It is necessary to have equipment and medicines in the department to stop possible adverse reactions, and in the institution - intensive care units.
Irinotecan is administered only by intravenous drip. It is necessary to avoid extravasation.
Before intravenous injection, the contents of the 20 mg / ml vial are diluted with 5% dextrose solution or 0.9% sodium chloride solution (at least 250 ml) to a concentration of 0.12-2.8 mg / ml.
With weekly use, it is possible to increase the dose to 150 mg /m2 and a decrease to 50 mg /m2 with a step of 25-50 mg /m2 (depending on the portability).
The modification of irinotecan dose when used in monotherapy during the next cycle depends on the severity of the toxicity. At a toxicity of II degree it is necessary to lower a dose on 25 mg /m2. If in the subsequent cycles there is a complete restoration of the body, then you can return to the original dose. At toxicity of III degree the next introduction postpone before the sanction of toxicity up to II degree and more low; with subsequent treatment, the dose is reduced by 25-50 mg /m2 and do not increase it with further therapy. With toxicity of IV degree, it is necessary to postpone the next administration until toxicity is resolved to grade II or less; with subsequent treatment, the dose is reduced by 50 mg /m2 and do not increase with further therapy.
With the development of toxicity against the background of the use of the drug every 3 weeks, it is necessary to postpone the administration or reduce the dose by 50 mg /m2.
When combined with fluorouracil and calcium folinate and development of grade II toxicity, it is necessary to reduce the dose by 25 mg /m2, III-IV degree - postpone the next administration until the toxicity is restored to grade II and below and resume treatment at a dose reduced by 50 mg /m2.
With the development of diarrhea after the first cycle of treatment with a weekly regimen, the next administration is postponed until its complete regression. With the development of late diarrhea II-IV degree, a reduction in the dose of irinotecan is necessary.
For the prevention of nausea and vomiting, it is recommended that premedication be carried out with anti-emetics 30 minutes before the administration of irinotecan: a combination of dexamethasone (10 mg) and a serotonin 5-HT3 receptor antagonist (ondansetron or granisetron). Other antiemetics (eg, prochlorperazine) can be used, if necessary, to stop nausea and vomiting that occur after the infusion.
Preventive administration of loperamide with a view to reducing the frequency and severity of late diarrhea is not recommended.
With the development of severe (grade III-IV) diarrhea or other toxicity, further treatment should be postponed until its complete regression (usually within 1-2 weeks) and later resume therapy in reduced doses.With the progression of toxicity for 2 weeks or more, consideration should be given to discontinuing treatment with irinotecan.
Possible long-term treatment with irinotecan, depending on the duration of response or stabilization of the process, provided that the drug is well tolerated.
It is not recommended to combine the use of irinotecan with the mode of the Mayo Clinic (fluorouracil and calcium folinate for 4-5 consecutive days every 4 weeks), except in cases of clinical trials due to the high incidence of severe toxicity and increased lethality.
The maximum dose for a weekly administration is 150 mg /m2, in combination with fluorouracil and calcium folinate - 125 mg /m2.
When extravasation is necessary, wash the place of its occurrence with sterile water and put ice on it.
In patients over the age of 65, there may be an increased risk of late diarrhea. Careful observation of patients is recommended. When treating patients over the age of 70, it is necessary to reduce the starting dose in the mode of administration once every 3 weeks. With a weekly dose adjustment is not required.
If you get on the skin of a solution of irinotecan, immediately wash it off with soap and water, and on mucous membranes with water.
After diluting with 5% dextrose solution, the resulting solution is stable for 48 hours at a temperature of 2-8 ° C and stored in a dark place or for 24 hours at room temperature and illuminated with fluorescent lamps. A dosage form that does not contain preservatives should be used for 6 hours at room temperature or for 24 hours when stored in a refrigerator.
After diluting with 0.9% sodium chloride solution, the resulting solution is stable for 24 hours at room temperature and illuminated with fluorescent lamps. A dosage form that does not contain preservatives should be used for 6 hours at room temperature. A solution of irinotecan in a 0.9% solution of sodium chloride should not be stored in the refrigerator due to the possible occurrence of precipitation.
Vials with a volume of 2 ml and 5 ml are intended for single use. Unused residue is to be disposed of.
Impact on the ability to drive vehicles and manage mechanisms
During treatment, especially within 24 hours after the administration of irinotecan, it is not recommended to engage in potentially dangerous activities associated with the need for concentration of attention and high speed of psychomotor reactions.