irinotecan (Intravenous route)

Pronunciation

ir-in-oh-TEE-kan

Intravenous route(Solution)

Irinotecan can induce both early and late forms of diarrhea. Early diarrhea may be accompanied by cholinergic symptoms that may be prevented or ameliorated by atropine. Late diarrhea can be life threatening and should be treated promptly with loperamide. Initiate antibiotic therapy if ileus, fever, or severe neutropenia develop. Administration of irinotecan should be interrupted and subsequent doses reduced if severe diarrhea occurs. Severe myelosuppression may occur with irinotecan administration .

Commonly used brand name(s)

In the U.S.

  • Camptosar
  • Novaplus Irinotecan Hydrochloride

Available Dosage Forms:

  • Solution

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Topoisomerase I Inhibitor

Uses For irinotecan

Irinotecan injection is given together with other medicines to treat patients with metastatic cancer (a cancer that has already spread) of the colon or rectum.

Irinotecan belongs to the group of medicines called antineoplastics (cancer medicines). It interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells may also be affected by the medicine, other effects may also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may occur after treatment with irinotecan has been stopped. Be sure that you have discussed with your doctor the possible side effects of irinotecan as well as the good it can do.

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

irinotecan is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, irinotecan is used in certain patients with the following medical conditions:

  • Carcinoma, lung, non-small cell (treatment of non–small cell cancer of the lung).
  • Extensive-stage small-cell lung cancer, first-line treatment, in combination with cisplatin (treatment of small-cell lung cancer; used together with cisplatin [Platinol®]).
  • Ovarian cancer, platinum-refractory or platinum-resistant (treatment of ovarian cancer that does not respond to platinum-type medicines).
  • Malignant glioma, recurrent or progressive (treatment of brain cancer that has returned or is advancing).

Before Using irinotecan

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For irinotecan, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to irinotecan or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of irinotecan injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of irinotecan injection in the elderly. However, elderly patients are more likely to have severe diarrhea, which may require caution and an adjustment in the dose for patients receiving irinotecan.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving irinotecan, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using irinotecan with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Atazanavir
  • Itraconazole
  • Ketoconazole
  • Rotavirus Vaccine, Live
  • St John's Wort

Using irinotecan with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adenovirus Vaccine Type 4, Live
  • Adenovirus Vaccine Type 7, Live
  • Aprepitant
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Carbamazepine
  • Fosaprepitant
  • Fosphenytoin
  • Influenza Virus Vaccine, Live
  • Lopinavir
  • Measles Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Phenobarbital
  • Phenytoin
  • Rifabutin
  • Rifampin
  • Rubella Virus Vaccine, Live
  • Smallpox Vaccine
  • Typhoid Vaccine
  • Varicella Virus Vaccine
  • Yellow Fever Vaccine

Using irinotecan with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Citalopram
  • Sorafenib

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using irinotecan with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use irinotecan, or give you special instructions about the use of food, alcohol, or tobacco.

  • Tobacco

Other Medical Problems

The presence of other medical problems may affect the use of irinotecan. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bleeding problems or
  • Diabetes or
  • Hereditary fructose intolerance, history of or
  • Hyperglycemia (high blood sugar) or
  • Kidney disease or
  • Liver disease or
  • Lung disease or
  • Severe diarrhea—Use with caution. May make these conditions worse.
  • Bone marrow disease, severe or
  • Bowel blockage or
  • Gilbert's syndrome (an inherited disorder) or
  • Neutropenia (low white blood cells) or
  • Reduced UGT1A1 activity (an enzyme problem)—May increase risk for more serious side effects.
  • Infection—irinotecan may decrease your body's ability to fight an infection.

Proper Use of irinotecan

A doctor or other trained health professional will give you irinotecan in a hospital or cancer treatment center. irinotecan is given through a needle placed in one of your veins.

Irinotecan often causes nausea and vomiting. However, it is very important that you continue to receive irinotecan even if you begin to feel ill. You may receive other medicines to help with the nausea and vomiting. Ask your doctor for other ways to lessen these effects.

