Topotecan – Uses, Dosage, Side Effects, Interactions

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 114 min read
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Topotecan is a semisynthetic derivative of camptothecin, a cytotoxic, quinoline-based alkaloid extracted from the Asian tree Camptotheca acuminate. Topotecan is a Topoisomerase Inhibitor. The mechanism of action of topotecan is as a Topoisomerase Inhibitor. Topotecan inhibits topoisomerase I activity by stabilizing the topoisomerase I-DNA covalent complexes during...

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Article Summary

Topotecan is a semisynthetic derivative of camptothecin, a cytotoxic, quinoline-based alkaloid extracted from the Asian tree Camptotheca acuminate. Topotecan is a Topoisomerase Inhibitor. The mechanism of action of topotecan is as a Topoisomerase Inhibitor. Topotecan inhibits topoisomerase I activity by stabilizing the topoisomerase I-DNA covalent complexes during the S phase of the cell cycle, thereby inhibiting the religation of topoisomerase I-mediated single-strand DNA breaks and producing potentially...

Key Takeaways

  • This article explains Mechanism of Action in simple medical language.
  • This article explains Indications in simple medical language.
  • This article explains Contraindications in simple medical language.
  • This article explains Dosage in simple medical language.
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Topotecan is a semisynthetic derivative of camptothecin, a cytotoxic, quinoline-based alkaloid extracted from the Asian tree Camptotheca acuminate. Topotecan is a Topoisomerase Inhibitor. The mechanism of action of topotecan is as a Topoisomerase Inhibitor. Topotecan inhibits topoisomerase I activity by stabilizing the topoisomerase I-DNA covalent complexes during the S phase of the cell cycle, thereby inhibiting the religation of topoisomerase I-mediated single-strand DNA breaks and producing potentially lethal double-strand DNA breaks when encountered by the DNA replication machinery.

Topotecan is a pyranoindolizinoquinoline used as an antineoplastic agent. It is a derivative of camptothecin and works by binding to the topoisomerase I-DNA complex and preventing the relegation of these 328 single-strand breaks. It has a role as an EC 5.99.1.2 (DNA topoisomerase) inhibitor and an antineoplastic agent.

Topotecan Hydrochloride is the hydrochloride salt of a semisynthetic derivative of camptothecin with antineoplastic activity. During the S phase of the cell cycle, topotecan selectively stabilizes topoisomerase I-DNA covalent complexes, inhibiting the religation of topoisomerase I-mediated single-strand DNA breaks and producing potentially lethal double-strand DNA breaks when complexes are encountered by the DNA replication machinery. Camptothecin is a cytotoxic quinoline-based alkaloid extracted from the Asian tree Camptotheca acuminate.

Mechanism of Action

Topotecan has the same mechanism of action as irinotecan and is believed to exert its cytotoxic effects during the S-phase of DNA synthesis. Topoisomerase I relieves torsional tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।" data-rx-term="strain" data-rx-definition="A strain is injury to a muscle or tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।">strain in DNA by inducing reversible single-strand breaks. Topotecan binds to the topoisomerase I-DNA complex and prevents the religation of these single-strand breaks. This ternary complex interferes with the moving replication fork, which leads to the induction of replication arrest and lethal double-stranded breaks in DNA. As mammalian cells cannot efficiently repair these double-strand breaks, the formation of this ternary complex eventually leads to apoptosis (programmed cell death). Topotecan mimics a DNA base pair and binds at the site of DNA cleavage by intercalating between the upstream (−1) and downstream (+1) base pairs. Intercalation displaces the downstream DNA, thus preventing the religation of the cleaved strand. By specifically binding to the enzyme–substrate complex, Topotecan acts as an uncompetitive inhibitor.

or

Topoisomerase I relieves torsional tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।" data-rx-term="strain" data-rx-definition="A strain is injury to a muscle or tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।">strain in DNA by inducing reversible single-strand breaks. Topotecan binds to the topoisomerase I-DNA complex and prevents the religation of these single-strand breaks. The cytotoxicity of topotecan is thought to be due to double-strand DNA damage produced during DNA synthesis when replication enzymes interact with the ternary complex formed by topotecan, topoisomerase I, and DNA. Mammalian cells cannot efficiently repair these double-strand breaks.

Topotecan, a semi-synthetic derivative of camptothecin (a plant alkaloid obtained from the Camptotheca acuminata tree), is an anti-tumor drug with topoisomerase I-inhibitory activity similar to irinotecan. DNA topoisomerases are enzymes in the cell nucleus that regulate DNA topology (3-dimensional conformation) and facilitate nuclear processes such as DNA replication, recombination, and repair. During these processes, DNA topoisomerase I create reversible single-stranded breaks in double-stranded DNA, allowing intact single DNA strands to pass through the break and relieve the topologic constraints inherent in supercoiled DNA. The 3′-DNA terminus of the broken DNA strand binds covalently with the topoisomerase enzyme to form a catalytic intermediate called a cleavable complex. After DNA is sufficiently relaxed and the strand passage reaction is complete, DNA topoisomerase reattaches the broken DNA strands to form the unaltered topoisomers that allow transcription to proceed. Topotecan interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells can be affected by the medicine, other effects may also occur. Unlike irinotecan, topotecan is found predominantly in the inactive carboxylate form at neutral pH and it is not a prodrug.

