toe-poe-TEE-kan
High Alert
Absorption: IV administration results in complete bioavailability. 40% absorbed following oral administration.
Distribution: Well distributed to tissues.
Half-Life: PO: 3–6 hr; IV: 2–3 hr.
Contraindicated in:
Use Cautiously in:
Derm: alopecia
GI: abdominal pain, diarrhea, nausea, vomiting, ↑liver enzymes, anorexia, constipation, stomatitis
Hemat: anemia, neutropenia, thrombocytopenia
MS: arthralgia
Drug-drug:
Renal Impairment
Renal Impairment
Monitor for bone marrow depression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and 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.
Lab Test Considerations:
Monitor CBC with differential and platelet count before administration and frequently during therapy. Baseline neutrophil count ≥1500 cells/mm3 and platelet count ≥100,000 cells/mm3 are required before 1st dose. The nadir of neutropenia occurs in 11 days, with a duration of 7 days. The nadir of thrombocytopenia occurs in 15 days, with a duration of 5 days. The nadir of anemia occurs in 15 days. Subsequent doses should not be administered until neutrophils recover to >1000 cells/mm3, platelets recover to >100,000 cells/mm3, and hemoglobin levels recover to 9 g/dL. Topotecan monotherapy: If neutrophils <500 cells/mm3 or platelets <25,000 cells/mm3,↓ dose to 1.25 mg/m2 or administer granulocyte-colony stimulating factor (G-CSF) starting no sooner than 24 hr following the last dose (specifically for neutropenia). When topotecan used with cisplatin:If febrile neutropenia (neutrophils <1000 cells/mm3 with temperature of ≥100.4°F or platelets <25,000 cells/mm3, ↓dose to 0.6 mg/m2 (and to 0.45 mg/m2 if necessary) or administer G-CSF starting no sooner than 24 hr following the last dose (specifically for neutropenia).
IV Administration:
Advise patient to notify health care provider if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or signs and symptoms of interstitial lung disease occur. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Patient should be cautioned not to drink alcoholic beverages or take products containing aspirin or NSAIDs.