Care During Chemotherapy and Beyond
Trade Name: Onivyde®
Irinotecan (liposomal) is the generic name for the trade name drug Onivyde. In some cases, health care professionals may use the trade name Onivyde when referring to the generic drug name irinotecan liposomal.
Drug Type: Irinotecan (liposomal) is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as a "Topoisomerase I Inhibitor." (For more detail, see "How Irinotecan (liposomal) Works" below)
What Irinotecan (Liposomal) Is Used For:
- Metastatic pancreatic cancer (in combination with flurouracil and leucovorin)
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.
How Irinotecan (Liposomal) Is Given:
- This drug is administered by infusion into a vein (intravenous, IV).
The amount of irinotecan (liposomal) that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition you have. Your doctor will determine your exact dosage and schedule.
Important things to remember about the side effects of irinotecan (liposomal):
- Most people will not experience all of the irinotecan (liposomal) side effects listed.
- Irinotecan (liposomal) side effects are often predictable in terms of their onset, duration, and severity.
- Irinotecan (liposomal) side effects will improve after therapy is complete.
- Irinotecan (liposomal) side effects may be quite manageable. There are many options to minimize or prevent the side effects of irinotecan (liposomal).
The following side effects are common (occurring in greater than 30%) for patients taking irinotecan (liposomal):
- Diarrhea; two types early and late forms.
- Early diarrhea: Occurring within 24 hours of receiving drug, accompanied by symptoms runny nose, increased salivation, watery eyes, sweating, flushing, abdominal cramping. (This can occur while the drug is being administered. If so, alert your healthcare professional promptly. Medication can be given to stop and/or lessen this early side effect).
- Late diarrhea: Occurring greater than 24 hours of receiving drug, usually peaks at about 11 days after treatment. Because of concerns of dehydration and electrolyte imbalances with diarrhea it is important to be in contact with health care professionals for monitoring, and for medication and diet modifications advice.
- Low blood counts. Your red and white blood cells and platelets may temporarily decrease. This can put you at increased risk for anemia, infection, and/or bleeding.
- Nausea and vomiting
- Loss of appetite
- Elevated liver enzymes
- Low magnesium
- Low albumin
- Low calcium
- Low potassium
- Mouth sores
These are less common side effects (occurring in 10-29%) for patients receiving irinotecan (liposomal):
Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But you should always inform your health care provider if you experience any unusual symptoms.
When To Contact Your Doctor or Health Care Provider:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
- Fainting, dizziness, lightheadedness, dark colored urine (symptoms of dehydration)
The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
- Diarrhea (4-6 episodes in a 24-hour period) despite use of anti-diarrhea medication and diet modifications.
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Extreme fatigue (unable to carry on self-care activities)
- Mouth sores (painful redness, swelling or ulcers)
Always inform your health care provider if you experience any unusual symptoms.
- Before starting irinotecan (liposomal) treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
- Avoid large amounts and/or concentrated grapefruit juice.
- Do not receive any kind of immunization or vaccination without your doctor's approval while taking irinotecan (liposomal).
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D irinotecan (liposomal) may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking irinotecan. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
- Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Sucking on lozenges and chewing gum may also help.
- You may be at risk of infection so try to avoid crowds or people with colds or not feeling well, and report fever or any signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
Monitoring and Testing While Taking Irinotecan (Liposomal):
You will be checked regularly by your doctor while you are taking irinotecan (liposomal), to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How Irinotecan (Liposomal) Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Irinotecan is a topoisomease inhibitor meaning that this drug interferes with the action of topoisomerase enzymes (topoisomerase I and II). Topoisomease enzymes control the manipulation of the structure of DNA necessary for replication.
Irinotecan (liposomal) is the drug irinotecan encapsulated in a liposome. Liposomes are closed lipid spheres made of the basic components of natural human cell walls. By enclosing a drug in a liposome, scientists have demonstrated improvements in the way a drug is released throughout the body and the amount of time it remains within the body. Liposomes may circulate in the bloodstream for extended periods, as compared to the same drug in a non-liposomal form. This may result in an extended treatment effect and a simplified dosing regimen. In some cases, liposomal drugs have been show to accumulate at the site of a tumor delivering higher concentrations of the drug to a disease target. The liposome carrier is believed to play a role in reducing the harmful effects of certain drugs on healthy tissues.
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.
Irinotecan Liposomal. Lexicomp Online® [updated 2016 July 12; cited 2016 July 12]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; July 12, 2016.
Irinotecan liposome injection [package insert on the Internet]. Cambridge (MA): Merrimack Pharmaceuticals, Inc. [updated 2015 Oct; cited 2016 July 12]. Available from: https:www.onivyde.com/_assets/pdf/ONIVYDE_USPI.pdf
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