Names and pronunciation
(ear-een-oh-tee′kan) Camptosar
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Individual generic drug information
Extracted information for irinotecan only.
(ear-een-oh-tee′kan) Camptosar
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Func. class.: Antineoplastic
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Chem. class.: Camptothecin analog
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ACTION: Cytotoxic by producing damage to single-strand DNA during DNA synthesis; binds to topoisomerase I
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USES: Metastatic carcinoma of the colon or rectum or 1st-line treatment in combination with 5-FU and leucovorin for metastatic colon or rectal carcinomas
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Unlabeled uses: Pancreatic cancer
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Extracted information for irinotecan only.
CONTRAINDICATIONS: Preg- nancy, hypersensitivity Precautions: Breastfeeding, children, geriatric patients, irradiation, hepatic disease
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Black Box Warning: Myelosuppression, diarrhea/dehydration Black Box Warning: Myelosuppres- sion: CBC, differential, platelet count weekly; use colony-stimulating factor if WBC <2000/mm3 or platelet count <100,000/mm3, HB ≤9 g/dL, neutrophil ≤1000/mm3; notify prescriber of results; product should be discontinued • Buccal cavity for dryness, sores or ul- ceration, white patches, oral pain, bleed- ing, dysphagia Black Box Warning: GI symptoms: fre- quency of stools; cramping; severe, life- threatening diarrhea may occur with fluid and electrolyte imbalances, treat diarrhea within 24 hr of use with 0.25-1 mg atro- pine IV; treat diarrhea >24 hr of use with loperamide, diarrhea >24 hr (late diar- rhea) can be fatal • Signs of dehydration: rapid respira- tions, poor skin turgor, decreased urine output, dry skin, restlessness, weakness • Bone marrow depression: bruising, bleeding, blood in stools, urine, sputum, emesis • Increased fluid intake to 2-3 L/day to prevent dehydration unless contraindi- cated Black Box Warning: To report diarrhea that occurs 24 hr after administration; severe dehydration can occur rapidly, may be fatal • To report immediately injection site pain, irritation • To report vomiting, dizziness • That regular lab exams will be needed • To report if pregnancy is planned or suspected; to use contraception during therapy HIGH ALERT
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SIDE EFFECTS CNS: Fever, headache, chills, dizziness CV: Vasodilation, edema, thromboembolism GI: Severe diarrhea, nausea, vomit ing, anorexia, constipation, cramps, flatus, stomatitis, dyspepsia, hepato toxicity HEMA: Leukopenia, anemia, neutropenia INTEG: Irritation at site, rash, sweating, alopecia MISC: Edema, asthenia, weight loss, back pain RESP: Dyspnea, increased cough, rhinitis
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INTERACTIONS Increase: toxicity—fluorouracil Increase: bleeding risk—NSAIDs, anti- coagulants Increase: irinotecan levels—some CYP3A4 inhibitors (ketoconazole) Increase: myelosuppression, diarrhea— other antineoplastics, radiation Increase: lymphocytopenia, hyperglyce- mia—dexamethasone Increase: akathisia—prochlorperazine Increase: dehydration—diuretics Decrease: irinotecan levels—CYP3A4 inducers (phenytoin, carBAMazepine, PHENobarbital) Drug/Herb Decrease: product level—St. John’s wort; avoid concurrent use Drug/Lab Test Increase: alk phos, LFTs, bilirubin Decrease: platelets, WBC, neutrophils, HB/HcT
Source page 720
Extracted information for irinotecan only.