Precautions While Using irinotecan

It is very important that your doctor check your progress at regular visits to make sure that irinotecan is working properly. Blood tests may be needed to check for unwanted effects.

Make sure your doctor knows if you are pregnant before you receive irinotecan. Using irinotecan while you are pregnant can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

irinotecan may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have chills; fever; hives; hoarseness; itching; rash; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth after you receive the medicine.

While you are being treated with irinotecan, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's approval. Irinotecan may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not get live vaccines (e.g., nasal influenza or flu vaccine). Try to avoid persons who have taken live vaccines. Do not get close to them and do not stay in the same room with them for very long. If you cannot take these precautions, you should wear a protective face mask that covers the nose and mouth.

Irinotecan may cause diarrhea, which can last long enough and be severe enough to cause serious medical problems. If diarrhea occurs while you are being treated with irinotecan:

  • Check with your doctor immediately. Be sure to let your doctor know if the diarrhea started during an irinotecan injection or less than 24 hours afterwards. Also, be sure to tell your doctor if you had any other symptoms, such as stomach cramps or sweating, before the diarrhea started. This means that you are having a certain kind of diarrhea that may need to be treated by your doctor.
  • If diarrhea first occurs more than 24 hours after a dose of irinotecan, start taking loperamide (Imodium A-D®) as soon as you notice that your bowel movements are occurring more often or are more loose than usual. Loperamide is available without a prescription. Buy some of it ahead of time, so that you will have it on hand in case it is needed. Unless otherwise directed by your doctor, take 4 milligrams (mg) of loperamide (2 capsules or tablets, or 4 teaspoonfuls of the oral solution dosage form) for the first dose, then 2 mg (1 capsule or tablet, or 2 teaspoonfuls of the oral solution dosage form) every two hours. To interrupt your sleep less often, you may take 4 mg of loperamide every four hours during the night. Continue taking loperamide, day and night, until you have not had any diarrhea for twelve hours. It is very important that you follow these (or your doctor's) directions, even though they are different from the directions on the nonprescription (over-the-counter [OTC]) loperamide package label. The largest amount of loperamide recommended on the package label for use in a twenty-four-hour period (8 mg) is not enough for treating diarrhea caused by irinotecan. Notify your doctor if the diarrhea is not controlled within 24 hours.
  • Diarrhea causes loss of body fluid, which can lead to dehydration, a serious medical problem. To prevent this, it is very important that you replace the lost fluid. While you have diarrhea, and for a day or two after the diarrhea has stopped, drink plenty of clear liquids, such as ginger ale, caffeine-free cola, decaffeinated tea, and broth. Ask your doctor about the amount of liquid you should be drinking every day. Also, ask your doctor whether you should use a sports drink (e.g., Gatorade®), which contains other substances, such as sodium and potassium, that may be lost along with body fluid. Follow your doctor's directions very carefully.
  • Because alcohol and caffeine can increase fluid loss, you should not drink beverages or take any medicines that contain them while you have diarrhea. Also, avoid eating foods that may make diarrhea worse, such as bran, raw fruits or vegetables, or fatty, fried, or spicy foods.
  • Vomiting can also increase the amount of fluid lost by the body and increase the risk of dehydration. If vomiting occurs at the same time as diarrhea, check with your doctor right away.
  • Signs of too much fluid loss (dehydration) include decreased urination, dizziness or light-headedness, dryness of the mouth, fainting, increased thirst, and wrinkled skin. If any of these occur, check with your doctor immediately.

Irinotecan can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are needed for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Also, check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

Call your doctor right away if you have an unexplained fever, cough, shortness of breath, trouble with breathing, or wheezing after receiving irinotecan. These may be symptoms of a serious lung problem.

irinotecan may increase your risk of having blood clots. Tell your doctor right away if you start having a sudden and severe headache, trouble with breathing, or problems with vision, speech, or walking.

irinotecan may cause some people to become dizzy, drowsy, or less alert than they are normally. irinotecan may also cause blurred vision or other vision problems. If any of these side effects occur, do not drive, use machines, or do anything else that could be dangerous if you are not alert or not able to see well. If these reactions are especially bothersome, check with your doctor.

