Example orders for Irinotecan (Camptosar) in colon cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.

Irinotecan (Camptosar)

Original references may be found at Irinotecan (Camptosar)

Example regimen #1

• Irinotecan (Camptosar) 350 mg/m² IV over 90 minutes on day 1

21-day cycles

Supportive therapy

• Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
• Dexamethasone (Decadron) 10 mg IV 30 minutes prior to chemotherapy
• Atropine 0.4 mg IV prn diaphoresis, visual changes, abdominal cramping, or diarrhea during or after irinotecan

Hydration:

• 500 ml NS at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• Dose reduction of Irinotecan (Camptosar) to 300 mg/m² IV over 90 minutes on day 1 is recommended for patients over 70 years old or with prior pelvic radiation.
• Hold for significant diarrhea, ANC less than 1000, or platelets less than 100, and notify physician.

Outpatient medications:

• Loperamide (Imodium) 4 mg PO x1 for each day's first episode of diarrhea; 2 mg PO prn each loose stool thereafter, up to a maximum of 16 mg per day

Comments:

• In contrast to the original regimen, my institution does not specifically mandate that patients with ECOG performance status 2 or higher should have a dose reduction of irinotecan.