irinotecan
Trade Name:Camptosar®
Other Names:Camptosar®
Synonym:CPT-11
Appearance:Clear, light-yellow solution mixed into larger bags of fluids
Monograph Name:irinotecan
Monograph Body:
Irinotecan is a semi-synthetic derivative of camptothecin, an alkaloid extract from camptotheca acuminata. Camptothecin and its analogue belong to the class of topoisomerase I inhibitors. Irinotecan and its active metabolite, SN-38, bind to the topoisomerase DNA complex, preventing religation of the single-strand breaks in the DNA molecule. The drug and its active metabolite are believed to exert their cytotoxic effects during the S-phase of cell cycle.
Peak plasma concentrations of irinotecan are reached by the end of intravenous infusion, whereas those of the SN-38 metabolite occur about 0.5 to 2 hours after the infusion period. Irinotecan exposure increased in a dose-dependent manner over the usual range, where SN-38 increases less than proportionally with dose. No impact of gender on pharmacokinetics.
Cross blood brain barrier? | No information found |
PPB |
30–68% (irinotecan); |
Irinotecan is metabolized to its active form, SN38, in the presence of hepatic or gastrointestinal carboxylesterase. Both irinotecan and SN-38 undergo pH-dependent, reversible hydrolysis from the active closed-ring lactone to an open inactive carboxylate form. Irinotecan is also metabolized in part by CYP3A4 and UGT1A1 to inactive metabolites.
Active metabolites | SN-38 |
Inactive metabolites | yes |
The complete disposition of irinotecan in human has not been fully elucidated. SN-38 subsequently undergoes conjugation (by UDP glucuronyl transferase – UGT1A1) to form a glucuronide metabolite and is excreted in bile. Approximately 10% of the North American population is homozygous for the wild-type UGT1A1*28 allele, which results in reductions in UGT1A1 enzyme activity and higher SN38 systemic exposure.
Urine | Low (11-20% unchanged, 5% as metabolites) |
Half-life | 5.8-11.7 h (irinotecan); 7.7-17 h (SN38) |
- Single-agent treatment for recurrent colorectal cancer after treatment with fluorouracil-based chemotherapy
- As a component of combination first-line chemotherapy for patients with metastatic colorectal cancer
Other Uses:
- Gastrointestinal cancer (gastric, pancreatic, small bowel and appendix)
- Ewing's sarcoma
- Small cell lung cancer
Emetogenic Potential:
Extravasation Potential: None
The adverse effects listed below were reported in > 10% of patients from 3 pooled clinical trials of single-agent, weekly irinotecan in previously treated metastatic colorectal cancer and includes severe or life-threatening events (from these trials or other sources).
ORGAN SITE | SIDE EFFECT* (%) | ONSET** | |||
---|---|---|---|---|---|
Cardiovascular | Bradycardia (during infusion) | I | |||
Hypotension (rare) | E | ||||
Thromboembolism (5%) | E | ||||
Dermatological | Alopecia (61%) | E | |||
Rash (13%) | E | ||||
Gastrointestinal | Abdominal pain (57%) (severe 16%) | I E | |||
Anorexia, weight loss (55%) | I E | ||||
Constipation (30%) | E | ||||
Diarrhea (51%) (early; late 88%, severe 31%) | I E | ||||
Dyspepsia (11%) | E | ||||
Flatulence (12%) | E | ||||
GI obstruction (rare) | E | ||||
GI perforation (rare) | E | ||||
Mucositis (12%) | E | ||||
Nausea, vomiting (86%) (severe 17%) | I E | ||||
General | Edema (10%) | E | |||
Fatigue (76%) (severe 12%) | I | ||||
Other (28%) (cholinergic symptoms) | I | ||||
Hematological | Myelosuppression ± infection, bleeding (28%) (grade 3/4) | E | |||
Hepatobiliary | ↑ LFTs (13%) (4% severe) | E | |||
Pancreatitis (rare) | E | ||||
Hypersensitivity | Hypersensitivity (rare) | I | |||
Metabolic / Endocrine | Hyperglycemia (uncommon) | E | |||
Tumour lysis syndrome (rare) | I | ||||
Musculoskeletal | Musculoskeletal pain (15%) | E | |||
Nervous System | Dizziness (15%) | I E | |||
Dysarthria (or speech disorder; rare, transient) | I | ||||
Headache (17%) | I E | ||||
Insomnia (19%) | I E | ||||
Renal | Renal failure (rare) | E | |||
Respiratory | Cough, dyspnea (22%) | I E | |||
Pneumonitis (infrequent) | I E | ||||
Rhinitis (16%) | I E | ||||
Vascular | Flushing (11%) | I |
* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare"
may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal
reports.
