topotecan (Oral route)
Use only in patients with neutrophil counts greater than or equal to 1500 cells/mm(3) or greater and platelet counts 100,000 cells/mm(3) or greater, and monitor blood cell counts, as severe myelosuppression can occur .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antineoplastic Agent
Pharmacologic Class: Topoisomerase I Inhibitor
Uses For topotecan
Topotecan is used to treat small cell lung cancer that has relapsed or gotten worse. It belongs to the group of medicines known as antineoplastics or cancer medicines.
Topotecan 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 unwanted effects may occur. Some of these may be serious and must be reported to your doctor. Some effects, like hair loss, may not be serious but may cause concern. Some unwanted effects may occur after treatment with topotecan has stopped.
topotecan is available only with your doctor's prescription.
Before Using topotecan
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 topotecan, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to topotecan 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.
Appropriate studies have not been performed on the relationship of age to the effects of topotecan in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of topotecan in the elderly. However, elderly patients are more likely to have diarrhea and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving topotecan.
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 taking topotecan, 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 topotecan 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.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine
Using topotecan 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
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Doxorubicin Hydrochloride Liposome
- Influenza Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine
- Yellow Fever Vaccine
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. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of topotecan. Make sure you tell your doctor if you have any other medical problems, especially:
- Bone marrow depression, severe—Should not be used in patients with this condition.
- Interstitial lung disease (a serious lung problem), history of—Use with caution. May make this condition worse.
- Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper Use of topotecan
Medicines used to treat cancer are very strong and can have many side effects. Before receiving topotecan, make sure you understand all of the risks and benefits. It is important for you to work closely with your doctor during your treatment.
Take topotecan only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
Swallow the capsule whole with water. Do not open, crush, break, or chew it.
You may take topotecan with or without food.
Be careful not to handle broken or leaking capsules. If you get the contents from the capsule on your skin, wash the area with soap and water and call your doctor right away. If the medicine gets in your eyes, rinse them immediately with gently flowing water for at least 15 minutes and call your doctor right away.
Topotecan often causes nausea and vomiting. It is very important that you continue to receive the medicine even if it makes you feel ill. Ask your doctor for ways to lessen these effects.
The dose of topotecan will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of topotecan. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (capsules):
- For small cell lung cancer:
- Adults—Dose is based on body size and must be determined by your doctor. The dose is 2.3 milligrams per square meter of body surface area once a day for 5 days. Your dose will be repeated every 21 days.
- Children—Use and dose must be determined by your doctor.
- For small cell lung cancer:
If you miss a dose of topotecan, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
If you vomit after taking your medicine, call your doctor or pharmacist for instructions.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using topotecan
It is very important that your doctor check your progress at regular visits to make sure topotecan is working properly. Blood tests are needed to check for unwanted effects.
Using topotecan while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
Topotecan 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 necessary 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 right away if you think you are getting an infection or if you have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
- Check with your doctor right away 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. 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.
Topotecan may cause diarrhea, and in some cases it can be severe. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.
topotecan may cause some people to become more tired or weaker than they are normally. If either of these side effects occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert.
Stop using topotecan and check with your doctor right away if you have breathing problems, a cough, a fever, a fast heartbeat, or shortness of breath. These could be symptoms of a serious lung problem.
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.
topotecan 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 immediately if any of the following side effects occur:More common
- Black, tarry stools
- bleeding gums
- blood in the urine or stools
- chest pain
- lower back or side pain
- painful or difficult urination
- pale skin
- pinpoint red spots on the skin
- shortness of breath
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- swollen glands
- troubled breathing with exertion
- unusual bleeding or bruising
- unusual tiredness or weakness
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
- hair loss or thinning of the hair
- lack or loss of strength
- loss of appetite
- weight loss
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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