• 1st line treatment metastatic colorectal cancer:
    • Combination therapy:
      • Regimen 1: 180mg/m² IV infusion over 30-90 min *1 on days 1, 15 and 29 of 42-day cycle then infusion with leucovorin and 5-fluorouracil
      • Regimen 2: 125mg/m² IV infusion over 90 min on days 1, 8, 15 and 22 of 42-day cycle, then bolus doses of leucovorin and 5-fluorouracil
    • Monotherapy:
      • Regimen 1: 125mg/m² IV infusion over 90 minutes on days 1, 8, 15 and 22, then 2 weeks off, then repeat
      • Regimen 2: 350mg/m2 IV infusion over 30-90 minutes every weeks

Injection: 20mg/mL

  • Patient should be pre-medicated with anti-emetics at least 30 min prior to infusion
  • Atropine considered in patients with cholinergic symptoms
  • For combination therapy, administer irinotecan, leucovorin then fluorouracil

Topoisomerase I inhibitor anticancer

It binds to topoisomerase I-DNA complexes, preventing religation of single-strand breaks

  • Anemia
  • Neutropenia
  • Leukopenia
  • Thrombocytopenia
  • Elevated bilirubin
  • Diarrhea
  • Nausea
  • Vomiting
  • Asthenia
  • Abdominal pain
  • Alopecia
  • Anorexia
  • Fever
  • Weight loss
  • Constipation
  • Mucositis
  • Stomatitis
  • Pain
  • Dyspnea
  • Dizziness
  • Cough
  • Insomnia
  • Headache
  • URI
  • Diaphoresis
  • Dehydration
  • Rash
  • Infection
  • Elevated LFTs
  • Edema
  • Abdominal distension
  • Somnolence
  • Vasodilation
  • Hypotension
  • Thromboembolism
  • Pneumonia
  • Confusion
  • Pregnancy 1st trimester
  • Bilirubin >2
  • GI obstruction
  • Severe myelosuppression
  • Avoid breastfeeding during treatment and for at least 7 days after discontinuing
  • Hypersensitivity to components/class

WARNING:

  • Diarrhea:
    • Both early and late forms of diarrhea can occur
    • Early diarrhea during or shortly after infusion may occur with cholinergic symptoms and abdominal cramping which may be prevented or ameliorated by atropine
    • Late diarrhea usually >24 hours after infusion can be life threatening and should be treated promptly with loperamide
    • Monitor and give fluid and electrolytes as needed
    • Institute antibiotic therapy if patients develop ileus, fever or severe neutropenia
    • Interrupt irinotecan and reduce subsequent doses if severe diarrhea occurs
  • Myelosuppression:
    • Severe myelosuppression may occur
    • Deaths reported due to sepsis following severe neutropenia
    • Temporarily omit irinotecan during cycle if febrile neutropenia or ANC <1000/mm3, resume reduced dose once ANC >1000/mm3
  • Carbamazepine
  • Clozapine
  • Cobicistat
  • Conivaptan
  • Darunavir
  • Fosamprenavir
  • Indinavir
  • Itraconazole
  • Lopinavir
  • Rifampin
  • Ritonavir
  • Live vaccines
  • Atazanavir
  • Ketoconazole

                          Drug Status

Availability Prescription only
Pregnancy Category D
Breastfeeding Contraindicated
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Campto 20mg/mL Injection 1’s Pfizer Labs Pfizer Labs
Glirin 40mg/2mL Injection 1’s Glenmark Pharma Glenmark Pharma
Glirin 100mg/5mL Injection 1’s Glenmark Pharma Glenmark Pharma
Irinotel 20mg/mL Injection 1’s Fresenius Kabi Nairobi Enterprises
Irinotel 100mg/5mL Injection 1’s Fresenius Kabi Nairobi Enterprises