** I = immediate (onset in hours to days)
E = early (days to weeks)
D = delayed (weeks to months)
L = late (months to years)
The most common side effects for irinotecan include nausea, vomiting, fatigue, alopecia, abdominal pain, anorexia, weight loss, diarrhea, constipation, myelosuppression ± infection, bleeding and cholinergic symptoms.
Late diarrhea (occurring more than 24 hours after administration) may lead to dehydration or electrolyte imbalances, and can be life-threatening. The mechanism of late onset diarrhea is not well understood, but it appears to be linked to a secretory process that may be a secondary consequence of an irinotecan cytotoxic effect on the GI mucosa. It occurs in 80% of patients and the median onset time is 5-11 days, depending on the irinotecan dosing schedule. Late diarrhea must be treated promptly with loperamide, 4 mg at the first onset of late diarrhea and then 2mg every 2 hours until the patient is diarrhea-free for at least 12 hours. During the night the patient may take 4mg of loperamide every 4 hours. At these doses, loperamide is not recommended to be used for more than 48 consecutive hours due to the risk of paralytic ileus. Fluid intake should be maintained to avoid dehydration. Premedication with loperamide is not recommended and laxatives should be avoided. Antibiotics should be used in patients with ileus, fever or severe neutropenia.
Irinotecan-induced neutropenia is dose-related, generally brief, and non-cumulative, with a typical onset between days 15 and 21 and recovery between days 28 and 35. The frequency of grade 3 or 4 neutropenia is higher in patients who had prior pelvic or abdominal irradiation, had elevated serum bilirubin or who received the drug over less than 90 minutes. Consider the use of G-CSF in patients experiencing severe neutropenia. An increased risk of neutropenia was observed in patients homozygous for the UGT1A1*28 allele. Consider reducing the irinotecan starting dose (appropriate dose not established) in these patients and those with a history of myelosuppression with previous treatment.
Pneumonitis has been reported infrequently (predominantly in studies from Japan) following administration of irinotecan. This has been described as dyspnea, a non-productive cough, or a diffuse pulmonary infiltrate on chest x-ray. The etiology of these problems is unknown, and it is not clear whether they truly are caused by irinotecan or are actually a manifestation of the disease, primary lung cancer, or lung metastases.
Speech disorders (e.g. dysarthria, stuttering, voice changed) have been reported in post-marketing of irinotecan, with most cases occurring during or shortly after the irinotecan infusion and resolved spontaneously within minutes to hours. The cause of these speech disorders appeared to be unknown; some cases occurred with other neurologic, cholinergic or hypersensitivity symptoms.
Refer to protocol by which the patient is being treated.
Screen for hepatitis B virus in all cancer patients starting systemic treatment. Refer to the hepatitis B virus screening and management guideline.
Adequate antiemetic therapy and prophylactic loperamide must be provided.
Patients should not be treated with irinotecan until they have recovered from prior toxicity: platelets ≥ 100 x 109/L, ANC ≥ 1.5 x 109/L, GI toxicity recovered to baseline (without loperamide for at least 24 hours) and all other toxicities to Grade ≤ 1.
Patients with ileus, fever or febrile neutropenia should receive antibiotics.
Consider a reduction in the starting dose described below for:
- elderly patients (≥ 70 years)
- patients with prior abdominal or pelvic irradiation
- patients with a poor performance status (ECOG of 2)
- patients with mild increases in bilirubin (including Gilbert's syndrome)
- patients homozygous for UGT1A1*28 allele or patients with a history of myelosuppression with previous treatment
For cholinergic adverse effects (early diarrhea):
- Prophylactic atropine may be considered in patients who have experienced cholinergic symptoms
- Diarrhea (including abdominal cramps) may be severe and delayed with irinotecan; use loperamide 4mg at the onset of diarrhea, then 2mg every 2 hours until patient is diarrhea-free for 12 hours. During the night the patient may take 4mg of loperamide every 4 hours
Single agent:
q1w: 125 mg/m2 weekly for 4 weeks with a 2 week rest period.
