Eribulin mesilate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Eribulin mesilate: clinical details
Prescribing considerations
- Restrict prescribing and administration to clinicians and staff experienced in cytotoxic anticancer therapy.
- Assess hepatic and renal function because impairment may increase eribulin exposure.
- Review baseline neuropathy and cardiac risk, including bradyarrhythmia, heart failure, QT-prolonging medicines and electrolyte disturbances.
- Discuss reproductive risks and fertility preservation before treatment where relevant.
Contraindications and cautions
- Hypersensitivity to eribulin mesilate or an excipient
- Breastfeeding
- Avoid in congenital long-QT syndrome; exercise caution with other QT-risk factors
Monitoring
- Full blood count before each planned administration and assessment for infection or bleeding
- Peripheral motor and sensory neuropathy
- Liver and renal function
- Potassium, calcium and magnesium where cardiac risk is relevant; correct abnormalities
- ECG in patients with heart failure, bradyarrhythmia, QT-prolonging treatment or another significant QT risk
Clinical pharmacology
A synthetic halichondrin-class antineoplastic agent that inhibits microtubule growth without inhibiting shortening, sequesters tubulin into non-productive aggregates and causes mitotic arrest. It is eliminated mainly through biliary and faecal routes, largely unchanged.
Formulation and product differences
- The product is a clear, colourless, ready-to-use intravenous solution supplied in a vial.
- It contains ethanol as an excipient.
- It may be used undiluted or diluted in sodium chloride solution; glucose solution is incompatible.
- Eribulin labelling may express quantities as eribulin base or eribulin mesilate, so product-specific calculations and labelling must not be interchanged.
Eribulin mesilate preparations and strengths
Injection
Route: Parenteral
Strengths: 0.44 mg/mL
Eribulin mesilate interactions
Give the cancer team a complete list of prescribed, over-the-counter and herbal products. Relevant considerations include:
Medicines that prolong the QT interval, including class Ia and III antiarrhythmics
Concurrent use may increase cardiac rhythm risk; ECG and electrolyte monitoring may be appropriate.
Narrow-therapeutic-index CYP3A4 substrates, such as ciclosporin, tacrolimus, fentanyl, quinidine or sirolimus
Eribulin mildly inhibits CYP3A4 in vitro, so monitoring for adverse effects is advised when these medicines are used together.
CYP3A4 inhibitors or inducers
Clinically important effects on eribulin exposure are not expected based on studies with ketoconazole and rifampicin.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.