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Precautions and Warnings With Irinotecan

Specific Irinotecan Precautions and Warnings

Some warnings and precautions to be aware of prior to receiving this medication include the following:
 
  • You may experience certain side effects during or up to 24 hours after your irinotecan dose. Such side effects may include:
 
    • Diarrhea (sometimes called "early diarrhea")
    • Runny nose
    • Watery eyes
    • Increased salivation
    • Sweating
    • Flushing (sudden redness and warmth of the face, neck, and chest)
    • Abdominal (stomach) cramps
    • Constricted or shrinking pupils.
Tell your healthcare provider right away if you develop any of the above symptoms. He or she can give you certain medicines to help relieve the symptoms, and to prevent them from occurring with future doses.
  • You may also feel nauseated or vomit while receiving your dose, or even a day afterward. Your healthcare provider will give you medications called antiemetics at least 30 minutes before each injection to help reduce these symptoms. You may need to continue using these medicines for a day after your dosage is given. Tell your healthcare provider if your nausea and vomiting are so severe you cannot take food or liquid by mouth, or if you have been vomiting for more than 12 hours.
 
  • Most people develop "late-onset" diarrhea from irinotecan. This is diarrhea that occurs more than 24 hours after an infusion. Late diarrhea is usually treated with loperamide (Imodium® and others). Loperamide should be taken at the first sign of loose or frequent stools. Your healthcare provider will tell you how much loperamide to take, and you should follow his or her dosing instructions.
Let your healthcare provider know if diarrhea continues for more than 24 hours, or if you have symptoms of dehydration (lightheadedness, dizziness, or fainting). Late-onset diarrhea can be life-threatening, as it may lead to dehydration, electrolyte problems (an imbalance in body salts, such as potassium and sodium), infection, and kidney failure. You may need other treatment, such as intravenous (IV) fluids, electrolytes, and antibiotics, to prevent serious problems from occurring.
  • Tell your healthcare provider right away if you experience swelling, burning, stinging, or pain, or leakage of fluid around the IV site while receiving your irinotecan dose.
 
  • Like other chemotherapy medicines, irinotecan can decrease the bone marrow's ability to make blood cells. A decrease in white blood cells will make it difficult for your body to fight infection, a decrease in red blood cells can cause severe anemia, and a decrease in platelets can cause bleeding. Your healthcare provider will check your blood counts before each dose by using simple blood tests.
Try to avoid being around people who are sick or have an infection (such as the flu or a cold) during your treatment. Also, tell your healthcare provider if you develop any signs of an infection, such as:
    • A fever higher than 100.4°F
    • Fatigue
    • Pale skin
    • Shortness of breath
    • Unusual bleeding or bruising.
 
  • Your healthcare provider may recommend that you have a genetic test before starting irinotecan treatment. This is because people who have a variation in a gene known as UGT1A1 may have an increased risk for developing low white blood cell counts from irinotecan, and may need a lower initial irinotecan dose.
 
  • In clinical studies, people who were better able to carry out daily activities were generally more likely to tolerate treatment, compared to those who had limitations in their abilities to perform normal daily activities.
 
  • Serious intestinal inflammation and blockage (obstruction) have been reported in people receiving this medicine. Call your healthcare provider immediately if you have:
 
    • Dark or bloody stools
    • Abdominal (stomach) fullness or cramping
    • Vomiting.
 
  • Some people who received irinotecan developed blood clots; however, it is unknown whether irinotecan actually caused the blood clots. Nonetheless, it is important to seek medical attention if you develop symptoms of a blood clot, such as:
 
    • Vision or speech changes
    • Weakness or numbness on one side of the body
    • A severe headache
    • Chest pain (angina) or tightness
    • Unexplained shortness of breath or coughing up blood
    • Warmth, redness, swelling, or pain in one or both legs.
 
  • Severe allergic reactions have been reported in people receiving irinotecan. Seek immediate medical attention if you have signs of an allergic reaction, such as:
 
    • An unexplained rash
    • Hives
    • Itching
    • Swelling of the mouth, tongue, face, lips, or throat
    • Difficulty breathing or swallowing.
 
  • There have been reports of serious lung disease in people receiving irinotecan. The risk appears to be higher in certain people, including those who already have lung disease, have received radiation or colony stimulating factor treatment (medications used to increase blood cell production), or are taking other medications that can damage the lungs. Let your healthcare provider know if you have any signs of lung disease, such as:
 
    • Shortness of breath
    • Fever
    • Coughing.
 
  • This medicine may cause dizziness or vision problems up to 24 hours after each dose. These side effects could impair your ability to drive or operate heavy machinery. You should avoid these activities if you cannot do them safely.
 
  • Talk to your healthcare provider before getting any vaccination or immunization during irinotecan treatment. It is generally recommended that people receiving irinotecan not receive "live" vaccines (see Drug Interactions With Irinotecan for more information).
 
 
  • It is unknown if irinotecan passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to receiving the drug (see Camptosar and Breastfeeding).
 
  • Irinotecan is a pregnancy Category D medication. This means it is likely not safe for use during pregnancy (see Camptosar and Pregnancy).
 
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