Indications

  • For the treatment of advanced ovarian cancer in patients with a disease that has recurred or progressed following therapy with platinum-based regimens. Also used as second-line therapy for treatment-sensitive small cell lung cancer, as well as in combination with cisplatin for the treatment of stage IV-B, recurrent, or persistent cervical cancer not amenable to curative treatment with surgery and/or radiation therapy.
  • Hycamtin capsules are indicated as monotherapy for the treatment of adult patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan is indicated for the treatment of patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy.
  • Hycamtin capsules are indicated as monotherapy for the treatment of adult patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate.
  • Topotecan monotherapy is indicated for the treatment of patients with relapsed small-cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate.
  • Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination.
  • Topotecan monotherapy is indicated for the treatment of patients with relapsed small cell lung cancer [SCLC] for whom re-treatment with the first-line regimen is not considered appropriate.
  • Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination.
  • Topotecan monotherapy is indicated for the treatment of: patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy, and patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate.
  • Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination.
  • Topotecan monotherapy is indicated for the treatment of: patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy; patients with relapsed small cell lung cancer [SCLC] for whom re-treatment with the first-line regimen is not considered appropriate.
  • Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination.
  • Topotecan monotherapy is indicated for the treatment of patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate.
  • Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination.
  • Topotecan is indicated for the treatment of patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy.
  • In combination with cisplatin, treatment of stage IVB, recurrent or persistent carcinoma of the cervix which is not amenable to curative treatment with surgery and/or radiation therapy.
  • For the treatment of advanced ovarian cancer in patients with a disease that has recurred or progressed following therapy with platinum-based regimens. Also used as second-line therapy for treatment-sensitive small cell lung cancer, as well as in combination with cisplatin for the treatment of stage IV-B, recurrent, or persistent cervical cancer not amenable to curative treatment with surgery and/or radiation therapy.
  • Acute Myeloid Leukemia (AML)
  • Ewing’s Sarcoma
  • Metastatic Cervical Cancer
  • Refractory Neuroblastoma
  • Metastatic Rhabdomyosarcoma
  • Refractory CNS lymphoma
  • Refractory CNS malignancy
  • Refractory, metastatic Ovarian cancer
  • Relapsed Platinum Sensitive Small Cell Lung Cancer (SCLC)

Use in Cancer

Topotecan hydrochloride is approved to be used alone or with other drugs to treat:

  • Cervical cancer that is metastatic, has recurred (come back), or cannot be cured with other therapy. It is used with cisplatin.
  • Ovarian cancer that is metastatic. It is used alone in patients whose cancer got worse during or after other chemotherapy.
  • Small cell lung cancer that is platinum sensitive. It is used alone in patients whose cancer got worse after first-line chemotherapy.

Topotecan hydrochloride is also being studied in the treatment of other types of cancer.

Contraindications

  • Topotecan Injection is contraindicated in patients who have a history of severe hypersensitivity reactions to topotecan. Reactions have included anaphylactoid reactions.
  • significantly decreased activity of the bone marrow
  • anemia
  • significant anemia
  • decreased blood platelets
  • a significant decrease in certain blood clotting cells called platelets
  • low levels of a type of white blood cell called neutrophils
  • a type of infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation of the lung called interstitial pneumonitis
  • a condition where there is a formation of fibrous tissue in the lung called pulmonary chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis
  • pregnancy
  • a patient who is producing milk and breastfeeding
  • moderate to severe kidney impairment
  • a significant drop in a certain type of white blood cell called a bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।" data-rx-term="neutrophil" data-rx-definition="Neutrophil is a white blood cell important for fighting bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।">neutrophil
  • radiation therapy involving the lungs
  • neutropenic colitis

Dosage

Strengths: 4 mg; 0.25 mg; 1 mg; 1 mg/mL

Ovarian Cancer

  • 1.5 mg/m(2) IV over 30 minutes once a day for 5 consecutive days, starting on day 1 of a 21-day course
  • In the absence of tumor progression, a minimum of 4 courses is recommended because tumor response may be delayed.
  • The median time to respond was 9 to 12 weeks.
  • The recommended dosage should generally not exceed 4 mg.

Cervical Cancer

  • 0.75 mg/m(2) IV over 30 minutes on days 1, 2, and 3 of each 21-day cycle
  • Administer cisplatin 50 mg/m(2) IV on day 1 of each 21-day cycle.
  • Consult cisplatin manufacturer product information for administration and hydration guidelines, and for dose adjustments.
  • The recommended dosage should generally not exceed 4 mg.

Small Cell Lung Cancer

  • IV formulation: 1.5 mg/m(2) IV over 30 minutes once a day for 5 consecutive days, starting on day 1 of a 21-day course
    Oral capsules: 2.3 mg/m(2) orally once a day for 5 consecutive days, starting on day 1 of a 21-day course (round dose to nearest 0.25 mg)
  • Duration of therapy: Until disease progression
  • In the absence of tumor progression, a minimum of 4 courses is recommended because tumor response may be delayed.
  • The median time to respond was 5 to 7 weeks.
  • Recommended IV dosage should generally not exceed 4 mg.
  • Do not prescribe a replacement oral capsule dose for emesis.

IV formulation: Small cell lung cancer sensitive disease after failure of first-line chemotherapy. Sensitive disease was defined as disease responding to chemotherapy but subsequently progressing at least 60 to 90 days after chemotherapy.
Capsule formulation: Treatment of relapsed small cell lung cancer in patients with a prior complete or partial response and who are at least 45 days from the end of first-line chemotherapy.

