Irinotecan

What is irinotecan?

Irinotecan is a medicine used to kill cancer cells. You may hear irinotecan called CPT-11 or by its brand name, Camptosar. Irinotecan comes in an injection form.

Before giving irinotecan to your child

Tell your doctor if your child has ever reacted badly to irinotecan or any other medicine, food, preservative, or colouring agent. Also tell your doctor if your child is receiving an antifungal medicine such as ketoconazole, itraconazole, or fluconazole.

Talk with your child's doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• infection or recent exposure to infection, such as chickenpox
• liver problems
• lung problems

How should you give your child irinotecan?

Irinotecan is a clear, light yellow liquid that a nurse will give by needle into your child's vein (intravenously or IV). Usually your child will get this medicine in the hospital clinic or nursing unit.

What are the possible side effects of irinotecan?

Diarrhea (loose, watery stools) is one of the common side effects of irinotecan. Irinotecan can cause early and late onset diarrhea. If it is not treated promptly, diarrhea may be life-threatening.

You must tell your child's doctor or nurse right away for both early and late onset diarrhea.

Early diarrhea:

• Starts while your child is getting irinotecan or 24 hours afterwards.
• Your child may experience other symptoms, such as runny nose, increased drooling, watery eyes, sweating, flushing, and stomach cramps.
• Let the doctor or nurse know about these symptoms right away.

Late diarrhea:

• Starts more than 24 hours after getting irinotecan, usually 5 to 11 days after irinotecan.
• You should have a supply of the medicine loperamide (Imodium) at home in case your child develops this type of diarrhea.
• Follow your doctor's instructions on how to give loperamide at home in case your child develops this type of diarrhea.
• Make sure you review with your doctor, clinic nurse, or clinic pharmacist what to do if your child develops this type of diarrhea at home.

Your child may also have some of these side effects while they take irinotecan. Check with your child's doctor if your child continues to have any of these side effects, if they do not go away, or they bother your child:

• hair loss
• sweating
• loss of appetite
• weight loss
• constipation
• nausea (upset stomach) and vomiting (throwing up)
• stomach pain or cramps
• trouble sleeping
• drowsiness
• sores on the mouth or lips

Call your child's doctor during office hours if your child has any of these side effects:

• diarrhea lasting more than 36 hours
• severe vomiting
• unusual tiredness or weakness
• yellow eyes or skin

Most of the following side effects are not common, and they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:

• fever or chills
• cough or sore throat
• pain or burning when passing urine
• diarrhea that occurs within the first 24 hours after irinotecan treatment
• signs of fluid loss due to diarrhea or vomiting such as fainting, dry and hot skin, extreme thirst, light-headedness, or dizziness
• black, tarry stools
• blood in urine or stools
• unusual bleeding or bruising
• fast, slow or uneven heartbeat
• pain in the chest, neck, or leg, especially calf
• severe headaches
• sudden and severe weakness in one part or side of the body
• trouble speaking or walking
• sudden vision changes
• shortness of breath or trouble breathing
• skin rash or itching

What safety measures you should take when your child is using irinotecan?

Your child will receive medicine to prevent upset stomach and throwing up caused by irinotecan.

Your child may lose their hair. It will grow back once treatment with irinotecan stops. Its colour and texture may change. Use a gentle shampoo and a soft brush.

Irinotecan may cause sores in the mouth. Rinse your child's mouth with a mouthwash made from baking soda to help keep it clean. Your nurse or pharmacist can review this with you. Avoid store-bought mouthwash as it may sting and cause dry mouth.

Diarrhea and severe vomiting can increase the risk of dehydration (loss of body fluid) and other serious problems. Symptoms of dehydration include dry hot skin, extreme thirst, feeling lightheaded or dizzy, urinating less, and dry mouth. Your child should drink plenty of clear liquids to replace the loss of body fluids. Your child may:

• Drink clear liquids, such as ginger ale, caffeine-free cola, diluted juices, broth, or Gatorade.
• Eat and drink in small amounts.

Irinotecan can lower the number of white blood cells in the blood temporarily, which increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections, especially when the blood count is low:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are very crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth. Your doctor, nurse, or dentist may suggest different ways to clean your child's mouth and teeth.
• You and your child should not touch their eyes or inside their nose without first washing your hands.
• Your child's nurse will review with you what to do in case of fever.

Your child should not receive any immunizations (vaccines) without the doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated for cancer. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps, and rubella (MMR), and the chicken pox vaccine.

Irinotecan can lower the number of platelets in the blood, which increases your child's risk of bleeding. You can take the following precautions:

• Be careful not to cut your child when using a razor, fingernail scissors, or toenail clippers.
• Be careful when shaving or waxing.
• Your child should avoid contact sports where bruising or injury could occur.
• Your child should not receive a permanent tattoo or any kind of body piercing.
• Before your child has surgery, including dental surgery, inform the doctor or dentist that your child is taking irinotecan.

There is a chance that irinotecan may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active it is best that they use some kind of birth control while receiving irinotecan. Tell the doctor right away if your child may be pregnant.

Irinotecan may affect other medicines. For example, some antifungal medicines and antibiotics may interact with irinotecan. Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).

Tell your doctor if your child is getting diuretics (water pills), such as furosemide, while getting irinotecan. There is a higher risk of serious problems caused by the loss of body fluid. If your child has severe diarrhea or vomiting, they can lose a lot of body fluid. Tell your doctor if your child has severe diarrhea or vomiting immediately.

Avoid giving laxatives such as PEG-Flakes, lactulose, or mineral oil to your child while they are getting irinotecan. There may be a greater risk of severe diarrhea.

Do not give grapefruit, grapefruit juice, or fruit punches with grapefruit juice to your child when they are receiving irinotecan treatment.

What other important information should you know about irinotecan?

• Keep a list of all medicines your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Gardez le irinotecan hors de la vue et de la portée de votre enfant. Conservez-le sous clé dans un endroit sécuritaire. Si votre enfant ingère trop de irinotecan, téléphonez à votre centre antipoison local à l'un des numéros suivants. Ces appels sont gratuits.

• Composez le 1-800-POISON-X, ou 1-844-764-7669, de n'importe où au Canada sauf au Québec.
• Composez le 1-800-463-5060 si vous habitez au Québec.