Parenteral Manual

Topotecan (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): 
HYCAMTIN®
Classification: 
Antineoplastic agent - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
September 2016
Indications: 
  • Phase II treatment for refractory solid tumors (i.e. neuroblastoma)
  • Phase II intrathecally for CNS neoplasms

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 1 mg/mL preservative free solution
  • Protect from light.  Store in refrigerator
  • Single use vials - discard unused portion
  • Solution is light yellow in color
  • Diluted solutions in D5W or 0.9% NS (0.02-0.5 mg/mL ) stable 24 hours refrigerated
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Incompatible: alkaline solutions

- Infusion time is short; run in dedicated line with D5W, 0.9% NaCl

Administration: 

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

SC NO
IM NO
IV Push NO
IV Intermittent Infusion YES
Usual dilution: 0.02 - 0.5 mg/mL
Infusion time: 30 minutes
IV Continuous Infusion NO
Intrathecal YES, physician or nurse practitioner ONLY
Infusion time: > 5 minutes
Infusion rate: at a constant slow rate (i.e. 2 mL/minute)

 

 

 

Dosage: 

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

Intravenous:

  • 0.75-3.5 mg/m2/day x 5 days every 3 weeks
  • Drug is very myelosuppressive and usual dosages are closer to lower end of range.

Intrathecal:

>3 years = 0.4 mg

Total volume of 8 mL

2 years = 0.32 mg

Total volume of 5 mL

1 year = 0.25 mg

Total volume of 5 mL
  • Intrathecally can be given twice weekly in induction, then once weekly for stable disease.

 ** Dosage may differ according to protocol

Dosage adjustment in renal/hepatic impairment:

  • May need dosage adjustment for elevated bilirubin; consult protocol
  • May need dosage adjustment for moderate renal failure; consult protocol
Potential hazards of parenteral administration: 
  • Nausea, vomiting, abdominal pain
  • Headache, fatigue
  • Dyspnea, cough
  • Myelosuppression
  • Mucositis
  • Alopecia

Not a vesicant, but may be irritant; administer through central line when possible. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

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

Notes: 
  • Not effective intravenously in pediatric CNS tumors
  • Continuous infusions have been tried, but do not offer any advantage over short infusions x 5 days

 

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