Dose may be increased to 150mg/m2 in the absence of toxicity.
q3w: ≥ 70 years: 300mg/m2
< 70 years: 350mg/m2
In combination with 5-fluorouracil and leucovorin:
- q2w: 180 mg/m2 (See FOLFIRI regimen)
- 6-week regimen: 125mg/m2 D1, 8, 15 ,22 (IFL regimen)
All dose adjustments should be based on the worst preceding toxicity.
Single Agent:
Dose Level | Dose (mg/m2) | |
Weekly Regimen | Q 3 Weeks Regimen | |
0 | 125 | 350 |
-1 | 100 | 300 |
-2 | 75 | 250 |
-3 | 50 | 200 |
Toxicity grade3
|
Suggested dose
During treatment course
of Weekly schedule2
|
At start of subsequent course1
|
|
Weekly schedule2
|
3-weekly schedule2
|
||
1
|
No change
|
No change
|
No change
|
2
|
↓ 25mg/m2
|
Diarrhea alone – no change
|
Diarrhea alone – no change
|
Hematologic alone – no change
|
Hematologic alone – no change
|
||
Other 3 : ↓ 25mg/m2
|
Other 3: ↓ 50mg/m2
|
||
3
|
Omit, then ↓ 25mg/m2 when ≤ grade 2
|
↓ 25mg/m2
|
↓ 50mg/m2
|
4 or febrile neutropenia
|
Omit, then ↓ 50mg/m2 when ≤ grade 2
|
↓ 50mg/m2
|
↓ 50mg/m2
|
Pneumonitis | Hold; investigate and if confirmed, discontinue. | ||
1 Relative to the starting dose used in the previous cycle. Start new cycle when the parameters below are met.
2 Patients should not be retreated until GI toxicity resolved to baseline (without loperamide for at least 24 h), platelets ≥ 100 x 109/L, ANC ≥ 1.5 x 109/L and other toxicities recovered to ≤ grade 1. If no recovery after a 2-week delay, consider discontinuing treatment. 3 Excludes alopecia, anorexia, and fatigue
|
In Combination Treatment:
Dose Levels:
Regimen | Drug | Starting dose (mg/m2) | Dose level -1 (mg/m2) | Dose Level -2 (mg/m2) |
FOLFIRI
|
Irinotecan
|
180
|
150
|
120
|
Leucovorin infusion
|
400 or 200#
|
No change
|
No change
|
|
5-FU bolus
|
400
|
320
|
240
|
|
5-FU infusion* (start day 1 over 46 h)
|
2400
|
2000
|
1600
|
|
Alternative schedule for 5-FU infusion (over 22 h on days 1 and 2)
