Irinotecan: side effects and precautions

Irinotecan is an anticancer drug that belongs to a class called plant alkaloids. It is also called Irinotecan Hydrochloride and Camptothecin-11, and is marketed under the trade names of Camputo, Irinotel, Inotecan, Iritecin, and Camptothecan.

Cancer cells are characterized by abnormal cell division, in which normal cells stop cell division by a certain signal, whereas cancer cells lose this ability to regulate the cell division to stop, resulting in an out-of-balance feature. Anticancer drugs show the action of stopping these cell divisions.

In general, anticancer drugs cause cancer cells to die by damaging RNA or DNA that is necessary for cell division, preventing further cell division. Anticancer drugs that act only during cell division are called cell cycle selective, and anticancer drugs that act when cells are at rest are classified as cell cycle non-selective. The schedule of anticancer drugs is based on the type of cancer cells, the rate of dividing, and the timing of administration that is likely to be effective. Therefore, the anticancer drugs are administered on a cycle-by-cycle basis. Irinotecan is a cell cycle-selective anticancer drug that inhibits cell division by blocking DNA synthesis. This drug is mainly used for rectal or colon cancer, stomach cancer, and lung cancer, and may also be used for other tumors.

How is Irinotecan administered?

Irinotecan is mixed with other fluids and given intravenously as directed by a doctor. Irinotecan is an irritating chemical, so leaving the vein can cause strong tissue damage or blister formation. Immediately after or during the administration of Irinotecan, the patient should inform the doctor immediately if the patient has a burning sensation, irritation, stabbing pain, swelling or redness at the site of administration.

What do patients need to tell their doctor before administering Irinotecan?

1. If the patient has had a previous allergy to the drug, the doctor should be informed in advance.
2. If a patient takes any other medications, including dietary supplements, prior to administration of Irinotecan, they must inform their doctor in advance. Patients should not take aspirin-containing formulations unless directed by a doctor. If a patient has been using the drug because of the diarrhea-causing side effects of Irinotecan, it should be avoided.
3. Irinotecan may have harmful effects on the unborn child. Both men and women should avoid child planning while receiving Irinotecan. Pregnancy should be avoided while Irinotecan is administered, and contraceptive methods such as condoms are recommended. Patients should consult their doctor about a safe pregnancy after treatment with irinotecan. Patients should not breastfeed while receiving Irinotecan.
4. Patients should inform their doctor in advance if they have liver disease, kidney disease, or bowel disease before taking Irinotecan.

What are the side effects of Irinotecan?

What patients should know first about side effects

1. Not most people experience all of the side effects listed here.
2. It is possible to predict the onset or duration of some side effects.
3. Some side effects are almost all recovered and disappear when treatment with irinotecan is terminated.
4. There are many ways to alleviate the side effects of irinotecan.

The following side effects are common in patients receiving Irinotecan (occurs in more than 30% of patients):

1. Diarrhea
   • Early type: Occurs within 24 hours of drug administration, and symptoms such as runny nose, increased salivation, increased tears, sweating, redness and abdominal pain may appear. It can also occur while this drug is being given to the patient, which must be informed to the healthcare provider.
   • Delayed type: It occurs 24 hours after drug administration, and generally peaks on the 11th day after treatment. Due to the risk of dehydration and electrolyte imbalance, patients must inform their healthcare provider.
2. Nausea, vomiting, loss of appetite, weight loss
3. Weakness
4. Decreased blood cell count (myelosuppression): White blood cells and red blood cells are temporarily reduced. This increases the risk of infection and can lead to anemia (dizziness).
   1. Estimated period to reach the minimum: 14-16 days
   2. Estimated period for recovery: 21-28 days
5. Fever
6. Hair loss

The following side effects may also occur in patients receiving Irinotecan (occurs in 10-29% of patients):

1. Difficulty breathing, coughing
2. Headache, insomnia
3. Dehydration
4. Chills
5. Skin rash
6. Constipation, abdominal bloating, heartburn (esophageal reflux)
7. Hot flushes during administration
8. Mouth ulcer
9. Foot and ankle swelling

Not all side effects of Irinotecan are listed here. Rare side effects, less than 10%, are not documented here. If a patient experiences unusual symptoms, these must be checked by a healthcare professional.

What are the side effects that patients should contact their healthcare provider right away?

1. High fever above 38℃, chills (signs of infection)
2. Dizziness, fainting, dizziness, dark urine (dehydration symptoms)

What are the side effects that patients should contact their healthcare provider for?

1. Diarrhea more than 4-6 times within a day despite taking antidiarrheal drugs
2. Vomiting more than 4-5 times a day
3. Nausea (disrupting daily life, not reduced to antiemetics)
4. Excessive fatigue (normal daily life impossible)
5. Mouth ulcer
6. Inform the healthcare provider if the patient experiences any other unusual symptoms.

What is the self-treatment for the side effects of irinotecan?

1. If there is pain, redness, or swelling at the site of the intravenous injection, place an ice on it and notify the doctor.
2. Unless otherwise instructed, it is recommended to drink at least 2-3 liters of water per day.
3. When the patient has softer stools than usual or frequent diarrhea begins, take the antidiarrheal prescribed by the doctor.
4. As there is a risk of getting an infection, it is better not to get close to people who are crowded or have a cold or other infection. If a patient shows signs of infection, such as a fever, contact a healthcare professional immediately. It is recommended that patients wash their hands frequently.
5. To reduce nausea, it is recommended to take prescribed antiemetics as directed and to eat small portions frequently.
6. To prevent mouth sores, it may be helpful to use a soft toothbrush, mix 1/2-1 teaspoon baking soda and 1/2-1 teaspoon salt in a cup of water and rinse three times a day. There is.
7. Patients should refrain from exposure to UV rays. For this, it is recommended to apply sunscreen or wear protective clothing. Patients should get adequate rest and ensure that their nutrition is well maintained.
8. Vaccinations should not be given without a doctor’s instructions.
9. If the patient experiences symptoms that appear to be side effects of Irinotecan, consult a healthcare provider. They will prepare patients with medications and treatments to relieve symptoms.