irinotecan sucrosofate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
irinotecan sucrosofate: clinical details
Prescribing considerations
- Confirm the licensed pancreatic-cancer setting and all combination-treatment components.
- Review liver disease, jaundice, previous abdominal radiotherapy, Whipple procedure, lung disease, inflammatory bowel disease, bowel obstruction and low body weight.
- Review CYP3A4 and UGT1A1 interactions, herbal products and vaccination plans.
- Discuss contraception, fertility preservation and the breastfeeding contraindication.
Contraindications and cautions
- Severe hypersensitivity to irinotecan or formulation excipients.
- Breastfeeding.
- Bowel obstruction or chronic inflammatory bowel disease.
- Severe bone-marrow failure.
Monitoring
- Full blood count, particularly neutrophils, haemoglobin and platelets.
- Diarrhoea, hydration status and electrolytes.
- Liver function and bilirubin, with additional caution in hepatic impairment or Gilbert's syndrome.
- Infection, infusion reactions and thromboembolic symptoms.
- New or progressive respiratory symptoms suggesting pneumonitis or interstitial lung disease.
Clinical pharmacology
The liposome contains irinotecan as a sucrosofate salt. Carboxylesterases convert released irinotecan to SN-38; both stabilise the topoisomerase I–DNA complex, causing replication-associated single-strand DNA damage. SN-38 is predominantly glucuronidated by UGT1A1.
Formulation and product differences
- This is a pegylated liposomal formulation with pharmacokinetics distinct from non-liposomal irinotecan.
- It is a concentrate for dilution before intravenous infusion and must not be administered undiluted or by bolus injection.
- Check product identity and formulation carefully when prescribing, preparing and administering irinotecan products.
irinotecan sucrosofate preparations and strengths
Dispersion for infusion
Route: Intravenous
Strengths: 4.3 mg/mL
irinotecan sucrosofate interactions
The oncology team should review prescription, over-the-counter and herbal products before treatment.
Strong CYP3A4 inducers, including carbamazepine, phenytoin, phenobarbital, rifampicin and rifabutin
May reduce irinotecan and SN-38 exposure and potentially reduce treatment activity.
St John's wort
May reduce irinotecan exposure and should not be used unless the specialist determines otherwise.
Strong CYP3A4 inhibitors, including clarithromycin, itraconazole, voriconazole and some HIV antivirals
May increase exposure and toxicity; specialist review or substitution is needed.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.