told particular care should be taken in monitoring toxicity when Ellence is administered to female patients ≥ 70 years of age [see Clinical Pharmacology (12.3) ]. Hepatic Impairment Epirubicin is eliminated by both hepatic metabolism and biliary excretion and clearance is reduced in patients with hepatic dysfunction. Do not treat patients with severe hepatic impairment with Ellence. Reduce the starting dose for patients with less severe hepatic impairment [see Dosage and Administration (2.2) and Clinical Pharmacology (12.3) ]. Renal Impairment No significant alterations in the pharmacokinetics of epirubicin or its major metabolite good sized
shrink back of Ellence have not been established in pediatric patients. Pediatric patients may be at greater risk for anthracycline-induced acute manifestations of cardiotoxicity and for chronic CHF. The pharmacokinetics of epirubicin in pediatric patients have not been evaluated. Geriatric Use Although a lower starting dose of Ellence was not used in trials in elderly female patients in good shape
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