DOSAGE AND ROUTES Premedications: atropine 0.25 to 1 mg IV or SUBCUT in patients with cholinergic symptoms (increased salivation, rhinitis, miosis, diaphoresis, abdominal cramp- ing) or early-onset diarrhea. Antiemetics are recommended First-line treatment colorectal can- cer, metastatic with 5-FU Adult: IV: 125 mg/m2 over 90 min fol- lowed by leucovorin 20 mg/m2 IV bolus, then 5-FU 500 mg/m2 IV bolus on days 1, 8, 15, and 22 of a 6-wk treatment cycle (may adjust upward to 150 mg/m2 if tolerated); Non-small cell lung cancer, advanced (unlabeled) Adult: IV: 60 mg/m2 days 1, 8, and 15 every 4 wk (in combination with cisplatin) Pancreatic cancer, advanced or metastatic (unlabeled) Adult: IV: FOLFIRINOX regimen: 180 mg/m2 over 90 min every 2 wk (in com- bination with oxaliplatin, leucovorin, and fluorouracil)
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Available forms: Inj 20 mg/mL
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Administer: • Use cytotoxic handling precautions IV route • Premedicate with antiemetic dexa- methasone plus another antiemetic agent, such as a 5-HT3 blocker, given at least 30 min before use • Before beginning a course of therapy, the granulocyte count should be ≥1.5 × 10 9/L, the platelet count recovered to ≥100 × 10 9/L, and treatment-related di arrhea should be fully resolved Dilution • Dilute appropriate dose in D5W (pre- ferred) or NS injection to a final concen- tration of 0.12-2.8 mg/mL • Store up to 24 hr at room temperature and room lighting; however, because of possible microbial contamination during preparation, an admixture prepared with D5W or NS should be used within 6 hr, solu- tions prepared with D5W, refrigerated, pro- tected from light must be used within 48 hr; avoid refrigeration if prepared with NS Intravenous infusion • Infuse over 90 min compatibilities: Alemtuzumab, Y-site alfentanil, amifostine, amikacin, aminoca- proic acid, aminophylline, amiodarone, ampicillin, ampicillin-sulbactam, anidula- fungin, argatroban, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, capreomycin, CARBO- platin, caspofungin, ceFAZolin, cefotetan, cefOXitin, cefTAZidime, cefTAZidime (L-arginine), ceftizoxime, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophospha- mide, cycloSPORINE, cytarabine, dacarba- zine, DAPTOmycin, DAUNOrubicin lipo- some, DAUNOrubicin, dexamethasone, dexrazoxane, digoxin, diltiaZEM, diphen- hydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPI- NEPHrine, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, flucon- azole, foscarnet, gallium, garenoxacin, gatifloxacin, gemtuzumab, gentamicin, granisetron, haloperidol, heparin, hydrAL- AZINE, hydrocortisone, HYDROmor- phone, hydrOXYzine, IDArubicin, imipe- nem-cilastatin, inamrinone, insulin, regular, isoproterenol, ketorolac, labet- alol, lepirudin, leucovorin, levoFLOXacin, LEVOleucovorin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, meperidine, meropenem, mesna, metaraminol, methadone, methyl- dopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANTRONE, mivacu- rium, morphine, moxifloxacin, nalbu- phine, naloxone, nesiritide, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, PACLitaxel (sol- vent/surfactant), palonosetron, pan- curonium, pantoprazole, pentamidine, pentazocine, PHENobarbital, phentol- amine, phenylephrine, polymyxin B, potassium acetate, chloride/phosphates, procainamide, prochlorperazine, pro- methazine, propranolol, quiNIDine, qui- nupristin-dalfopristin, raNITIdine, remi- I fentanil, riTUXimab, rocuronium, sodium acetate, bicarbonate/phosphates, succi- nylcholine, SUFentanil, sulfamethoxazole- trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, ticarcil- lin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimethobenza- mide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
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Extracted information for irinotecan only.
Assess: • CNS symptoms: fever, headache, chills, dizziness
Source page 720
Evaluate: • Therapeutic response: decrease in tu- mor size, spread of cancer
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid foods with citric acid, hot temperature, or rough texture if sto- matitis is present; to drink adequate fluids • To report stomatitis; any bleeding, white spots, ulcerations in mouth; to examine mouth daily, report symptoms • To report signs of anemia: fatigue, headache, faintness, SOB, irritability, in- fection, rash • To use contraception during therapy • To avoid salicylates, NSAIDs, alcohol because bleeding may occur; to avoid all products unless approved by pre- scriber • About alopecia; that when hair grows back, it may be different in texture, thickness • To avoid vaccinations while taking this product
Source page 720
Extracted information for irinotecan only.
PHARMACOKINETICS Rapidly and completely absorbed, excreted in urine and bile as metabo- lites, half-life 6-12 hr, bound to plasma proteins 30%-68%, increased risk for toxicity in patients homozygous for UGT1A1 28
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Filter the extracted dose blocks for this individual drug.