eribulin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
eribulin: clinical details
Prescribing considerations
- Restrict prescribing and administration to clinicians and staff experienced with cytotoxic anti-cancer treatment.
- Assess hepatic and renal function because impairment can increase exposure; severe hepatic impairment and cirrhosis are insufficiently studied.
- Consider antiemetic prophylaxis where clinically appropriate.
- Discuss reproductive risks, contraception and sperm preservation where relevant.
Contraindications and cautions
- Hypersensitivity to eribulin or an excipient.
- Breastfeeding.
- Avoid in congenital long-QT syndrome; use additional caution with cardiac disease, bradyarrhythmia, QT-prolonging medicines or electrolyte abnormalities.
Monitoring
- Full blood count before each administration, particularly neutrophils and platelets.
- Infection, febrile neutropenia and sepsis.
- Peripheral motor and sensory neuropathy.
- Liver and renal function.
- Potassium, calcium and magnesium; correct deficiencies.
- ECG when relevant risk factors are present.
Clinical pharmacology
Eribulin is a synthetic halichondrin-class microtubule dynamics inhibitor. It suppresses microtubule growth, causes mitotic arrest and subsequent apoptotic cell death. It circulates mainly unchanged and is eliminated predominantly through biliary and faecal routes.
Formulation and product differences
- Ready-to-use, clear, colourless aqueous solution in a single-use vial.
- Contains ethanol but is essentially sodium-free.
- May be diluted with sodium chloride solution but not glucose solution; cytotoxic handling precautions apply.
eribulin preparations and strengths
Injection
Route: Parenteral
Strengths: 0.44 mg/mL
eribulin interactions
A complete review of prescribed, non-prescribed and herbal products is required.
Medicines that prolong the QT interval, including class Ia and III antiarrhythmics
Combined use may increase heart-rhythm concerns; ECG and electrolyte monitoring may be appropriate in at-risk patients.
Narrow-therapeutic-index CYP3A4 substrates, including ciclosporin, fentanyl, quinidine, sirolimus and tacrolimus
Eribulin is a mild CYP3A4 inhibitor in laboratory studies, so monitor for adverse effects from the accompanying medicine.
Ketoconazole and rifampicin
Studies found no meaningful change in eribulin exposure, although all concurrent treatment should still be reviewed.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.