or irregular heartbeat

joint pain

pain, redness, or warmth at the injection site

skin rash or itching

swelling of the abdomen or stomach, lower legs, and feet

swelling or tenderness of the lymph nodes, abdomen, side or lower back

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Abdominal or stomach swelling or tenderness

high fever

stomach pain

swelling of the lining of the mouth, nose, or throat

vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Absent, missed, or irregular menstrual periods

burning, dry, or itching eyes

diarrhea

discharge or excessive tearing

feeling of warmth

hair loss or thinning of the hair

nausea

redness of the face, neck, arms, and occasionally, upper chest

redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid

stopping of menstrual bleeding

sudden sweating

unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Less common

Changes in the skin

loss of appetite

weight loss

Rare

Darkening of the soles, palms, or nails

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Epirubicin (Ellence)

thumbs-up

Pros

Available as a lower-cost generic

Given once (sometimes twice) during every 3- or 4-week treatment cycle

It can be infused over a short amount of time (15 to 20 minutes)

thumbs-down

Cons

Need to get regular heart monitoring because can cause heart problems

Put you at higher risk for serious infections

Must be given healthcare provider, typically at an infusion center

pharmacist-tips

Pharmacist tips for Epirubicin (Ellence)

pharmacist
  • Receiving epirubicin (Ellence) treatment can make it harder for your body to fight off infections because it weakens your immune system. You shouldn’t receive any live vaccines during this time because doing so can cause you to become seriously sick. Before you receive any vaccinations, let your provider or pharmacist know that you’re being treated with epirubicin (Ellence).

    • Let your provider know right away if you feel pain at the infusion site after they start the epirubicin (Ellence) infusion. This medication can cause burning pain and irritation to your veins or the skin area around the infusion site. If you experience this, your provider will stop the infusion and treat your skin with ice to ease the pain. Your provider might also give you other medications, such as dexrazoxane (Totect), to ease the irritation.

      • If you experience pain at the infusion site, your provider will likely ask you to continue icing that site for 3 days after your infusion. You should ice that area 4 times a day, for 15 minutes at a time.

        • If you need medication for heartburn while receiving epirubicin (Ellence) treatment, ask your provider what is a safe medication for you. Don’t take cimetidine (Tagamet HB) with epirubicin (Ellence) because this medication can raise the levels of epirubicin (Ellence) in your body and put you at higher risk for side effects.

          • Your urine might look red for 1-2 days after your epirubicin (Ellence) infusion. This is normal and not harmful. This happens because the medication itself is a red color.

            • If you’ve had radiation in the past, receiving epirubicin (Ellence) might cause a reaction called radiation recall, sometimes even years after your radiation. This is an inflammatory reaction that affects the areas of the body where you previously received radiation. Let your provider know if you develop blisters or skin peeling, or it looks like you have a severe sunburn. These can be symptoms of radiation recall.

              • Epirubicin (Ellence) can cause heart failure, which happens when your heart can't pump blood the way it should. Let your provider know right away if you experience signs of heart problems, such as trouble breathing, swelling of your ankles or feet, sudden weight gain, fast heartbeat, or pounding in your chest.

                faqs

                Frequently asked questions about Epirubicin (Ellence)

                Can epirubicin (Ellence) be used to treat tumors other than those in the armpit region after the breast tumor has been removed?
                Epirubicin (Ellence) is only FDA-approved to treat the cancer that remains in and around the armpit region after breast cancer surgery. But, the National Comprehensive Cancer Network (NCCN) guidelines do list it as one of the preferred options for high-risk triple negative breast cancer as well (when it’s used alongside other medications). Talk with your provider if you’ve any questions about whether epirubicin (Ellence) is an appropriate treatment for you.
                Does epirubicin (Ellence) commonly cause nausea and vomiting?
                In clinical trials, nearly all people treated with epirubicin (Ellence) experienced nausea and vomiting. If you've nausea and vomiting during your treatment, let your provider know. They can prescribe anti-nausea medications, such as ondansetron (Zofran), to help ease these symptoms. Your provider can also recommend tips to lower your risk and severity of nausea and vomiting without medication. Ways to do so include eating smaller meals, staying hydrated, avoiding smells that can trigger nausea, and getting fresh air. Keep track of when you experience nausea and vomiting and let your provider know so they can create a personalized plan to ease your symptoms.
                Can epirubicin (Ellence) cause hair loss?
                Yes, people who receive epirubicin (Ellence) often experience hair loss. This side effect is temporary and hair typically begins to grow back about 3 months after the treatment is finished. You can try to lessen hair loss by using a cooling cap. This works to reduce blood flow to your scalp, which means lower amounts of the drug can reach this area. You can also lessen hair loss by minimizing or avoiding certain hair care activities, such as brushing too often, hair dying, or applying heat to hair. Talk with your provider if you’re concerned about hair loss with epirubicin (Ellence).
                Can I breastfeed while receiving epirubicin (Ellence)?
                Based on animal studies, it’s possible for epirubicin (Ellence) to pass into breast milk. Because of the risk of harm to breastfed babies, you shouldn’t nurse during epirubicin (Ellence) treatment or for at least a week after your last dose. Talk with your provider if you have any questions about breastfeeding and epirubicin (Ellence) or other ways to feed your baby during treatment.
                Can I receive epirubicin (Ellence) if I have kidney or liver problems?
                Maybe. How well your kidneys and liver work can affect how well your body gets rid of epirubicin (Ellence). If your kidneys or liver aren't working very well, the medication might stay in your body longer and you might be at higher risk for developing side effects. Let your provider know your full medical history. They’ll use this information, in combination with results from lab work, to determine how well your kidneys and liver are working. If your kidney or liver problems are serious enough, your provider might lower your dose of epirubicin (Ellence) or recommend a different treatment option for you.
                Can epirubicin (Ellence) affect my ability to have children?
                Epirubicin (Ellence) can affect the menstrual cycle and lead to problems such as ammenorrhea or premature menopause. These conditions can affect your ability to have a child. Depending on your age at treatment, these effects on the menstrual cycle can be permanent. If you plan to have children, talk with your provider about the benefits and risks of receiving epirubicin (Ellence) before you start treatment.
                GoodRxEducationalIcon