Renal Dose Adjustments

Small cell lung cancer or Ovarian cancer, IV formulation:

  • Mild renal impairment (CrCl 40 to 60 mL/min): No adjustment recommended
  • Moderate renal impairment (CrCl 20 to 39 mL/min): Decrease dose to 0.75 mg/m(2)
  • Severe renal impairment: Insufficient data to provide a dosage recommendation

Small cell lung cancer, oral capsules:

  • Mild renal impairment (CrCl 50 to 79 mL/min): No adjustment recommended
  • Moderate renal impairment (CrCl 30 to 49 mL/min): Decrease dose to 1.5 mg/m(2)
  • Severe renal impairment (CrCl less than 30): Decrease dose to 0.6 mg/m(2)
  • Doses for moderate to severe renal impairment can be increased by 0.4 mg/m(2) after the first course if no severe hematologic or gastrointestinal toxicities occur.

Cervical cancer:

  • Only initiate treatment if serum creatinine is less than 1.5 mg/dL
  • Serum creatinine greater than 1.5 mg/dL on day 1 of the first cycle: Delay initiation of treatment until renal recovery
  • Serum creatinine greater than 1.5 mg/dL on day 1 of subsequent cycles: Delay cycle until renal recovery
  • Serum creatinine greater than 1.5 mg/dL in subsequent cycles: Permanently discontinue

Dose Adjustments

All cancer types:
On day 1 of the first cycle, delay therapy initiation until hematologic or renal recovery IF:

  • The neutrophil count is less than 1,500 cells/mm(3) OR
  • Platelet count 100,000 cells/mm(3) or less OR
  • Serum creatinine less than 1.5 mg/dL

On day 1 of subsequent cycles, delay the treatment cycle until hematologic or renal recovery IF:

  • The neutrophil count is less than 1000 cells/mm(3) OR
  • Platelet count 100,000 cells/mm(3) or less OR
  • Serum creatinine less than 1.5 mg/dL OR
  • Hemoglobin less than 9 gm/dL

Small cell lung cancer or Ovarian cancer:
IV formulation:
Severe neutropenia [less than 500 cells/mm(3)] in preceding cycle:

  • Permanently reduce IV dose by 0.25 mg [to 1.25 mg/m(2)] or oral dose by 0.4 mg/m(2) for subsequent courses OR
  • Administer granulocyte-colony stimulating factor (G-CSF) following the subsequent course (before resorting to dose reduction) starting from day 6 of the course (24 hours after completion of topotecan administration).
  • A platelet count below 25,000 cells/mm(3): Reduce dose to 1.25 mg/m(2) for subsequent courses.

Oral capsules (Small cell lung cancer only):
Permanently reduce dose by 0.4 mg/m(2) for subsequent courses for:

  • Neutrophil counts less than 500 cells/mm(3)] with fever or infection lasting 7 or more days
  • Neutrophil counts of 500 to 1,000 cells/mm(3) lasting beyond day 21 of treatment course
  • A platelet count below 25,000 cells/mm(3)
  • Do not give oral formulation to patients with Grade 3 or 4 diarrhea
  • After recovery to Grade 1 or less, reduce the dose by 0.4 mg/m(2) for subsequent courses

Cervical cancer:
The first occurrence of febrile neutropenia [less than 1,000 neutrophils/mm(3) with a fever of 38 C/100.4F or higher] in the preceding cycle:

  • Permanently reduce dose to 0.60 mg/m(2) OR
  • Administer prophylactic G-CSF during subsequent cycles

Re-occurrence of febrile neutropenia in the preceding cycle despite the use of G-CSF:

  • Permanently reduce dose to 0.45 mg/m(2)

Platelet nadir less than 25,000 cells/mm(3) in preceding cycle:

  • Permanently reduce dose to 0.60 mg/m(2)

Serum creatinine greater than 1.5 mg/dL in subsequent cycles:

  • Permanently discontinue topotecan

Administration advice:

  • Verify dose using body surface area.
  • Oral capsules should be swallowed whole: do not crush, chew, or divide the capsules.
  • Oral capsules can be taken with or without food.

Reconstitution/preparation techniques:

  • Prepare in a laminar flow hood while wearing gloves and protective clothing.
  • If the solution contacts the skin, wash the skin immediately and thoroughly with soap and water.
  • If the solution contacts mucous membranes, flush thoroughly with water.

Side Effects

The Most Common

  • nausea
  • vomiting
  • diarrhea
  • loss of appetite
  • hair loss
  • hives
  • rash
  • itching
  • hoarseness
  • difficulty breathing or swallowing
  • new or worsening cough, fever, trouble breathing;
  • diarrhea with fever and stomach cramps;
  • pain or burning when you urinate;
  • signs of pneumonia–fever, chills, cough with mucus, chest pain, feeling short of breath; or
  • low blood cell counts–fever, chills, flu-like symptoms, mouth sores, skin sores, pale skin, cold hands and feet, bruising or bleeding, feeling light-headed.
  • low blood cell counts;
  • feeling weak or tired.
  • hair loss; or loss of appetite;
  • nausea, diarrhea, vomiting, stomach pain;
  • trouble breathing, pneumonia

