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Scan.scot.nhs.uk

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.
CONTACT NUMBERS

Monday – Friday daytime hours
Edinburgh:
Ward 1
0131 537 2219
Dumfries: Isabel Williams 01387 241 380
Borders:
01896 826000, bleep 3041. Or contact treatment room 01896 826833
W.Lothian: Tina Gilbert
01506 419666 ext. 3991
01383 674 062

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.

Source: http://www.scan.scot.nhs.uk/Documents/Irinotecan%20infosheet%20-%2021082009.pdf

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