|
600
|
480
|
360
|
|
IFL
|
Irinotecan
|
125
|
100
|
75
|
Leucovorin bolus
|
20
|
20
|
20
|
|
5-FU bolus
|
500
|
400
|
300
|
# Dose depends on regimen used.
Toxicity Grade |
During a Cycle of Therapy2 (IFL)
|
At the start of subsequent cycles1, 2 (IFL or FOLFIRI) |
|
Hematologic
|
|||
Grade 1 |
No change |
No change |
|
Grade 2 |
↓ by 1 dose level |
No change |
|
Grade 3
|
Omit until ≤ grade 2 , then ↓ by 1 dose level |
↓ by 1 dose level |
|
Grade 4 or febrile neutropenia
|
Omit until ≤ grade 2 , then ↓ by 2 dose levels |
↓ by 2 dose levels |
|
Diarrhea
|
|||
Grade 1: 2-3/day > pre-treatment |
Delay until recovery to baseline then give same dose |
No change |
|
Grade 2: 4-6/day > pre-treatment |
Omit until recovery to baseline then ↓ by 1 dose level |
No change |
|
Grade 3: 7-9/day > pre-treatment |
Omit until recovery to baseline then ↓ by 1 dose level |
↓ by 1 dose level |
|
Grade 4: ≥ 10/day > pre-treatment |
Omit until recovery to baseline then ↓ by 2 dose levels |
↓ by 2 dose levels |
|
Other Non-hematologic toxicities (excludes alopecia, anorexia and fatigue). For mucositis/stomatitis, decrease 5FU only, not irinotecan. |
|||
Grade 1
|
No change |
No change |
|
Grade 2
|
Omit until ≤ grade 1, then ↓ by 1 dose level |
No change |
|
Grade 3
|
Omit until ≤ grade 2, then ↓ by 1 dose level |
↓ by 1 dose level |
|
Grade 4
|
Omit until ≤ grade 2, then ↓ by 2 dose levels |
↓ by 2 dose levels |
|
1 Relative to the starting dose used in the previous cycle. Start new cycle when the parameters below are met. 2 Patients should not be retreated until GI toxicity resolved to baseline (without loperamide for at least 24 h), platelets ≥ 100 x 109/L, ANC ≥ 1.5 x 109/L and other toxicities recovered to ≤ grade 1. If no recovery after a 2-week delay, consider discontinuing treatment. |
Elimination is decreased in hepatic impairment with increased exposure to SN-38. Patients with bilirubin 1-1.5 x ULN or Gilbert’s syndrome are at an increased risk of myelosuppression.
Bilirubin 1
|
|
Transaminases
|
Irinotecan dose
|
22-35 µmoL/L (1-1.5 x ULN) or with Gilbert’s syndrome |
|
|
Monitor closely; may consider dose reduction
|
> 35 µmoL/L
|
or
|
>3 x ULN (without liver metastases) or >5 x ULN (with liver metastases) |
Not recommended.
|
1Consider investigating for reversible causes such as biliary obstruction and re-evaluate after stent |
No specific studies, but as the kidney is not a major route of excretion, no adjustment anticipated to be required.
Monitor patients ≥ 65 years closely for increased risk of diarrhea. Patients ≥ 70 years of age using the q3w schedule should receive 300mg/m2 or 100 mg/m2 if using weekly dosing.
Safety and efficacy not established.
- Mix in 500mL bag (D5W-preferred or NS) in a concentration range between 0.12 to 3 mg/mL; infuse IV over 90 minutes
- Do not refrigerate admixtures in NS (may result in precipitation)
- Avoid freezing irinotecan and its admixtures since this may result in drug precipitation
- Do not admix with other drugs
- Protect from light
- Prior to the initial irinotecan treatment, patients should be given a sufficient supply of loperamide and instructed on its appropriate use
- Avoid grapefruit, starfruit, Seville oranges, their juices or products during irinotecan treatment
- Patients with a known hypersensitivity to the product or any of its ingredients
- Irinotecan should not be co-administered with azole antifungals (ketoconazole etc, see Interactions section)
- Avoid in patients with hereditary fructose intolerance since the product contains sorbitol
- Avoid the use of live or live attenuated vaccines
- Not recommended for use in patients with ECOG performance status 3 or 4, or in patients with moderate or severe increases in bilirubin.
- Carefully monitor and consider dose reduction for elderly patients, patients with poor performance status (= 2), limited marrow reserve, 3rd space accumulation, Gilbert’s syndrome and patients with reduced UGT1A1 activity; they may be more susceptible to the toxic effects of irinotecan.
- Concurrent administration of irinotecan with irradiation is not recommended. Patients with prior pelvic or abdominal irradiation are at an increased risk of severe myelosuppression following irinotecan therapy.
Other Drug Properties:
-
Carcinogenicity:
Unknown
The long-term carcinogenic potential of irinotecan has not been studied.
-
Embryotoxicity:
Yes
-
Teratogenicity:
Yes
-
Pregnancy:
Irinotecan is not recommended for use in pregnancy.
-
Adequate contraception should be used by patients who can become pregnant and their partners during treatment, and for 6 months after the last dose.
-
Adequate contraception should be used by patients who produce sperm and their partners during treatment, and for 3 months after the last dose.
-
-
Excretion into breast milk:
Documented in animals
Breastfeeding is not recommended during treatment and for 7 days after the last dose.