                How to save using GoodRx

                Compare Prices
                1. Compare PricesSpecify your dosage and quantity to find out exactly how much you can save.
                Select your free coupon
                2. Select your free couponYou can use the displayed coupon, or compare prices at other pharmacies near you.
                Show coupon to your pharmacist
                3. Show coupon to your pharmacistPresent your printed or electronic coupon when you pick up your prescription.
                Get free couponLearn more
                warings-icon

                What are the risks and warnings for Epirubicin (Ellence)?

                Epirubicin (Ellence) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                risk-warning

                Heart damage

                • Risk factors: Heart problems | Radiation to chest area | Taking other heart-damaging anticancer medications | Receiving more cycles of epirubicin (Ellence)

                  Epirubicin (Ellence) can cause various heart problems, including changes to your heartbeat and heart rhythm, as well as heart failure. These problems can happen early on in your treatment or they can show up months or years after you stop treatment. Your risk for heart problems goes up the more rounds of treatment you have with epirubicin (Ellence). Your provider will put a cap to the total life-time dose of epirubicin (Ellence) you can receive to try to lower your risk of heart problems. Your provider will also monitor your heart before you start epirubicin (Ellence) and regularly throughout your treatment to look for any problems. Let your care team know if you experience any signs and symptoms of heart damage, including trouble breathing, dizziness or lightheadedness, irregular heartbeats, chest pain, or weight gain.

                  risk-warning

                  Risk for blood cancers

                  • Risk factors: Receiving epirubicin (Ellence) or similar medications for a long time

                    Though rare, people who received epirubicin (Ellence) have developed blood cancers. Typically, these cancers occur within 1 to 3 years of epirubicin (Ellence) treatment. And the risk for developing blood cancers go up the longer a person receives epirubicin (Ellence). Let your provider know right away if you experience possible symptoms of blood cancer, such as feeling unusually tired and weak, getting infections more often, bruising and bleeding easily, bone pain, fever, unexplained weight loss, or night sweats.

                    risk-warning

                    Severe damage to skin tissue

                    • Risk factors: Faster than recommended infusion rates | Repeated injections into the same vein

                      Epirubicin (Ellence) can sometimes cause skin damage to areas near the infusion site and lead to symptoms such as burning, stinging, and pain. This happens when some of the medication leaks out of the infusion area (extravasation) or causes damage to the vein. If you have extravasation, your provider will stop your infusions. They’ll try to ease your pain by having you apply ice packs to the infusion site or administer other medications, like dexrazoxane Totect, to treat the problem. Depending on how severe your condition is, your provider might be able to restart epirubicin (Ellence).

                      risk-warning

                      Severely low blood cell counts

                      Epirubicin (Ellence) can cause your red blood cell, white blood cell, and platelet counts to drop. When your blood cell counts drop too low, you’re at risk for problems such as infection, anemia, and bleeding or bruising. Your provider will frequently monitor your blood cells through lab work. If your blood cell counts drop too low, your provider might need to pause your treatment or lower your dose. Let your provider know right away if you experience symptoms of low blood cell counts, such as:

                      risk-warning

                      High uric acid and electrolyte imbalances (Tumor lysis syndrome)

                      • Risk factors: Fast-growing cancer | Not drinking enough fluids | Kidney problems

                        Some people receiving epirubicin (Ellence) might experience tumor lysis syndrome (TLS), which can then lead to organ damage. TLS happens when cancer cells rapidly die and release their contents into the blood. It typically occurs within the first week of epirubicin (Ellence) treatment. Your provider will monitor your lab work for signs of TLS, which can include higher levels of uric acid, potassium, calcium, and phosphate. Let your provider know right away if you develop any symptoms of TLS, such as dark urine, a racing heart, muscle cramps or spasms, numbness, nausea, or vomiting.