More common

  • Black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • body aches or pain
  • chest pain
  • chills
  • congestion
  • cough
  • difficult or labored breathing
  • dryness or soreness of the throat
  • fever
  • hoarseness
  • lower back or side pain
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • runny nose
  • sneezing
  • tender, swollen glands in the neck
  • tightness in the chest
  • trouble in swallowing
  • troubled breathing with exertion
  • ulcers, sores, or white spots in the mouth
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • voice changes
  • Confusion
  • diarrhea
  • dizziness
  • fainting
  • fast heartbeat
  • lightheadedness
  • nausea
  • pain or cramping in the abdomen
  • rapid, shallow breathing
  • stomach pain
  • vomiting

Rare

  • redness or bruising at the site of the injection
  • swelling and pain of the mouth, tongue, or gums
  • temporary hair loss
  • vomiting
  • weakness
  • abdominal or stomach pain
  • fever
  • sores or white spots on the lips, tongue, or inside the mouth
  • signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • unusual fatigue or weakness
  • irregular or fast breathing
  • wheezing or tightness in the chest
  • signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up blood; vomiting blood or material that looks like coffee grounds)
  • signs of bowel inflammation (e.g., fever that appears after starting the medication, watery and severe diarrhea [may also be bloody])
  • signs of breathing problems (e.g., shortness of breath, troubled breathing, wheezing, or tightness in chest, fast or irregular breathing)
  • signs of severe infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • symptoms of gastrointestinal perforation (e.g., severe stomach pain, nausea, vomiting, bloody stool)

Drug Interactions

Pregnancy and Lactation

AU TGA pregnancy category: D
US FDA pregnancy category: D

Pregnancy

  • There is a possibility of birth defects with topotecan if it is taken during pregnancy. Effective birth control should be practiced while using this medication. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

  • A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
  • Excreted into human milk: Unknown
  • Excreted into animal milk: Yes
  • There is a potential for serious adverse reactions in nursing infants. Animal models excreted this drug into milk at concentrations up to 48 fold higher than those in plasma.

How should this medicine be used?

Topotecan comes as a capsule to take by mouth. It may be taken with or without food. It is usually taken once a day for 5 days in a row every 21 days. Your doctor will decide how many times you should repeat this cycle. Take topotecan at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take topotecan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the capsules whole with water; do not open, chew, or crush them.

Topotecan capsules come in two different strengths. Your doctor may want you to take a combination of both strengths of capsules to make up your full dose. Be sure that you know what each type of capsule looks like and how many you are to take of each. Ask your doctor or pharmacist if you have any questions.

If any of the capsules are broken or leaking, do not touch them with your bare hands. Carefully dispose of the broken capsules without touching them directly and then wash your hands well with soap and water. If the capsule contents do touch your skin, wash the area well with soap and water right away. If any capsule contents get in your eyes, wash your eyes right away with gently flowing water for at least 15 minutes. Call your doctor if you have any skin reaction or if the medication gets in your eyes.

You may vomit after you take the medication. If this happens, let your doctor know right away. Do not take another dose of topotecan on the same day.

Your doctor may need to delay your treatment or adjust your dose if you experience certain side effects. Be sure to tell your doctor how you are feeling during your treatment with topotecan. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

What special precautions should I follow?