-
Fertility effects:
Unknown
AGENT | EFFECT | MECHANISM | MANAGEMENT |
---|---|---|---|
Dexamethasone | Lymphocytopenia | Additive | Monitor blood count |
Dexamethasone | Hyperglycemia (especially in patients with glucose intolerance) | Lowers glucose tolerance | Monitor blood glucose |
Prochlorperazine | ↑ akathisia observed when given on same day as irinotecan weekly | Unknown | Caution; avoid on same day of irinotecan treatment |
Diuretics | ↑ dehydration | Additive | Monitor or Avoid |
Azole antifungals | ↑ irinotecan toxicity | ↑ exposure of SN38 (110%) | CONTRAINDICATED. (Discontinue ≥ 1 week before first dose of irinotecan) |
Other inhibitors of CYP3A4 (ciprofloxacin, clarithromycin, verapamil, grapefruit juice, etc) | ↑ irinotecan toxicity | ↑ exposure; increased formation of SN38 | Avoid concomitant use or adjust irinotecan dose |
CYP3A4 inducers (i.e. phenytoin, rifampin, dexamethasone, carbamazepine, phenobarbital, St. John’s Wort, etc) | ↓ irinotecan effects | ↓ exposure because of lower SN38 levels | Avoid concomitant use – switch to non-enzyme inducing anticonvulsants; discontinue St. John's Wort ≥ 1 week prior to irinotecan. |
Curcumin (tumeric) | may reduce effect of irinotecan | inhibits Irinotecan induced apoptosis | Avoid concomitant use |
Atazanavir | ↑ effect of irinotecan | inhibits UGT1A1 and CYP3A4 | Avoid concomitant use |
Bevacizumab | Unclear. Potential increased toxicity of irinotecan | Some pharmacokinetic studies have suggested ↑ SN38 levels with coadministration of bevacizumab | Caution |
Neuromuscular blocking agents (ie. suxamethonium, succinylcholine) | Prolonged neuromuscular blocking effects | Additive anticholinesterase activity | Caution |
UGT1A1 inhibitors (i.e. sorafenib, protease inhibitors) | ↑ effect of irinotecan | Inhibition of UGT1A1 (up to 120% ↑ exposure in SN-38) | Caution. Monitor for signs and symptoms of irinotecan toxicity. |
laxatives | Worsens diarrhea | Additive | Avoid |
Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.
Refer to the hepatitis B virus screening and management guideline for monitoring during and after treatment.
Monitor Type | Monitor Frequency |
---|---|
CBC |
Baseline and before each dose |
Liver function tests |
Baseline and before each cycle (q 3 week regimen) or monthly (weekly x 4 regimen) |
Toxicity rating of diarrhea and other GI effects, cholinergic symptoms, pneumonitis, neurological, bleeding, infection, dehydration, fatigue, pancreatitis, thromboembolism |
At each visit |
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
Monitor Type | Monitor Frequency |
---|---|
Renal function tests |
Periodic |
Blood glucose, especially in patients with diabetes |
Baseline and as clinically indicated |
Berg D. Irinotecan Hydrochloride: drug profile and nursing implications of a topoisomerase I inhibitor in patients with advanced colorectal cancer. ONF 1998;25(3):535-43.
Drengler RL, Kuhn JG, Schaaf LJ et al. Phase I and pharmacokinetic trial of oral irinotecan administered daily for 5 days every 3 weeks in patients with solid tumor. J Clin Oncol 1999: 17(2):685-96.
Irinotecan. Lexicomp Online, Lexi-Drugs Online, Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2018; October 26, 2018
McEvoy GK, editor. AHFS Drug Information 2013. Bethesda: American Society of Health-System Pharmacists, p. 1089-93.
Product Monograph: Avastin® (bevacizumab). Hoffmann-La Roche Ltd., February 23, 2012.
Product Monograph: Camptosar® (irinotecan). Pfizer Canada Inc., December 9, 2014.
Product Monograph: Irinotecan. Pfizer Canada Inc., February 11, 2015 and September 14, 2022.
Product Monograph: Nexavar® (sorafenib). Bayer Inc., May 1, 2013.
Somasundaram S, Edmund NA, Moore DT, Small GW, Shi YY, Orlowski RZ. Dietary curcumin inhibits chemotherapy-induced apoptosis in models of human breast cancer. Cancer Res 2002 Jul 1;62(13):3868-75.
Tournigand C, André T, Achile E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004;22(2):229-37.
