eye-ri-noe-TEE-kan
High Alert
Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Protein Binding: Irinotecan: 30–68%; SN-38 (active metabolite): 95%.
Half-Life: 6 hr.
Contraindicated in:
Use Cautiously in:
CV: edema, vasodilation
Derm: alopecia, rash, sweating
EENT: rhinitis
F and E: dehydration
GI: abdominal pain/cramping, anorexia, constipation, diarrhea, dyspepsia, flatulence, nausea, stomatitis, vomiting, weight loss, ↑liver enzymes, abdominal enlargement, colonic ulceration
GU: ↓fertility, menstrual abnormalities
Hemat: anemia, neutropenia, THROMBOCYTOPENIA
Local: injection site reactions
MS: back pain
Neuro: dizziness, headache, insomnia, weakness.
Drug-drug:
Drug-Natural Products:
Single Agent
Hepatic Impairment
As Part of Combination Therapy With Leucovorin and 5-Fluorouracil
Monitor for bone marrow suppression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis). Avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Monitor closely for the development of diarrhea. Two types may occur. The early type occurs within 24 hr of administration and may be preceded by cramps and sweating. Atropine 0.25–1 mg IV or SUBQ may be given to ↓ symptoms. Potentially life-threatening diarrhea may occur >24 hr after a dose; may be accompanied by severe dehydration and electrolyte imbalance. Loperamide 4 mg initially, followed by 2 mg every 2 hr until diarrhea ceases for >12 hr (or 4 mg every 4 hr if given during sleeping hours) should be administered promptly to treat late-occurring diarrhea. Do not administer loperamide at these doses for >48 hr. Careful fluid and electrolyte replacement should be instituted to prevent complications. If diarrhea of 2–3 stools/day pretreatment occurs, maintain dose. If 4–6 stools/day more than pretreatment occurs during a cycle,↓ by 25 mg/m2. If 4–6 stools/day more than pretreatment occurs at the beginning of a weekly cycle or at the beginning of a once-every-3-wk cycle, maintain dose. If 7–9 stools/day more than pretreatment occurs during a cycle, hold dose until resolved to Grade ≤2; then ↓ by 25 mg/m2. If 7–9 stools/day more than pretreatment occurs at the beginning of a weekly cycle,↓ by 25 mg/m2. If 7–9 stools/day more than pretreatment occurs at the beginning of a once-every-3-wk cycle,↓ by 50 mg/m2. If ≥10 stools/day more than pretreatment occurs during a cycle, hold dose until resolved to Grade ≤2; then ↓ by 50 mg/m2. If ≥10 stools/day more than pretreatment occurs at the beginning of a weekly cycle or at the beginning of a once-every-3-wk cycle,↓ by 50 mg/m2. If ileus, fever, or severe neutropenia occurs, initiate antibiotic therapy.
Lab Test Considerations:
Monitor CBC with differential and platelet count before each dose. If neutropenia with ANC 1500–1999/mm3 occurs, maintain dose. If ANC 1000–1499/mm3 occurs during a cycle,↓ dose by 25 mg/m2. If ANC 1000–1499/mm3 occurs at beginning of cycle, maintain dose. If ANC 500–999/mm3 occurs during a cycle, hold dose until resolved to Grade ≤2; then ↓ by 25 mg/m2. If ANC 500–999/mm3 occurs at the beginning of a weekly cycle,↓ dose by 25 mg/m2. If ANC 500–999/mm3 occurs at the beginning of a once-every-3-wk cycle,↓ dose by 50 mg/m2. If ANC <500/mm3 occurs during a cycle, hold dose until resolved to Grade ≤2; then ↓ by 50 mg/m2. If ANC 500–999/mm3 occurs at the beginning of a weekly cycle or at the beginning of a once-every-3-wk cycle,↓ dose by 50 mg/m2. If neutropenic fever occurs during a cycle, hold dose until resolved; then ↓ by 50 mg/m2 when resolved. If neutropenic fever occurs at the beginning of a weekly cycle or at the beginning of a once-every-3-wk cycle,↓ by 50 mg/m2. Administration of a colony-stimulating factor may be considered if clinically significant ↓ in WBC (<2000/mm3), neutrophil count (<1000/mm3), hemoglobin (<9 g/dL), or platelet count (<100,000 cells/mm3) occur.
IV Administration:
Instruct patient to report occurrence of diarrhea to health care provider immediately if diarrhea occurs for 1st time during treatment; black or bloody stools; symptoms of dehydration such as light-headedness, dizziness, or faintness; inability to take fluids by mouth due to nausea or vomiting; or inability to get diarrhea under control within 24 hr. Diarrhea may be accompanied by severe dehydration and electrolyte imbalance. It may be life-threatening; treat promptly. Loperamide may be used for treatment up to 48 hr.
Instruct patient to monitor their temperature and to notify health care provider promptly if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to monitor temperature frequently and use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or other NSAIDs.