请教表阿霉素的用法和用量

各位老师，请教一下：表阿霉素治疗乳腺癌的剂量：临床上用100mg/m2的是否剂量太大一般耐受不了？
静滴表阿霉素是溶于注射用水然后用生理盐水稀释 还是直接用注射用水溶解稀释至终浓度不超过2mg/ml？注射用水是低渗的是否有更易导致表阿霉素外渗的倾向？一般患者使用注射用水静滴是否会引起血管疼痛？感谢您的回答！

1、关于用量的问题：表阿霉素单独用药时，成人剂量为按体表面积一次60～90mg/m2，联合化疗时，每次50～60mg/m2静脉注射。但也有用到120mg/m2的，根据病人血象可间隔21天重复使用。

2、关于配制使用的问题：（1）静脉注射，用灭菌注射用水稀释，使其终浓度不超过2mg/ml；（2）建议先注入生理盐水检查输液管通畅性及注射针头确实在静脉之后，再经此通畅的输液管给药。以此减少药物外溢的危险，并确保给药后静脉用生理盐水冲洗；（3）可用生理盐水或5%GS溶解稀释后静滴；（4）表阿霉素注射时溢出静脉会造成组织的严重损伤甚至坏死。小静脉注射或反复注射同一血管会造成静脉硬化。建议以中心静脉输注较好；（5）不可肌肉注射和鞘内注射。
相应的参考资料：
Epirubicin hydrochloride is given by intravenous injection of a solution in sodium chloride 0.9% or Water for Injections into a fast-running infusion of sodium chloride 0.9% or glucose 5% over 3 to 5 minutes, or by infusion over up to 30 minutes. It is given as a single agent in usual doses of 60 to 90 mg/m2 as a single dose every 3 weeks; this dose may be divided over 2 or 3 days if desired. A regimen of 12.5 to 25 mg/m2 once a week has also been tried in palliative care. High-dose regimens, of 120 mg/m2 or more every 3 weeks, or 45 mg/m2 for 3 consecutive days every 3 weeks have been used.
Doses may need to be reduced if epirubicin is given with other antineoplastics. Doses should also be reduced in patients with liver impairment (see ) and in those whose bone-marrow function is impaired by age or previous chemotherapy or radiotherapy.

A total cumulative dose of 0.9 to 1 g/m2 should not generally be exceeded, because of the risk of cardiotoxicity.
－－－－Martindale 第35版

Martindale 35说得真是非常清楚，