Irinotecan

The recommended dose and dosing schedule of irinotecan varies according to the stage of therapy, the stage of cancer, the response to therapy, and the person's body size. Irinotecan is given in cycles that include rest periods between treatments. It is injected into a vein through a specially prepared site on the skin. The appropriate dose of irinotecan is usually given by an infusion over a period of about 90 minutes. This cycle is repeated until it is determined that treatment is completed. Very careful handling of Irinotecan is required. Irinotecan is always used under the supervision of a doctor in a hospital or similar setting with access to sterile equipment for preparation.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, discuss any concerns you may have with your doctor.

It is important Irinotecan be given exactly as prescribed by your doctor. If you miss an appointment to receive irinotecan, contact your doctor as soon as possible to reschedule your appointment.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Each mL of sterile, clear, colourless-to-pale-yellow solution contains irinotecan HCl trihydrate 20 mg. Nonmedicinal ingredients: lactic acid, sorbitol, and water for injection. May contain sodium hydroxide or hydrochloric acid as pH adjusters.

Do not use Irinotecan if you:

• are allergic to irinotecan or any ingredients of Irinotecan
• are taking an azole antifungal (e.g., fluconazole, ketoconazole, itraconazole)
• have hereditary fructose intolerance
• have taken ketoconazole within the past week

There may be an interaction between irinotecan and any of the following:

• Amiodarone
• amphotericin B
• Apalutamide
• Aprepitant
• azole antifungal medications (e.g., fluconazole, ketoconazole, itraconazole)
• BCG
• Baricitinib
• Bicalutamide
• Bosentan
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• Carbamazepine
• Carvedilol
• Clozapine
• Cobicistat
• conivaptan
• Cyclosporine
• Deferiprone
• Denosumab
• Dipyridamole
• Dronedarone
• echinacea
• Elagolix
• Eliglustat
• Enzalutamide
• Eslicarbazepine
• Fingolimod
• Flibanserin
• Gemfibrozil
• grapefruit juice
• Hepatitis C antivirals (e.g., dasabuvir, glecaprevir, ombitasvir, paritaprevir, pibrentasvir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• laxatives
• Leflunomide
• Lomitapide
• macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin)
• Natalizumab
• Mesalamine
• mifepristone
• Mitotane
• Modafinil
• natalizumab
• Ocrelizumab
• Phenobarbital
• Phenytoin
• Pimecrolimus
• Prazosin
• primidone
• Propafenone
• quinidine
• quinine
• rifabutin
• rifampin
• Roflumilast
• St. John's wort
• Sarilumab
• Tacrolimus
• Tocilizumab
• Tofacitinib
• Tolvaptan
• tyrosine kinase inhibitors (e.g., Dabrafenib, imatinib, Nilotinib, Pazopanib, Sunitinib)
• vaccines
• valproate

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Irinotecan. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Irinotecan.

Anemia: Irinotecan may cause low levels of red blood cells. If you experience symptoms of reduced red blood cell count (anemia) such as shortness of breath, feeling unusually tired, or pale skin, contact your doctor as soon as possible.

Your doctor will do blood tests regularly to monitor the number of specific types of blood cells, including red blood cells, in your blood.

Bleeding: Irinotecan may cause a reduced number of platelets in the blood, which can make it difficult to stop cuts from bleeding. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Blood Clots: Irinotecan may increase the chance of blood clot formation, causing reduction of blood flow to organs or the extremities.

If you experience symptoms such as sharp pain and swelling in the leg, difficulty breathing, chest pain, blurred vision, or difficulty speaking, contact your doctor immediately.

Diabetes: Irinotecan may cause an increase in blood glucose levels. If you have diabetes, your doctor should closely monitor your condition while you are taking irinotecan. Discuss with your doctor how Irinotecan may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Irinotecan, and whether any special monitoring is needed.

Diarrhea: Diarrhea occurring more than 24 hours after treatment is a common side effect. Your doctor may recommend that you take oral (by mouth) Loperamide if diarrhea occurs. It is important that diarrhea be treated promptly and aggressively if it occurs. If you are taking loperamide as directed by your doctor and diarrhea continues for more than 48 hours, get medical attention immediately. It is also important that you drink plenty of fluids if diarrhea occurs.

Drowsiness/reduced alertness: Irinotecan can cause fatigue, dizziness or vision changes. Avoid activities such as driving or operating machinery if the medication affects you in this way.

Infection: As well as killing cancer cells, Irinotecan can reduce the number of cells that fight infection in the body (white blood cells). If possible, avoid contact with people with contagious infections. Tell your doctor if you begin to notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Lung inflammation: Rarely, lung inflammation (interstitial lung disease), causing difficulty breathing has occurred in some people taking Irinotecan. This complication can be serious and sometimes fatal. If you experience new or worsening shortness of breath or cough (with or without fever) at any time while you are being treated with irinotecan, contact your doctor immediately.

Vaccines: Live vaccines should not be given while you are being treated with irinotecan. Any required vaccinations should be completed before starting cancer treatment or postponed until treatment is complete.

Pregnancy: Irinotecan may cause birth defects if either the mother or the father is using irinotecan at the time of conception, or if it is taken during pregnancy. Both partners should use a reliable form of birth control while taking Irinotecan. If you become pregnant while using irinotecan, contact your doctor immediately.

Breast-feeding: It is not known if irinotecan passes into breast milk. Women should not breast-feed while using irinotecan due to the risk of harm to the infant.

Children: The safety and effectiveness of using Irinotecan have not been established for children.

Seniors: There is an increased risk of diarrhea for people over the age of 65. Discuss any concerns you may have with your doctor.