irinotecan

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

• Starts during the infusion or within 24 hours
• Some other symptoms include excessive sweating, belly cramps, runny nose, watery eyes, more saliva in the 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 symptoms

Diarrhea (delayed onset) 

• Starts more than 24 hours to a few days after your irinotecan dose.
• May be severe in some cases with dehydration

If you have diarrhea :

• Take anti-diarrhea drug(s) as instructed by your healthcare team.  Refer to "How it is given" section for instructions on using loperamide (Imodium®)
• 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.
• If diarrhea lasts more than 24 hours while taking anti-diarrhea drugs or if you have fever, get emergency medical help right away.

​See the Diarrhea pamphlet for more information.

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. 

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.

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. 

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. 

Pains or cramps in the belly

• If you have constipation or diarrhea it may be causing the pain in your belly.
• If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.

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.

Constipation (less common than diarrhea)

To help prevent constipation :

• Drink more liquids and eat well. Drink at least 6 to 8 cups of liquids each day unless you have been told otherwise.
• Be Active. Exercise can help to keep you regular.
• Try to eat more fiber (e.g. fruits with skin, leafy greens and whole grains). If you take opioid pain medication, ask your health care team if eating more fibre is right for you.

To help treat constipation :

• If you have not had a bowel movement in 2 to 3 days you may need to take a laxative. Ask your health care team what to do.

See the Constipation Pamphlet for more information.

Low platelets in the blood

• Watch for bleeding (such as unusual nosebleeds or bleeding from the gums) or bruising easily (this is rare).
• Very rarely, severe symptoms can happen. If you notice black coloured stools (poo), red or pink coloured urine (pee), red or brown coloured mucus when you cough, severe headache/confusion or bleeding that will not stop, you need to talk to your health care team or go to the nearest emergency room right away.

See the Low Platelet Count pamphlet for more information.

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 to prevent infection.
• 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.

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.

Trouble falling asleep

• This may be caused by one of your medications and may improve once your body gets used to the medication or when your treatment ends.
• Talk to your doctor if this bothers you.

Headache; muscle pain or cramps 

• Take your pain medication as prescribed by your doctor.
• You can take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
• Talk to your doctor or pharmacist first before taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin. These medication may increase bleeding risk.
• Rest often and try light exercise as it may help.

Dizziness

• You may feel light headed.
• Lay down if this happens.
• Get up and move slowly once you feel better.
• Do not drive a motor vehicle or use machinery if you feel dizzy.

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.

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,

• Use skin moisturizer.
• Protect your skin from the sun and the cold.
• Use sunscreen with UVA and UVB protection and a SPF of at least 30.

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.

Heartburn; stomach upset

To help prevent heartburn:

• Avoid fatty or spicy foods.
• Remain upright after eating.
• Drink clear liquids and eat small meals.

Mild swelling in arms and legs; puffiness

To help prevent swelling :

• Eat a low-salt diet.
• Avoid tight fitting clothing.

If you have swelling in your legs, keep your feet up when sitting.