Before taking topotecan,

  • tell your doctor and pharmacist if you are allergic to topotecan, any other medications, or any of the ingredients in topotecan capsules. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: cyclosporine (Gengraf, Neoral, Sandimmune); ketoconazole (Nizoral); ritonavir (Norvir, in Kaletra); or saquinavir (Fortovase, Invirase). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had kidney disease.
  • tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are taking topotecan. Talk to your doctor about birth control methods that you can use during your treatment. If you become pregnant while taking topotecan, call your doctor immediately. Topotecan may harm the fetus.
  • tell your doctor if you are breastfeeding. You should not breastfeed while you are taking topotecan.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking topotecan.
  • you should know that topotecan may make you drowsy, tired, or weak. Do not drive a car, use heavy tools, or operate machinery until you know how this medication affects you.
  • you should know that topotecan can cause severe diarrhea that may need to be treated in a hospital. Talk to your doctor about how to prevent and treat diarrhea. Call your doctor right away if you have any of the following symptoms: diarrhea with fever, diarrhea 3 or more times a day, or diarrhea with stomach pain or cramps.
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician
Tests to discuss with doctor
  • Temperature chart and hydration assessment
  • CBC with platelet count if fever persists or dengue/other infection is possible
  • Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Topotecan – Uses, Dosage, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Mechanism of Action Topotecan has the same mechanism of action as irinotecan and is believed to exert its cytotoxic effects during the S-phase of DNA synthesis. Topoisomerase I relieves torsional strain in DNA by inducing reversible single-strand breaks. Topotecan binds to the topoisomerase I-DNA complex and prevents the religation of these single-strand breaks. This ternary complex interferes with the moving replication fork, which leads to the induction of replication arrest and lethal double-stranded breaks in DNA. As mammalian cells cannot efficiently repair these double-strand breaks, the formation of this ternary complex eventually leads to apoptosis (programmed cell death). Topotecan mimics a DNA base pair and binds at the site of DNA cleavage by intercalating between the upstream (−1) and downstream (+1) base pairs. Intercalation displaces the downstream DNA, thus preventing the religation of the cleaved strand. By specifically binding to the enzyme–substrate complex, Topotecan acts as an uncompetitive inhibitor. or Topoisomerase I relieves torsional strain in DNA by inducing reversible single-strand breaks. Topotecan binds to the topoisomerase I-DNA complex and prevents the religation of these single-strand breaks. The cytotoxicity of topotecan is thought to be due to double-strand DNA damage produced during DNA synthesis when replication enzymes interact with the ternary complex formed by topotecan, topoisomerase I, and DNA. Mammalian cells cannot efficiently repair these double-strand breaks. Topotecan, a semi-synthetic derivative of camptothecin (a plant alkaloid obtained from the Camptotheca acuminata tree), is an anti-tumor drug with topoisomerase I-inhibitory activity similar to irinotecan. DNA topoisomerases are enzymes in the cell nucleus that regulate DNA topology (3-dimensional conformation) and facilitate nuclear processes such as DNA replication, recombination, and repair. During these processes, DNA topoisomerase I create reversible single-stranded breaks in double-stranded DNA, allowing intact single DNA strands to pass through the break and relieve the topologic constraints inherent in supercoiled DNA. The 3'-DNA terminus of the broken DNA strand binds covalently with the topoisomerase enzyme to form a catalytic intermediate called a cleavable complex. After DNA is sufficiently relaxed and the strand passage reaction is complete, DNA topoisomerase reattaches the broken DNA strands to form the unaltered topoisomers that allow transcription to proceed. Topotecan interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells can be affected by the medicine, other effects may also occur. Unlike irinotecan, topotecan is found predominantly in the inactive carboxylate form at neutral pH and it is not a prodrug. Indications For the treatment of advanced ovarian cancer in patients with a disease that has recurred or progressed following therapy with platinum-based regimens. Also used as second-line therapy for treatment-sensitive small cell lung cancer, as well as in combination with cisplatin for the treatment of stage IV-B, recurrent, or persistent cervical cancer not amenable to curative treatment with surgery and/or radiation therapy. Hycamtin capsules are indicated as monotherapy for the treatment of adult patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan is indicated for the treatment of patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy. Hycamtin capsules are indicated as monotherapy for the treatment of adult patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan monotherapy is indicated for the treatment of patients with relapsed small-cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination. Topotecan monotherapy is indicated for the treatment of patients with relapsed small cell lung cancer [SCLC] for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination. Topotecan monotherapy is indicated for the treatment of: patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy, and patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination. Topotecan monotherapy is indicated for the treatment of: patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy; patients with relapsed small cell lung cancer [SCLC] for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination. Topotecan monotherapy is indicated for the treatment of patients with relapsed small cell lung cancer (SCLC) for whom re-treatment with the first-line regimen is not considered appropriate. Topotecan in combination with cisplatin is indicated for patients with carcinoma of the cervix recurrent after radiotherapy and for patients with Stage IVB disease. Patients with prior exposure to cisplatin require a sustained treatment-free interval to justify treatment with the combination. Topotecan is indicated for the treatment of patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy. In combination with cisplatin, treatment of stage IVB, recurrent or persistent carcinoma of the cervix which is not amenable to curative treatment with surgery and/or radiation therapy. For the treatment of advanced ovarian cancer in patients with a disease that has recurred or progressed following therapy with platinum-based regimens. Also used as second-line therapy for treatment-sensitive