Pharmorubicin is mainly used in combination with other cytotoxic drugs and additive toxicity may occur especially with regard to bone marrow/haematologic and gastrointestinal effects.
In addition, the concomitant use of Pharmorubicin with other antitumour drugs which have been reported as potentially cardiotoxic (e.g., 5-fluorouracil, cyclophosphamide, cisplatin, taxanes, trastuzumab), as well as the concomitant use of other cardioactive compounds (e.g., calcium channel blockers), requires a close monitoring of cardiac function throughout treatment.
Propranolol: concurrent administration of Pharmorubicin and propranolol may result in an additive cardiotoxic effect.
Cimetidine increased the AUC of Pharmorubicin by 50% and should be stopped during treatment with Pharmorubicin.
When given prior to epirubicin, paclitaxel can cause increased plasma concentrations of unchanged epirubicin. Co-administration of paclitaxel or docetaxel did not affect the pharmacokinetics of epirubicin when epirubicin was administered prior to the taxane.
Concurrent mediastinal radiotherapy and Pharmorubicin may be associated with enhanced myocardial toxicity of Pharmorubicin.
Pharmorubicin is extensively metabolised by the liver. Changes in hepatic function induced by concomitant therapies may affect Pharmorubicin metabolism, pharmacokinetics, therapeutic efficacy and/or toxicity.