Wiseman LR, Markham A. Irinotecan: a review of its pharmacological properties and clinical efficacy in the management of advanced colorectal cancer. Drugs 1996;52(4):606-23.
August 2025 Updated Pregnancy/Lactation section
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for 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.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Berg D. Irinotecan Hydrochloride: drug profile and nursing implications of a topoisomerase I inhibitor in patients with advanced colorectal cancer. ONF 1998;25(3):535-43.
Drengler RL, Kuhn JG, Schaaf LJ et al. Phase I and pharmacokinetic trial of oral irinotecan administered daily for 5 days every 3 weeks in patients with solid tumor. J Clin Oncol 1999: 17(2):685-96.
Irinotecan. Lexicomp Online, Lexi-Drugs Online, Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2018; October 26, 2018
McEvoy GK, editor. AHFS Drug Information 2013. Bethesda: American Society of Health-System Pharmacists, p. 1089-93.
Product Monograph: Avastin® (bevacizumab). Hoffmann-La Roche Ltd., February 23, 2012.
Product Monograph: Camptosar® (irinotecan). Pfizer Canada Inc., December 9, 2014.
Product Monograph: Irinotecan. Pfizer Canada Inc., February 11, 2015 and September 14, 2022.
Product Monograph: Nexavar® (sorafenib). Bayer Inc., May 1, 2013.
Somasundaram S, Edmund NA, Moore DT, Small GW, Shi YY, Orlowski RZ. Dietary curcumin inhibits chemotherapy-induced apoptosis in models of human breast cancer. Cancer Res 2002 Jul 1;62(13):3868-75.
Tournigand C, André T, Achile E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004;22(2):229-37.
Wiseman LR, Markham A. Irinotecan: a review of its pharmacological properties and clinical efficacy in the management of advanced colorectal cancer. Drugs 1996;52(4):606-23.
irinotecan (patient)
Info Sheet Introduction:- For treating cancer of the colon, rectum or other cancers
irinotecan
Pronunciation:
eye-reen-oh-TEE-can
Other Name(s):
Camptosar®
Appearance:
Clear, light-yellow solution mixed into larger bags of fluids
This handout gives general information about this cancer medication.
You will learn:
-
who to contact for help
-
what the medication is
-
how it is given
-
what to expect while on medication
This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
My cancer health care provider is: _____________________________________________
During the day I should contact: _______________________________________________
Evenings, weekends and holidays: _____________________________________________
This page gives general information about this cancer medication.
You will learn:
-
who to contact for help
-
what the medication is
-
how it is given
-
what to expect while on this medication
This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
- For treating cancer of the colon, rectum or other cancers
Tell your health care team if you have or had significant medical condition(s), such as:
-
liver, heart or lung problems
-
diabetes
-
hereditary fructose intolerance or
-
any allergies
Remember To:
-
Tell your health care team about all of the other medications you are taking.
-
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
- This drug is given by injection into a vein.
To Treat Diarrhea
The irinotecan in your treatment regimen can cause diarrhea. Diarrhea is when you have loose bowel movements (watery poo) or you need to have bowel movements (go poo) more often than usual. Diarrhea may start a few days after your treatment.
You will be given a medication called loperamide (Imodium®) to help treat your diarrhea. Take this medication only if you need it.
Keep your loperamide with you all the time. When diarrhea starts, take the loperamide right away.
If you start to have diarrhea:
- Take 2 tablets (4 mg) of loperamide right away.
- Take 1 tablet (2 mg) every 2 hours after that.
- During the night you may take 2 tablets (4 mg) every 4 hours.
- Keep taking loperamide until you have no diarrhea for 12 hours.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs or substances, or natural health products without checking with your health care team.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic products, without checking with your health care team.
-
DO NOT use tobacco products (such as smoking cigarettes or vaping) or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
-
DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. These may increase the quantity of the medication in your blood and increase the side effects.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs or substances, or natural health products without checking with your health care team.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic products, without checking with your health care team.
-
DO NOT use tobacco products (such as smoking cigarettes or vaping) or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
-
DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. These may increase the quantity of the medication in your blood and increase the side effects.
Yes, this medication can interact with other medications, vitamins, foods, traditional medicines and natural health products. Interactions can make this medication not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications
- other drugs and substances, such as cannabis/marijuana (medical or recreational)
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements, or traditional medicines
Check with your health care team before starting or stopping any of them.
- Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®.
- Over-the-counter products such as dimenhydrinate (Gravol®)
- Natural health products such as St. John’s Wort
- Traditional medicines
- Supplements such as vitamin C
- Grapefruit juice
- Alcoholic drinks
- Tobacco
- All other drugs or substances, such as marijuana or cannabis (medical or recreational)
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Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
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Fever can be a sign of infection that may need treatment right away.
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If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
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How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
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You have a fever if your temperature taken in your mouth (oral temperature) is:
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38.3°C (100.9°F) or higher at any time
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OR
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38.0°C (100.4°F) or higher for at least one hour.
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If you do have a fever:
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Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
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Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Talk to your health care team about:
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How this treatment may affect your sexual health
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How this treatment may affect your ability to have a baby, if this applies to you
This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance you may become pregnant, you and your partner together must use 2 effective forms of birth control at the same time until 6 months after your last dose. Talk to your health care team about which birth control options are best for you.
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If you are a patient that can get somebody pregnant, you and your partner together must use 2 effective forms of birth control at the same time until 3 months after your last dose. Talk to your health care team about which birth control options are best for you.
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Do not breastfeed while on this treatment and for 7 days after your last dose.
You may not have all of the side effects below. You may have side effects that are not listed.
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Diarrhea (early onset) and other early side effects of irinotecan
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Talk to 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. |
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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.
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Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours | ||||
Fatigue (tiredness)
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Talk to your health care team if no improvement or if severe | ||||
Hair thinning or loss
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Talk to your health care team if this bothers you | ||||
Pains or cramps in the belly
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Talk to your health care team if no improvement or if severe | ||||
Low appetite
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Talk to your health care team if no improvement or if severe |
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Constipation (less common than diarrhea) To help prevent constipation :
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Talk to your health care team if no improvement or if severe | ||||
Low platelets in the blood
See the Low Platelet Count pamphlet for more information.
You have a fever if your temperature taken in your mouth (oral temperature) is:
While you are getting treatment:
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Get emergency medical help right away |
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Cough; feeling short of breath You may have cough and feel short of breath without any signs of infection, such as a sore throat or a stuffed nose. Rarely this may be severe with chest pain, trouble breathing or coughing up blood. If this happens get medical help right away. |
Talk to your health care team if no improvement or if severe | ||||
Trouble falling asleep
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Talk to your health care team if no improvement or if severe | ||||
Headache; muscle pain or cramps
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Talk to your health care team if no improvement or if severe | ||||
Dizziness
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Talk to your health care team if no improvement or if severe | ||||
Abnormal liver lab tests
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Talk to your health care team if no improvement or if severe | ||||
Rash; dry, itchy skin Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away. To prevent and treat dry skin,
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Talk to your health care team if no improvement or if severe | ||||
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:
If you have mouth sores:
See the Mouth Care pamphlet for more information. |
Talk to your health care team as soon as possible | ||||
Heartburn; stomach upset To help prevent heartburn:
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Talk to your health care team if no improvement or if severe | ||||
Mild swelling in arms and legs; puffiness To help prevent swelling :
If you have swelling in your legs, keep your feet up when sitting. |
Talk to your health care team if no improvement or if severe |
Other rare, but serious side effects are possible with this treatment.
If you have any of the following, talk to your cancer health care team or get emergency medical help right away:
- Swelling and hardening of a vein in your arms or leg
- Feel confused, trouble seeing, speaking, or using your arms or legs
- Severe or sudden belly pain, bloating or feeling of fullness and severe constipation
- Pain in the centre of your belly that may extend to your back
- Flushing, itchiness, rash, swollen lips, face or tongue, wheezing, chest and throat tightness
- Fever, severe joint pain; lower back pain, swelling, pee less than usual and have unusual weight gain; muscle twitching, severe weakness or cramping and feel confused
For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.
August 2025 Updated/revised information sheet
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.



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Eligibility Form:
Drug Monograph: Updated Pregnancy/Lactation section
Patient Info Sheet EN: Updated/revised information sheet
Patient Info Sheet FR: Updated/revised information sheet (Fiche d’information mise à jour/révisée)