March 2006 SOUTH EAST SCOTLAND CANCER NETWORK Irinotecan: An Information Leaflet for GPs NB. ALL SUPPLIES w ill be dispensed by the HOSPITAL pharmacy Indication for Therapy
Irinotecan (CamptoTM) is a topoisomerase inhibitor cytotoxic drug and is given by intravenous infusion. It is used to treat patients with metastatic disease who have progressive disease resistant to 5-FU containing regimens, are symptomatic but generally well and who do not have bulky liver disease. Preparations Available Irinotecan is available as an intravenous infusion (CamptoTM). Recommended Dosage and Administration Irinotecan is given at a dose of 350 mg/m2 by intravenous infusion over 90 minutes every 21 days for up to 6 cycles. If severely deranged LFTs, it is given at a dose of 200 mg/m2. Atropine is used as premedication to prevent the acute cholinergic syndrome associated with Irinotecan administration. Adverse Effects and Drug Interactions Common toxicities include diarrhoea (severe 20%), myelosuppression 79% (severe 23%), alopecia, anti-cholinergic reaction, nausea, vomiting (severe 10%), sun sensitivity. Myelosuppression is common and can be profound. The combination of these toxicities may be life threatening. Patients will receive supplies of loperamide for self administration (late onset diarrhoea) and ciprofloxacin (prolonged diarrhoea), both with instructions for use. However, if prolonged or severe symptoms or associated with fever or dehydration, patient must be referred for urgent oncology review. Patient should contact G.P. and/or contact points below for advice: • If they have an increase in frequency of more than 4 bowel motions each day or develop cramping abdominal pains or night-time
diarrhoea which is not settling despite taking loperamide and ciprofloxacin and maintaining a good fluid intake. Admission may be required if symptoms not settling or associated with fever (>38°C) or dehydration. Parenteral support may be required.
• If they vomit more than once in a 24 hour period. • If they develop a fever (>38°C) or become shivery or unwell. Precautions and Contra-indications • Contraindicated in pregnancy or breast feeding. • Caution with inflammatory bowel disease, bowel obstruction, severe renal / liver dysfunction or jaundice. Drug Interactions • St John’s Wort, rifampicin, carbamazepine, phenobarbital, phenytoin (may decrease irinotecan activity). • Avoid concomitant use of ketoconazole (may increase irinotecan toxicity). Aspects of care for which the oncologists are responsible • Assessment, initiation, prescribing and administration of irinotecan. • Specialist review/clinic visits with monitoring of the patient and adjustments to dose according to toxicities. • Management of patients with severe chemotherapy toxicities including hospital admission if necessary. • Discontinuation of treatment. Aspects of care for which the General Practitioner are responsible • Take bloods for full blood counts, liver function tests and electrolytes and urea the morning before chemotherapy is due. • Management of mild chemotherapy side effects. • Discussion and referral of patients with severe side effects (contact points below, or responsible oncologist). Contact Points Monday – Friday daytime hours: Edinburgh: Ward 0131 537 2219 Pharmacy Medicines Information 0131 536 2920 Dumfries: 01387 241 380 Borders: 01896 826000, bleep 3041. Or contact treatment room 01896 826833 W.Lothian: 01506 419666 ext. 3991 01383 674 062
Out of hours: All hospitals:
Oncology registrar 0131 537 1000 (ask for on call oncology registrar) Version 1: (March 2006). This information was prepared by the Consultants from the Edinburgh Cancer Centre and the Pharmacists at the Western General Hospital, Edinburgh. IRINOTECAN PATIENT INFORMATION SHEET
The drug you have been given today is called Irinotecan and it has some potentially serious side effects that you need to be aware of. These side effects require certain treatments to reduce their risk to you. This sheet summarises what you need to do if you get side effects. However do not hesitate to contact your doctor or nurse if you have any concerns or questions. Irinotecan can cause you to have diarrhoea. It causes two different types of diarrhoea: Early onset – which starts less than 24 hours after the treatment. Delayed onset – which starts more than 24 hours after the treatment. DO NOT take the anti-diarrhoeal medication that you have been given for diarrhoea that starts within 24 hours of treatment. In this case contact the hospital. If you experience diarrhoea after 24 hours you MUST follow these instructions: AS SOON AS THE FIRST EPISODE OF DIARRHOEA OCCURS:
• Immediately take the anti-diarrhoeal tablets you have been given. They are called Loperamide. You
must take Loperamide 2mg capsules every 2 hours and continue taking these until 12 hours after the last episode of diarrhoea.
• If the diarrhoea reappears after this, continue to take the Loperamide 2mg capsules every 2 hours until
• If you have taken the Loperamide for 48 hours it is important that you then start to take the antibiotics
you were given for 7 days. These are called Ciprofloxacin. You should take Ciprofloxacin 250mg one tablet morning and evening. Please let the hospital know you have started to take these.
• DO NOT TAKE LOPERAMIDE CAPSULES FOR MORE THAN 48 CONSECUTIVE HOURS WITHOUT STARTING CIPROFLOXACIN.
• Please INFORM THE HOSPITAL if your diarrhoea is not improving despite these measures.
• PLEASE INFORM THE HOSPITAL IMMEDIATELY, AT ANY TIME, IF YOU HAVE A HIGH TEMPERATURE (more than 38°C) OR IF YOU FEEL SHIVERY OR UNWELL.
Also if you are having this diarrhoea it is important that you:
• Drink large amounts of rehydration fluids such as water, juices, soda water and soups. • Contact the hospital to inform them of your symptoms. • Contact the hospital immediately if you also have vomiting and/or a fever.
Out of hours (all hospitals) GP out of hours services. Remember to say you are receiving chemotherapy. If GP needs to contact oncology for advice, phone 0131 537 1000 (ask for oncology registrar). Version 1: (March 2006). This information was prepared by the Consultants from the Edinburgh Cancer Centre and the Pharmacists at the Western General Hospital, Edinburgh.
Paper 1: Background information on theuse of non-human primates Controls on the use of non-human primates 1.1 Controls on the use of non-human primates in research and testing in Britain In Section 5(6) of the Animals (Scientific Procedures) Act 1986 (ASPA), which regulates the use of laboratoryanimals in Britain, special mention is made of the use of non-human primates (as well as cats, do
Intrauterine Device and Adolescents Committee on ABSTRACT: The intrauterine device (IUD) is highly effective and widely used by Adolescent Health women throughout the world. Data support the safety of IUDs for most women, includ-ing adolescents. This document addresses the major benefits of IUD use in adolescents,a population at particular risk of unintended pregnancy. The committee