irinotecan hydrochloride trihydrate at a glance
Medicine class
Cytotoxic topoisomerase I inhibitor.
Usual role
Treatment of advanced or metastatic colorectal cancer.
Administration
Diluted and given into a vein by a specialist cancer team.
Key safety issue
Delayed diarrhoea and reduced neutrophils can become serious.
What is irinotecan hydrochloride trihydrate used for?
The selected UK product is licensed for adults with advanced colorectal cancer.
With fluorouracil and folinic acid when advanced disease has not previously been treated with chemotherapy.
Alone after failure of an established fluorouracil-containing treatment.
With cetuximab for EGFR-expressing, RAS wild-type metastatic colorectal cancer in specified settings.
With fluorouracil, folinic acid and bevacizumab as initial treatment for metastatic colon or rectal cancer.
With capecitabine, with or without bevacizumab, as initial treatment for metastatic colorectal cancer.
How does irinotecan hydrochloride trihydrate work?
Irinotecan is converted partly into the active metabolite SN-38. Both inhibit topoisomerase I, causing DNA damage when cells copy genetic material. Irinotecan also inhibits acetylcholinesterase, helping explain early diarrhoea, sweating, cramping and excess saliva.
irinotecan hydrochloride trihydrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 1.5 mg/mL, 20 mg/mL, 40 mg, 100 mg, 300 mg
How to take irinotecan hydrochloride trihydrate
It is not taken by mouth. Trained staff dilute the concentrate and administer it through a peripheral or central vein in a specialist chemotherapy unit.
Tell the team about diarrhoea, fever, infection, vomiting or unresolved effects before treatment.
Keep prescribed anti-diarrhoeal medicine available and follow the oncology team's written instructions when delayed diarrhoea begins.
Tell staff immediately about pain, burning, redness or swelling around the infusion site.
Do not drive or operate machinery if dizziness or visual disturbance occurs.
irinotecan hydrochloride trihydrate side effects
Common or expected effects
- Delayed diarrhoea
- Feeling or being sick
- Abdominal pain or reduced appetite
- Tiredness or weakness
- Sore or inflamed mouth and digestive tract
- Temporary hair loss
- Reduced neutrophils, red cells or platelets
- Early diarrhoea, sweating, cramps, watery eyes or excess saliva
- Fever
Get urgent medical advice
- Diarrhoea with fever, vomiting, dehydration or inability to drink
- High temperature, chills or infection symptoms
- Unexpected bleeding, extensive bruising or marked breathlessness
- Severe allergic reaction with facial or throat swelling or breathing difficulty
- New or worsening cough or shortness of breath
- Severe pain, redness or swelling at the infusion site
irinotecan hydrochloride trihydrate in pregnancy
Human information is limited, but animal studies and the DNA-damaging mechanism indicate potential fetal harm. Pregnancy should be excluded where relevant, and treatment should normally be avoided during pregnancy unless a specialist multidisciplinary team considers it clearly necessary. Effective contraception is required during treatment and for the product-specified period afterwards. Contact the cancer team if pregnancy occurs or is planned.
irinotecan hydrochloride trihydrate while breastfeeding
Breastfeeding is contraindicated during treatment because irinotecan and its metabolite may enter breast milk and seriously harm the infant. Discuss feeding plans and restarting breastfeeding with the oncology and maternity teams.
irinotecan hydrochloride trihydrate interactions
Give the oncology team a complete list of prescription, non-prescription and herbal products, and check before vaccination.
St John's wort
Contraindicated because it reduces exposure to the active metabolite and may reduce treatment effect.
Live attenuated vaccines
Contraindicated because immunosuppression can cause serious generalised vaccine infection.
Strong CYP3A4 or UGT1A1 inducers
Rifampicin, carbamazepine, phenytoin, phenobarbital and apalutamide may reduce irinotecan and SN-38 exposure and should generally be avoided.
Common questions about irinotecan hydrochloride trihydrate
Answers are fully visible for fast scanning and source review.
Why is diarrhoea important?
Delayed diarrhoea can cause severe dehydration and may become life-threatening, particularly when neutrophils are low. Follow the prescribed instructions and contact the oncology team promptly.
Why are blood tests needed?
They check blood-cell counts and liver function because treatment can reduce neutrophils, red cells and platelets, while impaired liver clearance can increase toxicity.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.