small cell lung cancer, as well as in combination with cisplatin for the treatment of stage IV-B, recurrent, or persistent cervical cancer not amenable to curative treatment with surgery and/or radiation therapy. Acute Myeloid Leukemia (AML) Ewing's Sarcoma Metastatic Cervical Cancer Refractory Neuroblastoma Metastatic Rhabdomyosarcoma Refractory CNS lymphoma Refractory CNS malignancy Refractory, metastatic Ovarian cancer Relapsed Platinum Sensitive Small Cell Lung Cancer (SCLC) Use in Cancer Topotecan hydrochloride is approved to be used alone or with other drugs to treat: Cervical cancer that is metastatic, has recurred (come back), or cannot be cured with other therapy. It is used with cisplatin. Ovarian cancer that is metastatic. It is used alone in patients whose cancer got worse during or after other chemotherapy. Small cell lung cancer that is platinum sensitive. It is used alone in patients whose cancer got worse after first-line chemotherapy. Topotecan hydrochloride is also being studied in the treatment of other types of cancer. Contraindications Topotecan Injection is contraindicated in patients who have a history of severe hypersensitivity reactions to topotecan. Reactions have included anaphylactoid reactions. significantly decreased activity of the bone marrow anemia significant anemia decreased blood platelets a significant decrease in certain blood clotting cells called platelets low levels of a type of white blood cell called neutrophils a type of inflammation of the lung called interstitial pneumonitis a condition where there is a formation of fibrous tissue in the lung called pulmonary fibrosis pregnancy a patient who is producing milk and breastfeeding moderate to severe kidney impairment a significant drop in a certain type of white blood cell called a neutrophil radiation therapy involving the lungs neutropenic colitis Dosage Strengths: 4 mg; 0.25 mg; 1 mg; 1 mg/mL Ovarian Cancer 1.5 mg/m(2) IV over 30 minutes once a day for 5 consecutive days, starting on day 1 of a 21-day course In the absence of tumor progression, a minimum of 4 courses is recommended because tumor response may be delayed. The median time to respond was 9 to 12 weeks. The recommended dosage should generally not exceed 4 mg. Cervical Cancer 0.75 mg/m(2) IV over 30 minutes on days 1, 2, and 3 of each 21-day cycle Administer cisplatin 50 mg/m(2) IV on day 1 of each 21-day cycle. Consult cisplatin manufacturer product information for administration and hydration guidelines, and for dose adjustments. The recommended dosage should generally not exceed 4 mg. Small Cell Lung Cancer IV formulation: 1.5 mg/m(2) IV over 30 minutes once a day for 5 consecutive days, starting on day 1 of a 21-day course Oral capsules: 2.3 mg/m(2) orally once a day for 5 consecutive days, starting on day 1 of a 21-day course (round dose to nearest 0.25 mg) Duration of therapy: Until disease progression In the absence of tumor progression, a minimum of 4 courses is recommended because tumor response may be delayed. The median time to respond was 5 to 7 weeks. Recommended IV dosage should generally not exceed 4 mg. Do not prescribe a replacement oral capsule dose for emesis. IV formulation: Small cell lung cancer sensitive disease after failure of first-line chemotherapy. Sensitive disease was defined as disease responding to chemotherapy but subsequently progressing at least 60 to 90 days after chemotherapy. Capsule formulation: Treatment of relapsed small cell lung cancer in patients with a prior complete or partial response and who are at least 45 days from the end of first-line chemotherapy. Renal Dose Adjustments Small cell lung cancer or Ovarian cancer, IV formulation: Mild renal impairment (CrCl 40 to 60 mL/min): No adjustment recommended Moderate renal impairment (CrCl 20 to 39 mL/min): Decrease dose to 0.75 mg/m(2) Severe renal impairment: Insufficient data to provide a dosage recommendation Small cell lung cancer, oral capsules: Mild renal impairment (CrCl 50 to 79 mL/min): No adjustment recommended Moderate renal impairment (CrCl 30 to 49 mL/min): Decrease dose to 1.5 mg/m(2) Severe renal impairment (CrCl less than 30): Decrease dose to 0.6 mg/m(2) Doses for moderate to severe renal impairment can be increased by 0.4 mg/m(2) after the first course if no severe hematologic or gastrointestinal toxicities occur. Cervical cancer: Only initiate treatment if serum creatinine is less than 1.5 mg/dL Serum creatinine greater than 1.5 mg/dL on day 1 of the first cycle: Delay initiation of treatment until renal recovery Serum creatinine greater than 1.5 mg/dL on day 1 of subsequent cycles: Delay cycle until renal recovery Serum creatinine greater than 1.5 mg/dL in subsequent cycles: Permanently discontinue Dose Adjustments All cancer types: On day 1 of the first cycle, delay therapy initiation until hematologic or renal recovery IF: The neutrophil count is less than 1,500 cells/mm(3) OR Platelet count 100,000 cells/mm(3) or less OR Serum creatinine less than 1.5 mg/dL On day 1 of subsequent cycles, delay the treatment cycle until hematologic or renal recovery IF: The neutrophil count is less than 1000 cells/mm(3) OR Platelet count 100,000 cells/mm(3) or less OR Serum creatinine less than 1.5 mg/dL OR Hemoglobin less than 9 gm/dL Small cell lung cancer or Ovarian cancer: IV formulation: Severe neutropenia [less than 500 cells/mm(3)] in preceding cycle: Permanently reduce IV dose by 0.25 mg [to 1.25 mg/m(2)] or oral dose by 0.4 mg/m(2) for subsequent courses OR Administer granulocyte-colony stimulating factor (G-CSF) following the subsequent course (before resorting to dose reduction) starting from day 6 of the course (24 hours after completion of topotecan administration). A platelet count below 25,000 cells/mm(3): Reduce dose to 1.25 mg/m(2) for subsequent courses. Oral capsules (Small cell lung cancer only): Permanently reduce dose by 0.4 mg/m(2) for subsequent courses for: Neutrophil counts less than 500 cells/mm(3)] with fever or infection lasting 7 or more days Neutrophil counts of 500 to 1,000 cells/mm(3) lasting beyond day 21 of treatment course A platelet count below 25,000 cells/mm(3) Do not give oral formulation to patients with Grade 3 or 4 diarrhea After recovery to Grade 1 or less, reduce the dose by 0.4 mg/m(2) for subsequent courses Cervical cancer: The first occurrence of febrile neutropenia [less than 1,000 neutrophils/mm(3) with a fever of 38 C/100.4F or higher] in the preceding cycle: Permanently reduce dose to 0.60 mg/m(2) OR Administer prophylactic G-CSF during subsequent cycles Re-occurrence of febrile neutropenia in the preceding cycle despite the use of G-CSF: Permanently reduce dose to 0.45 mg/m(2) Platelet nadir less than 25,000 cells/mm(3) in preceding cycle: Permanently reduce dose to 0.60 mg/m(2) Serum creatinine greater than 1.5 mg/dL in subsequent cycles: Permanently discontinue topotecan Administration advice: Verify dose using body surface area. Oral capsules should be swallowed whole: do