Cimetidine and Epirubicin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cimetidine
Epirubicin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of epirubicin toxicity (myelosuppression, cardiotoxicity)
Interaction Deep Dive
The administration of cimetidine 400 mg twice daily for seven days, starting five days before epirubicin, increased the mean area under the concentration-time curve (AUC) of epirubicin (100 mg/m2) by 50%. Plasma clearance of epirubicin was decreased by 30%. Cimetidine should be discontinued during epirubicin therapy1.
Why it happens (mechanism)
Unknown
Common questions
Can I take Cimetidine and Epirubicin together?
An increased risk of epirubicin toxicity (myelosuppression, cardiotoxicity) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Cimetidine and Epirubicin interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Cimetidine or Epirubicin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Product Information: Ellence(R), epirubicin hydrochloride. Pharmacia & Upjohn Company, Kalamazoo, MI, 2003. DailyMed
Keep reading about Cimetidine
Keep reading about Epirubicin
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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