Ketoconazole (Nizoral®) and St. John's wort should not be used while you are receiving irinotecan. If you are using St. John's Wort, it should be discontinued at least 2 weeks before the first cycle of irinotecan. If you are using ketoconazole, it should be discontinued at least 1 week before starting irinotecan treatment.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

irinotecan Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
  • Anxiety
  • black, tarry stools
  • blood in the urine or stools
  • blurred vision
  • changes in skin color
  • chest pain or discomfort
  • chest tightness or heaviness
  • chills
  • clay colored stools
  • cold hands and feet
  • confusion
  • constricted pupils
  • cough or hoarseness
  • dark urine
  • diarrhea with or without stomach cramps or sweating
  • dizziness
  • fainting
  • fast, slow, or irregular heartbeat
  • fever
  • full or bloated feeling or pressure in the stomach
  • headache
  • increased production of saliva
  • increased tear production
  • itching
  • lightheadedness when getting up suddenly from a lying or sitting position
  • loss of appetite
  • low blood pressure or pulse
  • lower back or side pain
  • nausea or vomiting
  • numbness or tingling in the face, arms, or legs
  • pain
  • pain in the chest, groin, or legs, especially calves of the legs
  • pain in the shoulders, arms, jaw, or neck
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • redness or swelling of the leg
  • runny nose
  • severe headache of sudden onset
  • shortness of breath or troubled breathing
  • skin rash
  • slow breathing
  • slurred speech
  • sore throat
  • stomach pain
  • stopping of the heart
  • sudden and severe weakness in the arm or leg on one side of the body
  • sudden loss of coordination
  • sudden vision changes
  • sweating
  • swelling
  • swelling of the abdomen or stomach area
  • temporary blindness
  • tenderness, pain, or swelling of the arm, foot, or leg
  • trouble with speaking or walking
  • ulcers, sores, or white spots on the lips or in the mouth
  • unconsciousness
  • unpleasant breath odor
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting of blood
  • warm, red feeling over the body
  • yellow eyes or skin
Less common
  • Bleeding gums
  • coughing up blood
  • decreased urination
  • difficulty with swallowing
  • dryness of the mouth
  • increased menstrual flow or vaginal bleeding
  • increased thirst
  • nosebleeds
  • paralysis
  • prolonged bleeding from cuts
  • sneezing
  • wheezing
  • wrinkled skin
Rare
  • Decreased amount of urine
  • decreased frequency of urination
  • fast, irregular, or troubled breathing
  • hives
  • increased blood pressure
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rapid weight gain
Incidence not known
  • Abdominal or stomach pain and tenderness
  • agitation
  • bloated or full feeling
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • coma
  • constipation
  • depression
  • heartburn or indigestion
  • hostility
  • irritability
  • lethargy
  • muscle pain and cramps
  • muscle twitching
  • pain in the stomach, side, or abdomen, possibly radiating to the back
  • pain or discomfort in the arms, jaw, back, or neck
  • rectal bleeding
  • severe abdominal or stomach cramping or burning
  • severe and continuing nausea
  • stupor
  • swelling of the face, lower legs, ankles, fingers, or hands
  • tightness in the chest
  • unusual tiredness or weakness
  • vomiting of material that looks like coffee grounds

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Acid or sour stomach
  • belching
  • blistering, peeling, redness, or swelling of the palms of hands or bottoms of the feet
  • cracked lips
  • excess air or gas in the stomach or intestines
  • feeling of constant movement of self or surroundings
  • numbness, pain, tingling, or unusual sensations in the palms of hands or bottoms of feet
  • passing gas
  • right upper abdominal or stomach pain and fullness
  • sensation of spinning
  • sleepiness or unusual drowsiness
  • sleeplessness
  • stomach discomfort, upset, or pain
  • trouble sleeping
  • unable to sleep
  • weight loss
Incidence not known
  • Hiccups

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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