Topotecan

The recommended dose and dosing schedule of topotecan varies according to body size and the results of blood tests carried out before your treatment. It is injected into a vein through a specially prepared site on your skin. The appropriate dose is usually injected over 30 minutes, once daily for 5 consecutive days followed by 16 days without medication. This cycle is then repeated at least 3 more times.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. Your doctor may choose a schedule different from the one listed here.

Very careful handling of Topotecan is required. It is always given under the supervision of a doctor in a hospital or similar setting with access to sterile equipment for preparation.

As well as interfering with the genetic material DNA of cancer cells, topotecan can interfere with some of your normal cells. This can cause a number of side effects such as hair loss and mouth sores. Topotecan often causes nausea and vomiting, but you will be given medications to help control this. Your doctor, nurse, or pharmacist can advise you on how to reduce the effects of nausea and vomiting. Keep track of any side effects and report them to your doctor as suggested in the section, "What side effects are possible with Topotecan?"

It is important Topotecan be given exactly as recommended by your doctor. If you miss an appointment to receive topotecan, contact your doctor as soon as possible to reschedule your appointment.

Topotecan is stored at room temperature and protected from light.

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 vial of sterile lyophilized powder contains topotecan 4 mg (topotecan hydrochloride 4.48 mg). Nonmedicinal ingredients: mannitol and tartaric acid. Hydrochloric acid and/or sodium hydroxide may be added to adjust the pH.

Topotecan should not be used by anyone who:

• is allergic to topotecan or to any of the ingredients of the medication
• is breast-feeding
• is pregnant
• has severe depletion of neutrophils (white blood cells) or platelets
• has severely reduced kidney function

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

• antiarrythmics (e.g., Amiodarone, Dronedarone, quinidine)
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• BCG vaccine
• Carvedilol
• clarithromycin
• Clopidogrel
• Clozapine
• Cobicistat
• Cyclosporine
• Dabrafenib
• Denosumab
• echinacea
• Filgrastim
• Fingolimod
• Flibanserin
• grapefruit juice
• Hepatitis C antivirals (e.g., daclatasvir, dasabuvir, ledipasvir, velpatasvir)
• HIV protease inhibitors (e.g., darunavir, indinavir, lopinavir, saquinavir, tipranavir)
• Leflunomide
• macrolide antibiotics (e.g., azithromycin, clarithromycin)
• Natalizumab
• other cancer medications (e.g., Cisplatin, Carboplatin, Oxaliplatin, Trastuzumab)
• Pegfilgrastim
• Phenytoin
• Pimecrolimus
• protein kinase inhibitors (e.g., Crizotinib, Dasatinib, imatinib, Nilotinib)
• quinine
• Roflumilast
• Tacrolimus
• Tofacitinib
• Tolvaptan
• vaccines
• Verapamil

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 Topotecan. 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 Topotecan.

Anemia: Topotecan 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.

Blood clotting: Topotecan can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Extravasation: Topotecan may be irritating to your veins while it is being administered. Please let your nurse know immediately if you feel any burning or pain at the injection site while the medication is being given.

Infection: As well as killing cancer cells, Topotecan can reduce the number of cells that fight infection in the body (white blood cells). If possible, avoid contact with people who have contagious infections. Tell your doctor immediately 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: Topotecan can cause lung inflammation, especially for people with a history of lung problems (e.g., fibrosis, lung cancer, chest radiation). This can be serious and sometimes fatal. If you experience cough, fever, or shortness of breath, contact your doctor immediately.

Neutropenic colitis: Topotecan can cause neutropenic colitis, which is an inflammation of the colon associated with a decrease in white blood cells. If you experience abdominal pain with fever, seek immediate medical attention.

Weakness/tiredness: Topotecan is not expected to make you drowsy and impair your ability to drive or use machinery. However, it may make some people feel weak or tired. Do not drive or use machinery if you feel weak or tired.

Pregnancy: There is a possibility of birth defects with topotecan if it is taken during pregnancy. Effective birth control should be practiced while using Topotecan. If you become pregnant while taking Topotecan, contact your doctor immediately.

Breast-feeding: It is not known if topotecan passes into breast milk. Women who are receiving Topotecan should not breast-feed.

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