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topotecan

Generic Name: topotecan (TOE poe TEE kan)
Brand Names: Hycamtin

What is topotecan?

Topotecan is a cancer medication that interferes with the growth and spread of cancer cells in the body.

Topotecan is used to treat ovarian cancer, small cell lung cancer, and certain types of cervical cancer.

Topotecan may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about topotecan?

Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Topotecan can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection.

Do not receive a "live" vaccine while you are being treated with topotecan, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.

Call your doctor at once if you have fever, chills, body aches, flu symptoms, pale skin, easy bruising or bleeding, severe diarrhea with fever or stomach pain, unusual weakness, white patches or sores inside your mouth or on your lips, or other signs of infection.

What should I discuss with my healthcare provider before using topotecan?

You should not use topotecan if you have:

severe bone marrow depression; or
if you are pregnant or breast-feeding.

Before using topotecan, tell your doctor if you have kidney disease. You may need a dose adjustment or special tests to safely use this medication.

FDA pregnancy category D. Do not use topotecan without telling your doctor if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. It is not known whether topotecan passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use topotecan?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Topotecan is usually given once daily for 5 days in a row. This treatment is then repeated every 21 days, usually for at least 4 treatments. It may take several weeks for your body to respond to the medication.

Topotecan capsules are taken by mouth. You may need to take two different colored capsules at one time. Make sure you know the difference between capsules because one contains 4 times as much topotecan as the other, even though they may look the same in size.

Take the topotecan capsule with a full glass (8 ounces) of water. You may take the medicine with or without food.

If you vomit after taking a topotecan capsule, do not take another dose that same day. Call your doctor for instructions.

Do not crush or break a topotecan capsule, or use a capsule that has been accidentally broken. The medicine from a broken capsule can be dangerous if it gets in your eyes or on your skin. If contact does occur, wash the area with soap and water, or rinse the eyes for at least 15 minutes with plain water. If you must handle a broken capsule, ask your doctor or pharmacist how to safely dispose of it. Store topotecan capsules in the refrigerator and protect them from light.

Topotecan injection is given through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion, and can take up to 30 minutes to complete.

Tell your doctor right away if any of this medicine gets on your skin during the injection. If this does happen, the exposed skin should be rinsed thoroughly with soap and warm water.

What happens if I miss a dose?

Call your doctor for instructions if you miss any of your topotecan doses.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose can cause bone marrow depression (fever, chills, body aches, flu symptoms, sores or white patches in your mouth, or other signs of infection).

What should I avoid while using topotecan?

Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection.

Topotecan can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Topotecan side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

fever, chills, body aches, flu symptoms;
diarrhea with fever and stomach cramps;
pain or burning when you urinate;
pale skin, easy bruising or bleeding, unusual weakness;
white patches or sores inside your mouth or on your lips; or
skin changes or severe irritation where the needle is placed.

Less serious side effects may include:

bruising or swelling where the medicine was injected;
tired feeling;
headache, body pain, joint or muscle pain;
mild skin rash;
nausea, diarrhea, vomiting; or
temporary hair loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Topotecan Dosing Information

Usual Adult Dose for Ovarian Cancer:

For use in metastatic carcinoma of the ovary after failure of initial or subsequent chemotherapy:

Dose: 1.5 mg/m2 by intravenous infusion over 30 minutes daily for 5 consecutive days, starting on day 1 of a 21 day course. In the absence of tumor progression, a minimum of 4 courses is recommended because tumor response may be delayed.

Usual Adult Dose for Cervical Cancer:

For use in stage IV-B, recurrent, or persistent carcinoma of the cervix which is not amenable to curative treatment with surgery and/or radiation therapy:

Dose: 0.75 mg/m2 by intravenous infusion over 30 minutes daily on days 1, 2, and 3; followed by cisplatin 50 mg/m2 by intravenous infusion on day 1 repeated every 21 days (a 21 day course).

Usual Adult Dose for Small Cell Lung Cancer:

Injection: For use in small cell lung cancer sensitive disease after failure of first-line chemotherapy:

Dose: 1.5 mg/m2 by intravenous infusion over 30 minutes daily for 5 consecutive days, starting on day 1 of a 21 day course. In the absence of tumor progression, a minimum of 4 courses is recommended because tumor response may be delayed.

Capsules: For use in the treatment of relapsed small cell lung cancer in patients with a prior complete or partial response who are at least 45 days from the end of first line chemotherapy:

Recommended dose of topotecan capsules: 2.3 mg/m2/day once daily for 5 consecutive days repeated every 21 days.

The calculated oral daily dose should be rounded to the nearest 0.25 mg. The minimum number of 1 mg and 0.25 mg capsules should be prescribed. The same number of capsules should be prescribed for each of the 5 dosing days.

Topotecan capsules may be taken with or without food. The capsules must be swallowed whole and must not be chewed, crushed, or divided. If a patient vomits after taking the dose of topotecan, the patient should not take a replacement dose.

Usual Pediatric Dose for Malignant Disease:

Safety and effectiveness in pediatric patients have not been established. However, two phase 1 trials have reported using doses in the range of 2 to 7.5 mg/m2 over 24 hours every 21 days.

What other drugs will affect topotecan?

Before using topotecan, tell your doctor if you also use cyclosporine (Gengraf, Neoral, Sandimmune).

This list is not complete and there may be other drugs that can interact with topotecan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your doctor or pharmacist can provide more information about topotecan.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.