Parenteral Manual

Irinotecan (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
CAMPTOSAR
Classification: 
Antineoplastic - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Phase II or phase III window in various solid tumors (ie. sarcomas)

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as a 20 mg/mL solution
  • Stable 24 hours at room temperature in D5W or NS
  • Stable in D5W under refrigeration for 48 hours
  • Protect from light
Compatibility: 

- Solutions Compatible: D5W preferred

- Y-site Compatible: D5W, NS or combinations

- NO COMPATIBILITY information available for other drugs

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES
Usual dilution: 0.12-1.1 mg/mL in D5W
Infusion time: > 60 minutes

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 50 mg/m2 daily x 5 days
    20 mg/m2  daily x 5 days each week for 2 weeks

** Dosage may differ according to protocol

  • Dosage adjustment may be required for hyperbilirubinemia or increase liver enzymes
  • Patients with prior pelvic or abdominal radation have a  greater risk of irinotecan-related toxicities; dose reduction may be necessary.
Potential hazards of parenteral administration: 
  • Dizziness, nausea, vomiting
  • Flushing, fever, sweating, chills, abdominal pain or cramping (cholinergic syndrome)
  • Fatigue
  • Hypotension (6%)
  • Alopecia
  • Myelosuppression
  • Not a vesicant, but may be irritating to peripheral veins. If extravasation occurs, click HERE for treatment guidelines.   

- Diarrhea:

Early Onset Diarrhea: (<24 hours) is cholinergic in nature.  May rarely be severe, but is usually transient and can be accompanied by diaphoresis, flushing and cramping. May be managed with atropine (consult pre-printed orders or protocol for dose).  Monitor blood pressure and heart rate during atropine. Late Onset Diarrhea: (>24 hours after last dose) prompt use of loperamide (Imodium) is recommended.  Diarrhea may be prolonged and lead to dehydration and electrolyte imbalance.  Consider admission for management.  Consult protocol for details.

- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Irinotecan should not be administered to patients who are within 6 weeks of abdominal or pelvic irradiation
  • Patients with Gilbert's syndrome may have increased risk of toxicity (re: difficulty eliminating active metabolite SN-38)
  • Drug Interactions: carbamazepine, phenytoin, phenobarbital, chronic dexamethasone, ketoconazole and citalopram

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