Irinotecan is used on its own or together with other anti-cancer medicines to treat cancer of the colon, rectum or pancreas.
This medicine is available as conventional and lipid formulation.
Irinotecan conventional formulation is used on its own or together with other medicines to treat advanced cancer of the colon or rectum.
Irinotecan lipid formulation is used together with other medicines to treat cancer of the pancreas for those who have failed previous therapy and the tumour has spread to other parts of the body.
This medicine may be used to treat other conditions as decided by your doctor.
Irinotecan is to be given intravenously (into the vein) as an infusion. It is delivered directly into the bloodstream via the blood vessel.
Your doctor or nurse will administer the injection for you.
You will need to rest in the hospital ward or clinic while you are on this medicine drip.
Before starting Irinotecan drip, you may be given other medicines to prevent or lessen the side effects of Irinotecan. These medicines may be given as tablets or as injections.
The dose of Irinotecan will be decided by your doctor. Your doctor will advise you on the course of your treatment depending on the type and severity of your condition, effectiveness of the therapy, and your tolerability to this medicine.
This medicine must be administered regularly for it to be effective. Continue Irinotecan therapy even when you feel better. Do not stop your treatment unless instructed by your doctor.
Ensure that you keep all appointments with your doctor so that you do not miss any doses. Your doctor also needs to regularly monitor your response to Irinotecan.
If you miss an appointment or miss an infusion, alert your doctor or nurse. A replacement appointment or infusion should be given as soon as possible.
Alert your doctor if you have the following conditions:
- long-term inflammatory bowel disease or bowel obstruction
- severe bone marrow failure
- high bilirubin level
- high liver enzymes
- generalised weakness
as Irinotecan may not be suitable for you.
Do not take this medicine if you are pregnant. If you become pregnant while on Irinotecan therapy, alert your doctor immediately. This medicine may cause harm to your unborn child.
It is important that you do not get pregnant while taking this medicine. You must use proven birth control methods during Irinotecan therapy and 1 month after stopping the treatment. Birth control medicines containing hormones may not be effective. You may wish to discuss other reliable methods of birth control with your doctor.
Men should also use birth control methods (e.g. condoms) during treatment with this medicine and for 4 months after stopping the treatment.
Do not breastfeed while you are being treated with this medicine.
Do not use Irinotecan with certain herbal supplement such as St. John’s wort.
Alert your doctor if you have been recently vaccinated or if you are planning to get vaccinated. You must avoid any live vaccinations without consulting with your doctor.
Inform your doctor if you have the following conditions:
- Gilbert syndrome (inherited disorder where the liver does not properly process bilirubin in the body)
- previously received radiotherapy to the hip or abdomen region
- history of Whipple procedure (surgical procedure to remove a part of pancreas and stomach)
- heart disease
- liver disease
- kidney disease
- conditions which increase the risk of heart disease e.g. high blood pressure, high cholesterol levels, smoking
- low body weight (body mass index of <18.5 kg/m2)
Be sure to check with your doctor or pharmacist before using Irinotecan to an elderly.
A certain enzyme called UGT1A1 is involved in the breakdown of this medicine in the body. Individuals who have reduced UGT1A1 activity, known as UGT1A1 poor metabolisers, and those with certain genes known as UGT1A1*28/*28
may experience enhanced side effects of Irinotecan (e.g. low levels of white blood cells in the body, diarrhoea). Although not routinely done, your doctor may perform genetic testing before giving you this medicine. If you know you have this gene type, inform your doctor.
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- You may need to have routine blood tests (e.g. complete blood count, liver function test, bilirubin, electrolytes) before and during your treatment with Irinotecan. Your doctor will advise you about how often you will need to have these tests.
- Regular monitoring for signs and symptoms of blood infection, delayed diarrhoea, lung problems, and infusion site reactions may be needed.
Irinotecan may cause dizziness and some problems with your eyesight. If affected, do not drive or take part in any activity in which you need to be alert.
You may experience diarrhoea while being treated with this medicine. As soon as the first loose stool occurs, drink lots of fluids (e.g. water, soda water, “fizzy” drinks, soup) to replace the fluids lost. Your doctor may also give you medicines for diarrhoea. However, if you have diarrhoea that lasts more than 24 hours, or if you experience light-headedness or fainting, alert your doctor immediately.
Other side effects include any of the following: nausea, vomiting, stomach pain, constipation, decreased appetite, weight loss, difficulty sleeping, fever, tiredness, and hair loss (reversible).
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- rashes, breathlessness, swollen face, eyes, tongue or throat
- diarrhoea with increased salivation, watery eyes, increased sweating, and stomach cramps
- new or worsening cough, difficulty breathing, fever
- pain, swelling and tenderness in your leg accompanied by redness and warmth, chest pain
This medicine will cause the level of your red blood cells, white blood cells and platelets to drop.
Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.
White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Alert your doctor if you have a fever or a cough or flu that does not go away.
Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Alert your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not use Irinotecan with St. John’s wort (herbal supplement).
Avoid live vaccinations during treatment with this medicine. Alert your doctor if you have been recently vaccinated or if you are planning to get vaccinated.
Inform your doctor and pharmacist if you are taking or using any of these medicines:
- other medicines for cancer e.g. crizotinib, idelalisib, regorafenib
- medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenytoin, phenobarbital
- medicines to treat fungal infections e.g. ketoconazole, itraconazole, voriconazole, posaconazole
- certain antibiotics e.g. erythromycin, clarithromycin, telithromycin
- medicines for tuberculosis or TB e.g. rifampicin, rifabutin
- medicines for HIV infection e.g. atazanavir, indinavir, ritonavir, nelfinavir, lopinavir
- medicines used in organ transplant or certain immune disorders e.g. ciclosporin, tacrolimus
- blood-thinning medicine e.g. warfarin
- muscle relaxant used during surgery e.g. suxamethonium
This list does not include all medicines that may interact with Irinotecan.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
Avoid excessive consumption of grapefruit or grapefruit juice.
Store in a cool, dry place away from the reach of children.
Keep the conventional formulation at room temperature between 15-30°C. Protect from light.
The lipid formulation must be stored in the refrigerator between 2-8°C. Protect from light. Do not freeze the lipid formulation otherwise, it will no longer be effective and should not be used.
If you notice that the injection has changed colour or has become cloudy, do not use it. Throw it away and use a new injection.
Medicines must not be used past the expiry date.
As this is a cancer medicine, always return any unused or expired medicine to the clinic, hospital, or pharmacy for disposal. Do not throw it away in the household waste.