not crush, chew, or divide the capsules. Oral capsules can be taken with or without food. Reconstitution/preparation techniques: Prepare in a laminar flow hood while wearing gloves and protective clothing. If the solution contacts the skin, wash the skin immediately and thoroughly with soap and water. If the solution contacts mucous membranes, flush thoroughly with water. Side Effects The Most Common nausea vomiting diarrhea loss of appetite hair loss hives rash itching hoarseness difficulty breathing or swallowing new or worsening cough, fever, trouble breathing; diarrhea with fever and stomach cramps; pain or burning when you urinate; signs of pneumonia--fever, chills, cough with mucus, chest pain, feeling short of breath; or low blood cell counts--fever, chills, flu-like symptoms, mouth sores, skin sores, pale skin, cold hands and feet, bruising or bleeding, feeling light-headed. low blood cell counts; feeling weak or tired. hair loss; or loss of appetite; nausea, diarrhea, vomiting, stomach pain; trouble breathing, pneumonia More common Black, tarry stools bleeding gums blood in the urine or stools body aches or pain chest pain chills congestion cough difficult or labored breathing dryness or soreness of the throat fever hoarseness lower back or side pain painful or difficult urination pale skin pinpoint red spots on the skin runny nose sneezing tender, swollen glands in the neck tightness in the chest trouble in swallowing troubled breathing with exertion ulcers, sores, or white spots in the mouth unusual bleeding or bruising unusual tiredness or weakness voice changes Confusion diarrhea dizziness fainting fast heartbeat lightheadedness nausea pain or cramping in the abdomen rapid, shallow breathing stomach pain vomiting Rare redness or bruising at the site of the injection swelling and pain of the mouth, tongue, or gums temporary hair loss vomiting weakness abdominal or stomach pain fever sores or white spots on the lips, tongue, or inside the mouth signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath) signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools) unusual fatigue or weakness irregular or fast breathing wheezing or tightness in the chest signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up blood; vomiting blood or material that looks like coffee grounds) signs of bowel inflammation (e.g., fever that appears after starting the medication, watery and severe diarrhea [may also be bloody]) signs of breathing problems (e.g., shortness of breath, troubled breathing, wheezing, or tightness in chest, fast or irregular breathing) signs of severe infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness) signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat) symptoms of gastrointestinal perforation (e.g., severe stomach pain, nausea, vomiting, bloody stool) Drug Interactions DRUG INTERACTION Abacavir Topotecan may decrease the excretion rate of Abacavir which could result in a higher serum level. Abatacept The risk or severity of adverse effects can be increased when Topotecan is combined with Abatacept. Abciximab The risk or severity of bleeding can be increased when Abciximab is combined with Topotecan. Abemaciclib The excretion of Abemaciclib can be decreased when combined with Topotecan. Abrocitinib The serum concentration of Topotecan can be increased when it is combined with Abrocitinib. Aceclofenac Aceclofenac may decrease the excretion rate of Topotecan which could result in a higher serum level. Acemetacin Acemetacin may decrease the excretion rate of Topotecan which could result in a higher serum level. Acenocoumarol The serum concentration of Acenocoumarol can be increased when it is combined with Topotecan. Acetaminophen Acetaminophen may decrease the excretion rate of Topotecan which could result in a higher serum level. Acetazolamide Acetazolamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Acetylsalicylic acid The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Topotecan. Aclidinium Topotecan may decrease the excretion rate of Aclidinium which could result in a higher serum level. Acrivastine Topotecan may decrease the excretion rate of Acrivastine which could result in a higher serum level. Acyclovir The excretion of Topotecan can be decreased when combined with Acyclovir. Adalimumab The risk or severity of adverse effects can be increased when Adalimumab is combined with Topotecan. Adefovir dipivoxil Adefovir dipivoxil may decrease the excretion rate of Topotecan which could result in a higher serum level. Adenovirus type The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Topotecan. Afatinib The serum concentration of Topotecan can be increased when it is combined with Afatinib. Albutrepenonacog Topotecan may decrease the excretion rate of Albutrepenonacog alfa which could result in a higher serum level. Alclofenac Alclofenac may decrease the excretion rate of Topotecan which could result in a higher serum level. Aldesleukin The risk or severity of adverse effects can be increased when Aldesleukin is combined with Topotecan. Alectinib Alectinib may decrease the excretion rate of Topotecan which could result in a higher serum level. Alefacept The risk or severity of adverse effects can be increased when Alefacept is combined with Topotecan. Alemtuzumab The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Topotecan. Alfuzosin The metabolism of Alfuzosin can be decreased when combined with Topotecan. Allogeneic The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Topotecan. Allopurinol The risk or severity of adverse effects can be increased when Allopurinol is combined with Topotecan. Almasilate Topotecan may decrease the excretion rate of Almasilate which could result in a higher serum level. Almotriptan Almotriptan may decrease the excretion rate of Topotecan which could result in a higher serum level. Alogliptin Topotecan may decrease the excretion rate of Alogliptin which could result in a higher serum level. Alprazolam The metabolism of Alprazolam can be decreased when combined with Topotecan. Alteplase The risk or severity of bleeding can be increased when Alteplase is combined with Topotecan. Altretamine The risk or severity of adverse effects can be increased when Altretamine is combined with Topotecan. Amantadine Amantadine may decrease the excretion rate of Topotecan which could result in a higher serum level. Ambrisentan The serum concentration of Topotecan can be increased when it is combined with Ambrisentan. Amikacin Topotecan may decrease the excretion rate of Amikacin which could result in a higher serum level. Amiloride Amiloride may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Aminophenazone Aminophenazone may decrease the excretion rate of Topotecan which could result in a higher serum level. Amiodarone The serum concentration of Topotecan can be increased when it is combined with Amiodarone. Amitriptyline Amitriptyline may decrease the excretion rate of Topotecan which could result in a higher