A chemotherapy regimen for patients with colorectal cancer and a number of other malignant pathologies often includes a drug such as Irinotecan. Cytostatic is prescribed in different dosage, the duration of the course is also selected for each patient individually.
Composition, Form and Packing
The main active ingredient of the medication is irinotecan hydrochloride trihydrate. Additional components - hydrochloric acid, lactic acid, sorbitol, sodium hydroxide, water is sterile.
Manufacturer
Produced in Russia by the company BIOCAD.
Indications for use
Irinotecan is used as the first line of chemotherapy for metastatic or locally advanced rectum and rectum cancer:
- In the form of monotherapy , that is, as the only antitumor drug, is given to patients with relapse after an antitumor treatment.
- In combination with other chemotherapeutic drugs , such as Folinate or Ftoruracil, is prescribed to patients with cancer as an initial antitumor treatment.
Irinotecan is a drug for the second line of chemotherapy treatment for small cell lung cancer and for ovarian cancer.
Contraindications
The drug is not assigned to patients:
- With chronic inflammatory processes in the intestine.
- With violation of patency of the intestine.
- With severe oppression of bone marrow hematopoiesis.
- With an increase of more than 1.5 times the level of bilirubin.
- If their overall status, as assessed by the adopted Voz scale, corresponds to> 2.
- Pregnant and lactating women.
- With increased sensitivity to irinotecan or other constituents of the drug.
- for children. The drug is not used in pediatric practice in the treatment of cancer due to the fact that there is no reliable data on its effectiveness and complete safety.
With care, irinotecan should be prescribed to those patients who have a history of radiation exposure to the abdominal cavity or pelvis, with leukocytosis. It should be borne in mind that in women, irinotecan increases the risk of diarrhea.
Pharmacological action
The main action is cytotoxic. After entering the body, the active substance interacts with a complex called I-DNA topoisomerase, after which the secondary cross-linking of DNA strands is prevented.
The DNA structure is broken and reproduction of cancer cells ceases.
Instructions for use Irinotecan: dosage
The dose of irinotecan and the general treatment regimen are selected by the doctor depending on how widespread the malignant process is, whether there are metastases. The patient's state of health and the readiness of the organism for chemical treatment are taken into account.
In combination therapy, the dosage is determined by the frequency of administration:
- In a weekly Irinotecan formulation, 80 mg / m2.
- In the mode of use, once every two weeks - 180 mg / m2.
- With the appointment mode at 6 weeks, once - 350 mg / m2.
Irinotecan treatment is long enough. The drug is canceled in two cases - if there are signs of progression of the disease or when the patient develops unacceptable and dangerous toxicity.
The solution is prepared from two components - actually Irinotecan in the required dose and from 5% glucose or 0.9% sodium chloride in the amount of 250 ml.
After mixing, the medicine bottle is carefully rotated so that no sediment remains in it. The medicine is prepared and administered with observance of all asepsis rules.
Side effects of
The treatment of any antitumor drugs develops a mass of adverse reactions.
For Irinotecan, the most characteristic of them is:
- Nausea with vomiting.
- Diarrhea or constipation.
- Colitis.
- Intestinal obstruction.
- Hemorrhages in the gastrointestinal tract.
- Alopecia.
- In the blood - neutropenia, signs of anemia, thrombocytopenia.
- Dehydration.
- Hypokalemia and hyponatremia.
- Increased sweating.
- Frequent dizziness until fainting.
- Chills.
- Visual function disorder.
- Increased lacrimation.
- General malaise.
- Falling blood pressure.
- Convulsions.
- Allergic reactions, manifested mainly on the skin.
Overdose
An overdose is possible if a single dose of irinotecan is exceeded twice.
There is a complication of heavily flowing diarrhea, a significant neutropenia in the blood. A lethal outcome is not excluded.
There is no specific antidote, drugs are selected depending on pathological changes. In severe cases, hospitalization and control of vital body functions are indicated.
Special instructions
Irinotecan is used only in specialized hospitals with various departments. The main condition is the presence of an intensive care unit. Treatment is carried out under the supervision of a qualified oncologist.
It should be noted that with hyperbilirubinemia, the risk of developing severe neutropenia is increased.
Patients of both sexes who are in reproductive age must strictly follow the contraceptive measures not only during treatment with irinotecan, but also at least three months after the completion of therapy.
If diarrhea is accompanied by frequent loose stools( more than 6 times a day), false urge to defecate, profuse vomiting, colic and fever, the patient is transferred to the intensive care unit. With the preventive purpose, antibiotics, which belong to the broad spectrum of the group, can also be prescribed with easily flowing diarrhea.
The acute cholinergic syndrome evolving against the background of treatment with Irinotecan is stopped by subcutaneous administration of atropine in an amount of 0.25 mg.
For febrile neutropenia( with a temperature of more than 38 degrees and neutrophils in an amount of less than 1 thousand / μL), the use of intravenous antibiotics is necessary.
Patients should be warned that during the therapy with irinotecan, care must be taken when driving vehicles. Care is also taken when handling complex instruments and mechanisms, that is, where concentration of attention should be increased.
Drug Interaction
When prescribing irinotecan, it is necessary to find out which medications the patient is still using:
- With the simultaneous use of irinotecan and hematotoxic medications, the development of thrombocytopenia and leukopenia is possible.
- Radiation exposure aggravates myelodepression.
- Glucocorticosteroids increase the likelihood of lymphocytopenia and hyperglycemia.
- Diuretics increase dehydration.
- Immunosuppressants increase the likelihood of infectious complications.
During the period of using irinotecan and after treatment for a period of 3 to 12 months, vaccination is canceled.
Combination of antitumor drugs and vaccines increases the side effects of the latter drugs and reduces the production of antibodies.
Reviews
High antitumor activity of irinotecan is evaluated by most oncologists involved in the therapy of malignant diseases of the rectum.
The use of this drug has increased the effectiveness of therapy.
The use of irinotecan in the first line of chemotherapy with Leykvoron and Fluorouracil is considered to be a priority. This scheme of antitumor treatment for today is standard.
The use of the standard regimen has increased the life expectancy of patients with colorectal cancer and reduced the number of relapses. However, in most cases, the disease could not be completely defeated.
Prices for Irinotecan in Moscow
Concentrated solution Irinotecan 100mg / 5ml is in a number of Moscow pharmacies. 1950.00 rub.
Analogs
Refnod, Velcade, Hydroxycarbamide, Prospidin.
Synonyms of medication
Irinax, Irinotecan actavis, Irinotecan medak, Irinotel, Iriten, Irinotecan-Filaxis, Irnokam, Camptothecan, Campto, Kolotekan, Irinotecan-Teva.
Conditions for dispensing from pharmacies
Irinotecan is sold in pharmacies according to a prescription.
Storage conditions and shelf life
Concentrated solution should be stored in an undisclosed vial at a temperature not 25 degrees Celsius. Shelf life - two years from the date of issue. The diluted solution must be administered to the patient within 6 hours.