Irinotecan Liposome (Onivyde®)

How to Take Irinotecan Liposome

Irinotecan Liposome is administered intravenously (IV, directly into a vein). The dose is based on the patient’s weight. Patients will receive pre-medication with a corticosteroid and an antiemetic (anti-nausea) medication. This medication is given in combination with other chemotherapy medications.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided for 1-2 weeks before treatment. These include: grapefruit, grapefruit juice, carbamazepine, ketoconazole, rifampin, phenytoin, phenobarbital, and St. John’s wort, among others. Be sure to tell your provider about all medications and supplements you take.

Possible Side Effects of Irinotecan Liposome

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Diarrhea

Diarrhea is a common side effect of the medication and can be very dangerous because it can lead to serious dehydration. Diarrhea can be defined as an increase in the number of bowel movements you have in a day. Your healthcare team may give you medication in the clinic if you develop diarrhea right away. Your provider will tell you how to take loperamide (an anti-diarrheal medication) at home, which you should start taking as soon as diarrhea develops. In some cases, diarrhea can lead to severe dehydration. Notify your healthcare team if diarrhea does not stop on this medication so they can help you better manage this side effect.

Runny nose, excess saliva, watery eyes, sweating, and cramping can accompany diarrhea that occurs within the first day of receiving this medication. If any of these symptoms occur during the infusion, notify your provider. Diarrhea can continue to occur for 10-12 days after the treatment.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) help your body fight infection. While you have cancer treatment, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily.
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines

Low Red Blood Cell Count (Anemia)

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

Low Platelet Count (Thrombocytopenia)

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor.

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. Talk to your providers before using over-the-counter medications and supplements during treatment.
• Do not floss or use toothpicks, and use a soft-bristle toothbrush to brush your teeth.

Fatigue

Fatigue can cause exhaustion, feeling worn out, and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Nausea and/or Vomiting

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty, spicy, or acidic foods like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.

Call your provider if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Decrease in Appetite

Nutrition is an important part of your care. Cancer treatment can affect your appetite and make it hard to eat. Ask your providers about nutrition counseling services. Some tips you can follow are:

• Try to eat five or six small meals or snacks during the day, instead of 3 larger meals.
• Nutritional supplements may help if you are not eating enough.
• You may have a metallic taste or find that food has no taste. You may dislike foods or beverages that you liked before cancer treatment. These symptoms can last for months or longer after treatment ends.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products, and fish without a strong smell. Sometimes cold food has less of an odor.
• Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce, or dressings.
• Use seasonings like basil, oregano, or rosemary to add flavor

Mouth Ulcers (Mucositis)

This medication can cause sores or soreness in your mouth and/or throat, called mucositis. Tell your providers if your mouth, tongue, inside of your cheek, or throat becomes white, has ulcers, or is painful. Medications can be used to manage pain. Regular mouth care can help prevent or manage mouth sores. Some things you can do are:

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) can be used a few times each day.
• If your mouth gets dry, eat moist foods, drink plenty of fluids (6 to 8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, drinking alcoholic beverages, and citrus juices.

Liver Toxicity

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

Electrolyte Abnormalities

This medication can affect your electrolytes (potassium, magnesium, calcium, etc.). Your electrolyte levels will be checked with blood tests. If your levels get too low, you may be given electrolytes by IV (intravenously through your vein) or by mouth. Talk to your provider before taking any supplements. 

Important but Less Common Side Effects

• Allergic Reactions: In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include: shortness of breath or difficulty breathing, chest pain, swelling of the face, eyelids, or lips, rash, flushing, itching, or a decrease in blood pressure. If you notice any changes in how you feel during the infusion, let your provider know right away. The infusion will be slowed or stopped if this occurs.
• Lung Changes: This medication can cause scarring of your lungs, called interstitial lung disease. If you have any new or worsening symptoms, like shortness of breath, cough (with or without mucous), fever, or chest pain, call your provider right away.

Reproductive Concerns

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. If you can become pregnant, you will need to use effective birth control for 7 months after the last dose of this medication, even if your menstrual cycle has stopped or changed.

If you can get someone pregnant, you will need to use effective birth control for 4 months after the last dose of this medication, even if you believe you are not producing sperm.

You should not breastfeed during treatment and for 1 month after the last dose of this medication.