Pharmacy Services

Eribulin (Halaven) and Epirubicin (Ellence, generic)

January 17, 2012

Healthcare providers are concerned that eribulin (Halaven) and epirubicin (Ellence, generic) may be inadvertently interchanged. An order for eribulin was misinterpreted as epirubicin by a pharmacist, but the medication error was caught by the nurse and the drug was not administered to the patient. Similar errors have occurred in the past. Although both drugs are used for breast cancer, they have different indications and doses.

Eribulin is an antimicrotubular antineoplastic agent labeled for the treatment of metastatic breast cancer in patients who have had at least 2 prior chemotherapy regimens. Eribulin is administered intravenously and is supplied in 2-mL vials at a concentration of 0.5 mg/mL. The approved dose is 1.4 mg/m2 on days 1 and 8 of a 21-day cycle.

Epirubicin is an anthracycline antineoplastic agent labeled as adjuvant therapy for axillary node-positive breast cancer. Epirubicin is administered intravenously and is supplied in 25-mL and 100-mL vials at a concentration of 2 mg/mL, and also as a powder in 50 mg and 200 mg vials. The approved dose ranges from 60 mg/m2 to 120 mg/m2 and may be given on day 1 or days 1 and 8 depending on the regimen.

If these drugs are mistakenly interchanged, patients prescribed eribulin may receive much greater doses than recommended and patients prescribed epirubicin may receive subtherapeutic doses. Potential toxicities as a result of an overdose of eribulin include increased nausea, anemia, neutropenia, peripheral neuropathy, fatigue, fever, and weight loss. Treatment failure is a potential consequence of underdosing epirubicin. The following can be done to lessen the chance of an error:

  • Pharmacies – Store the medications in separate places in the pharmacy. Use tall man lettering and include the salt form of the drug (ie, eriBULin mesylate and EPIrubicin hydrochloride).
  • Prescribers – Write both the brand and generic names on all prescriptions along with indication.
  • Pharmacy staff – Verify the brand and generic names with the prescriber whenever possible and recalculate the dose of all antineoplastic agents prior to dispensing.

Additional information is available online at the following link:

January 17, 2012; University of Utah, Drug Information Service. Copyright 2012, Drug Information Service, University of Utah, Salt Lake City, UT.