                        risk-warning

                        Blood clots

                        Though rare, epirubicin (Ellence) can cause blood clots, including those in the lungs. Sometimes, these clots can be life-threatening. Symptoms of blood clots can differ depending on where your blood clot is located. Let your provider know right away if you experience dizziness, chest pain, feeling faint, or trouble breathing.

                        risk-warning

                        Liver and kidney problems

                        Your provider will check you liver and kidney health before you start and throughout treatment with Epirubicin (Ellence). If you have liver damage, you’re likely to experience more side effects from this medication, so your provider might lower your dose. And if you have kidney damage, your provider might also adjust your dose of epirubicin (Ellence).

                        risk-warning

                        Harm to unborn baby

                        Based on animal studies, epirubicin (Ellence) can cause harm to an unborn baby if taken by mothers during pregnancy. If you're able to become pregnant, you should use birth control while you’re receiving epirubicin (Ellence) and for at least 6 months after your last dose. Your provider might ask you to take a pregnancy test before you start treatment to make sure you’re not pregnant.

                        Males with partners who are able to become pregnant should use birth control while receiving epirubicin (Ellence) and for at least 3 months after your last dose. And if your partner is already pregnant, you should use condoms while receiving this medication and for at least a week after your last dose.

                        Let your provider know right away if you or your partner become pregnant during this time.

                        dosage

                        Epirubicin (Ellence) dosage forms

                        Typical dosing for Epirubicin (Ellence)

                        Epirubicin (Ellence) is given by a healthcare provider as an injection into the vein (IV). Your provider will calculate your dose of epirubicin (Ellence) based on your body surface area (BSA, in units of m2), which takes into account your body weight and height.

                        • The typical dose of epirubicin (Ellence) is 100 to 120 mg/m2 injected once on Day 1 (or divided into 2 doses and given on Day 1 and 8) of every 3- or 4-week treatment cycle.

                        Your dose of epirubicin (Ellence) and the length of time of each treatment cycle depends on what other anticancer medications your provider is prescribing as part of your treatment. Typically, you'll receive 6 cycles of treatment with epirubicin (Ellence).

                        interactions

                        Interactions between Epirubicin (Ellence) and other drugs

                        Epirubicin (Ellence) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Epirubicin (Ellence). Please note that only the generic name of each medication is listed below.

                        Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                        Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                        • Measles Virus Vaccine, Live
                        • Mumps Virus Vaccine, Live
                        • Rotavirus Vaccine, Live
                        • Rubella Virus Vaccine, Live
                        • Tasonermin
                        • Varicella Virus Vaccine, Live
                        • Zoster Vaccine, Live

                        Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                        Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                        contraindications-icon

                        Epirubicin (Ellence) contraindications

                        Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Epirubicin (Ellence) will not be safe for you to take.
                        • Severe heart problems

                        • Recent heart attack or severe change in heart rhythm

                        • Previous use of chemotherapy (anthracyclines) that can cause heart damage

                        • Severely low red blood cells, white blood cells, and platelets caused by other medications

                        • Severe liver damage

                        • Past serious allergic reaction to certain other anticancer medications (anthracyclines or anthracenediones)

                        alternatives

                        What are alternatives to Epirubicin (Ellence)?

                        There are a number of medications that your doctor can prescribe in place of Epirubicin (Ellence). Compare a few possible alternatives below.
                        Epirubicin (Ellence)
                        Used for:
                        • Remaining cancer in the armpit region (axillary node tumor) after removal of primary breast cancer tumor

                        Used for:
                        • Breast cancer

                        • Non-small cell lung cancer

                        • Prostate cancer

                        • Stomach cancer

                        • Head and neck cancer

                        Get savings updates for Epirubicin (Ellence)

                        Receive price alerts, news, and other messages from GoodRx about Epirubicin (Ellence) and other healthcare topics and relevant savings offers.

                        By providing your email, you consent to receive marketing communications from GoodRx, which may include content and/or data related to men’s health, women's health, reproductive care, or sexual health. You agree to the GoodRx Terms of Use and acknowledge the Privacy Policy. You can unsubscribe at any time.

                        Browse medications

                        View All

                        Research prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.