Irinotecan (Camptosar)

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Irinotecan (eye-rin-oh-tee-kan) (also known as Camptosar, CPT-11, irinotecan hydrochloride) is a chemotherapy drug used to treat colon or rectal cancer. It may also be used for other cancers.

With respect to colon or rectal cancer that has spread beyond the colorectum (metasticized), Irinotecan is used in combination with 5-FU and Leucovorin both before and after surgery. The combination is referred to as FOLFIRI. (For information about FOLFIRI, cilck here).

Irinotecan is a partly manmade drug which comes from an extract of a plant that grows in Asia called Campthotheca acuminata.

According to the American Cancer Society, Irinotecan is thought to work by blocking the action of an enzyme in cells called topoisomerese I. Cells need this enzyme to keep their DNA in the proper shape when they are dividing into 2 cells. Blocking this enzyme leads to breaks in the DNA, which leads to cell death. Because cancer cells divide faster than normal cells, they are more likely than normal cells to be affected by irinotecan.

Do not take any medications without first checking with your oncologist or nurse. (If you stop taking a medication prescribed by another doctor, let that doctor know.

Lowered platetlet count which can increase your risk of bleeding. Do not take aspirin, ibuprofen such as Mortin or Advil, products containing them, warafin (Coumadin), or vitamin E without checking with your doctor first. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

If you undergo surgery or other procedure, tell your doctor or dentist before hand that you are on Irinotecan.

Keep an anti nausea prescription filled and with you "just in case" so you can stop nausea quickly.

Do not get any vaccines during or after treatment without first checking with your doctor. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine.

Call your doctor if :

• You have pain your belly and cannot move your bowels, especially if you also have bloating and loss of appetite.
• You experience any unexpected symptoms, or they are worse than expected.
• You have a fever of 100.5 degrees F or higher.
• You get a new or worsening cough or trouble breathing. It may be a rare lung side effect.

NOTE: As a practical matter, if you experience chemotherapy related diarrhea, it is usually advisable to start with an over-the-counter medication such as Immodium rather than a stronger medication. Stronger medications can lead to constipation, which then has to be treated. This can become a back and forth seesaw making you very uncomfortable in the process. (For information about dealing with constipation, click here.)

To make life easier, patient advocates suggest that patients carry Immodium or another over-the-counter anti-diarrheal medication "just in case." The odds are that if diarrhea happens, you won't be able to immediately get to a pharmacy or other store to get anti-diarrheal medication. The sooner you start treating diarrhea, the sooner you are likely to get it under control. Uncontrolled diarrhea can leads to unnecessary complications - and feeling poorly to boot.

When taking Immodium, follow the instructions on the container. However, if the diarrhea is more like a watery liquid (not just loose bowels), experienced patient advocates have found that Immodium can be more effective if taken every two hours for 12 hours straight. It doesn't matter if the condition continues - one episode of watery diarrhea is enough to trigger the suggestion. DO NOT take this suggestion without checking with your health care team first.

Immediate Side Effects (start wtihin 24 hours of infusion)

• Early onset diarrhea. Diarrhea which occurs during infusion or soon after is referred to as "early onset diarrhea" as compared to "late onset diarrhea" which is diarrhea which occurs later. It is not advisable to treat early onset diarrhea because it usually clears up on its own. Treating such diarrhea can lead to constipation.
• Abdominal cramping (stomach pain) while the drug is being given
• Mild sweating, wtihout or without feeling warm
• Nausea/Vomiting.
• Dizziness and/or trouble with eyesight. If you experience this side effect, do not drive or operate machinery while it continues.

Common Side Effects That Start Later

• Diarrhea - Diarrhea must be treated immediately to prevent dehydration and other serious complications. In addition to an over the counter medication such as Imodium, it is advisable to get a prescription from your doctor to have on hand in case you need something more effective to help control this side effect. That medication as prescribed as soon as ou notice anay loose stools.
• Runny nose, increased salive, excess tears in the eyes, sweating, flushing and abdominal cramps (due to the fact that drug may affect part of your nervous sytem that controls body secretions. This is known as cholinergic syndrome. Medications from your doctor can help control these symptoms.
• Nausea/vomiting. As you will see if you click on the link, medication for nausea should always be kept on hand so you can take the medication on the first sign of nausea. Nausea can lead to vomiting which can lead to dehydration and complications.
• Lowered white blood cell count with increased risk of infection. To learn how to avoid infection, click here.
• Lowered platetlet count which can increase your risk of bleeding. Do not take aspirin, ibuprofen such as Mortin or Advil, products containing them, warafin (Coumadin), or vitamin E without checking with your doctor first. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.
• Temporary hair thinning or loss, including face and body hair
• Abdominal (belly) pain (cramping)
• Loss of appetite
• Fatigue

According to the American Cancer Society, the following symptoms are less common

• Cholinergic syndrome (may include runny nose, increased saliva, sweating, tearing in the eyes, flushing, abdominal cramps, and diarrhea)
• Sores in the mouth or on the lips*
• Constipation
• Skin rash
• Abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)

According to the American Cancer Society, the following symptoms are rare

• Llowered blood platelet count with increased risk of bleeding
• Major blood clots in the veins of the legs or lungs which can travel to other parts of the body. Tell your doctor immediately if you notice chest pain, shortness of breath, swelling, pain, redness or warmth in an arm or leg.
• Lowered red blood cell count (anemia)
• Shortness of breath
• Cough
• Feeling sleepy
• Allergic reaction with shortness of breath, itching, hives, swelling in the mouth or throat, or dizziness, which can happen with the first dose or later doses of this drug
• Death due to infection, bleeding, severe diarrhea, lung disease, or other problems

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop the above or any other problems.