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liposomal irinotecan

( lip-o-SOM-al i-RIN-o-te-can )
Other Name(s): Onivyde® (Baxalta Canada)
Appearance: suspension mixed into larger bags of fluids

Medication Information Sheet
liposomal irinotecan (lip-o-SOM-al i-RIN-o-te-can)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Onivyde®

Appearance:
suspension

mixed into larger bags of fluids

What is this medication for?
  • For treating pancreatic cancer in combination with other medications. 

What should I do before I have this medication?
  • Tell your health care team if you have or had significant medical condition(s) such as:
    • liver, heart or lung problems,
    • if you are taking other medications, 
    • or if you have any allergies.
  • People with cancer have a higher risk of getting other cancers or developing blood clots. Some cancer medications may increase these risks, especially if used for a long period of time. Discuss any concerns about this medication with your health care team.
How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding.
     
  • If there is any chance that you or your partner may become pregnant, you and your partner together must: 
     
  • ► Use 2 effective forms of birth control at the same time while taking this drug. Keep using birth control for at least 1 month (women) or 4 months (men) after your last dose unless your health care team told you differently. Talk to your health care team to figure out the best method(s) for you and/or your partner.
     
  • Do not breastfeed while using this drug or for 1 month after the last dose.
     
  • This medication may affect fertility (ability to get pregnant).
How is this medication given?
  • This drug is given by injection into a vein.

  • Your healthcare team may tell you to use loperamide (Imodium®) for delayed diarrhea. 
     
  • Make sure you have a supply of loperamide available, as diarrhea needs to be treated as soon as possible.
     
  • Your healthcare team may ask you to follow these instructions for loperamide (Imodium®): 
     
    • For delayed diarrhea (starts 1 or more days after your infusion), at the first sign of loose bowel movements (poo) or when bowel movements are more frequent than usual, take 2 tablets (4mg) right away, then take 1 tablet (2mg) every 2 hours.  
    • During the night you may take 2 tablets (4mg) every 4 hours.
       
  • Continue taking loperamide (Imodium®) until you have no more diarrhea for 12 hours. 
What else do I need to know while on this medication?
  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • Do not eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.

  • For mild aches and pain:

    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding.
    • Talk to your health care team before you start or stop these medications.
    • If you feel unwell, take your temperature before taking any of these medications. They may hide a fever. 
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.

What are the side effects of this medication?

You may not have all of the side effects below. You may have side effects that are not listed.

Side effects and what to do When to contact doctor?
Very Common Side Effects (50 or more out of 100 people)

Diarrhea (early onset) and other early side effects of liposomal irinotecan:

  • Starts during your infusion or up to one day after.
  • You may have other side effects such as excessive sweating, belly cramps, runny nose, watery eyes or mouth, face or neck flushing or pinpointed pupils.
  • Let your healthcare team know right away if this happens. Medication(s) may be given to you to control these side effects.

Diarrhea (delayed onset, may be severe):

  • Starts one or more days after your dose.
  • Take anti-diarrhea drug(s) as instructed by your healthcare team.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy

​See the Diarrhea pamphlet for more information.

Contact your health care team if no improvement or if severe

 

 

If diarrhea lasts more than 24 hours while taking anti-diarrhea drugs or if you have fever, get emergency medical help right away.

Nausea and vomiting

May occur in hours to days after your treatment. It is easier to prevent nausea than to treat it if it happens. 

To help prevent nausea:

  • Take anti-nausea medication(s) as prescribed to you by your doctor.
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (e.g. coffee, tea) and alcohol.

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

Contact your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours

Abnormal liver lab tests

  • You may have yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. Talk to your health care team if this happens.
  • Your doctor may monitor your liver regularly with a blood test.
Contact your health care team if no improvement or if severe

 

Side effects and what to do When to contact doctor?
Common Side Effects (25 to 49 out of 100 people)

Salt imbalances

It may cause muscle twitching, severe weakness or cramping, confusion and irregular heartbeat.

Get emergency medical help right away

Low appetite

  • You may not feel like eating or you may lose weight.
  • Try to eat foods that you like and eat small meals throughout the day. 
  • You may need to take meal supplements to help keep your weight up.
  • Talk to your health care team if you have a low appetite.
  • See our Loss of appetite pamphlet for more information.
Contact your health care team if no improvement or if severe

Fatigue (tiredness)

  • Be active and aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Eat well and stay hydrated by drinking at least 6 to 8 glasses of water or other liquids every day (unless your doctor told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired

See our Fatigue pamphlet for more information. 

Contact your health care team if no improvement or if severe

 

Side effects and what to do When to contact doctor?
Less Common Side Effects (10 to 24 out of 100 people)

Hair thinning or loss 

  • Use a gentle soft brush and avoid hair sprays, bleaches, dyes and perms.
  • In most cases, your hair will grow back after treatment, but the texture or colour may change. 
 

Unusual bleeding or bruising (may be severe)

You may have black stools, cough up blood, blood in your urine, purple or red dots on your skin or bleeding that will not stop. 

Fever, chills, infection

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (or 100.4°F) or higher for at least one hour.

While you are getting treatment:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.


If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

Get emergency medical help right away

Blood clot

Blood clots can cause pain, swelling and hardening of the vein in the affected body part.

The blood clot may be more severe and  block an artery or vein (blood vessels) and cause :

  • Blood clot in your lungs: you can start to cough, have problems  breathing, have pain in your chest or cough up blood
  • Blood clot in your brain (stroke): you can have trouble seeing, speaking, or using your arms and legs
  • Blood clot in your heart (heart attack): you can have chest pain, shortness of breath, pain in your belly or arms.
Get emergency medical help right away

Mouth sores

You may have round, painful, white or gray sores inside your mouth. They can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard swallow, eat or to brush your teeth. They usually last 1 to 2 weeks.

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often. Do not use mouthwashes with alcohol.
  • Instead, try a homemade mouthwash:
  • Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.

If you have mouth sores:

  • Check with your health care team as soon as you notice mouth or lip sores or if it hurts to swallow.
  • Avoid hot, spicy, acidic, hard or crunchy foods.  Your doctor may prescribe a mouthwash to relieve mouth sores and prevent infection.

See the Mouth Care pamphlet for more information.

Contact your health care team as soon as possible 

 

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

  • Trouble breathing or coughing up blood
  • Lower back pain, swelling, pee less than usual and have unusual weight gain
  • Signs of an allergy such as  fever, flushing, itchiness, rash, swollen lips, face or tongue, wheezing, chest and throat tightness


For more links on how to manage your symptoms go to https://www.cancercareontario.ca/en/symptom-management.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.