serum level. Ammonium Topotecan may decrease the excretion rate of Ammonium chloride which could result in a higher serum level. Amobarbital Amobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Amoxicillin Topotecan may decrease the excretion rate of Amoxicillin which could result in a higher serum level. Amphetamine Amphetamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Amphotericin B Amphotericin B may decrease the excretion rate of Topotecan which could result in a higher serum level. Ampicillin Ampicillin may decrease the excretion rate of Topotecan which could result in a higher serum level. Amrinone Topotecan may decrease the excretion rate of Amrinone which could result in a higher serum level. Amsacrine The risk or severity of adverse effects can be increased when Amsacrine is combined with Topotecan. Anagrelide The risk or severity of bleeding can be increased when Anagrelide is combined with Topotecan. Anakinra The risk or severity of adverse effects can be increased when Anakinra is combined with Topotecan. Ancestim Topotecan may decrease the excretion rate of Ancestim which could result in a higher serum level. Ancrod The risk or severity of bleeding can be increased when Ancrod is combined with Topotecan. Anifrolumab The risk or severity of adverse effects can be increased when Topotecan is combined with Anifrolumab. Anistreplase The risk or severity of bleeding can be increased when Anistreplase is combined with Topotecan. Anthrax immune The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Topotecan. Anthrax vaccine The risk or severity of infection can be increased when Anthrax vaccine is combined with Topotecan. Antihemophilic Topotecan may decrease the excretion rate of Antihemophilic factor (recombinant), PEGylated which could result in a higher serum level. Antilymphocyte The risk or severity of adverse effects can be increased when Topotecan is combined with Antilymphocyte immunoglobulin (horse). Antipyrine Antipyrine may decrease the excretion rate of Topotecan which could result in a higher serum level. Antithrombin Alfa The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Topotecan. Antithrombin III Topotecan may decrease the excretion rate of Antithrombin III human which could result in a higher serum level. Antithymocyte The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Topotecan. Antrafenine Antrafenine may decrease the excretion rate of Topotecan which could result in a higher serum level. Apalutamide The serum concentration of Topotecan can be decreased when it is combined with Apalutamide. Apixaban The serum concentration of Topotecan can be increased when it is combined with Apixaban. Apremilast The risk or severity of adverse effects can be increased when Topotecan is combined with Apremilast. Ardeparin The risk or severity of bleeding can be increased when Ardeparin is combined with Topotecan. Arformoterol Topotecan may decrease the excretion rate of Arformoterol which could result in a higher serum level. Argatroban The risk or severity of bleeding can be increased when Argatroban is combined with Topotecan. Aripiprazole The metabolism of Aripiprazole can be decreased when combined with Topotecan. Aripiprazole The metabolism of Aripiprazole lauroxil can be decreased when combined with Topotecan. Arsenic trioxide The serum concentration of Topotecan can be increased when it is combined with Arsenic trioxide. Articaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Articaine. Asciminib The serum concentration of Topotecan can be increased when it is combined with Asciminib. ACOVID-19 The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Topotecan. Asunaprevir The serum concentration of Topotecan can be increased when it is combined with Asunaprevir. Atazanavir Atazanavir may decrease the excretion rate of Topotecan which could result in a higher serum level. Atomoxetine Atomoxetine may decrease the excretion rate of Topotecan which could result in a higher serum level. Atorvastatin The metabolism of Atorvastatin can be decreased when combined with Topotecan. Auranofin Auranofin may decrease the excretion rate of Topotecan which could result in a higher serum level. Aurothioglucose Topotecan may decrease the excretion rate of Aurothioglucose which could result in a higher serum level. Avanafil Avanafil may decrease the excretion rate of Topotecan which could result in a higher serum level. Avatrombopag Avatrombopag may decrease the excretion rate of Topotecan which could result in a higher serum level. Azacitidine The risk or severity of adverse effects can be increased when Azacitidine is combined with Topotecan. Azathioprine The risk or severity of adverse effects can be increased when Azathioprine is combined with Topotecan. Azelaic acid Azelaic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Aztreonam Aztreonam may decrease the excretion rate of Topotecan which could result in a higher serum level. Bacillus The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Topotecan. Bacillus antigen The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Topotecan. Bacillus calmette The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Topotecan. Bacitracin Bacitracin may decrease the excretion rate of Topotecan which could result in a higher serum level. Baclofen Baclofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Balsalazide Balsalazide may decrease the excretion rate of Topotecan which could result in a higher serum level. Baricitinib The risk or severity of adverse effects can be increased when Topotecan is combined with Baricitinib. Basiliximab The risk or severity of adverse effects can be increased when Basiliximab is combined with Topotecan. BCG vaccine The risk or severity of infection can be increased when BCG vaccine is combined with Topotecan. Beclomethasone The risk or severity of adverse effects can be increased when Beclomethasone dipropionate is combined with Topotecan. Belantamab The serum concentration of Topotecan can be increased when it is combined with Belantamab mafodotin. Belatacept The risk or severity of adverse effects can be increased when Topotecan is combined with Belatacept. Belimumab The risk or severity of adverse effects can be increased when Topotecan is combined with Belimumab. Belinostat The risk or severity of adverse effects can be increased when Topotecan is combined with Belinostat. Belumosudil The serum concentration of Topotecan can be increased when it is combined with Belumosudil. Bemiparin The risk or severity of bleeding can be increased when Bemiparin is combined with Topotecan. Bendamustine The risk or severity of adverse effects can be increased when Topotecan is combined with Bendamustine. Bendroflumethia Bendroflumethiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Benorilate Benorilate may decrease the excretion rate of Topotecan which could result in a higher serum level. Benoxaprofen Benoxaprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Benserazide Topotecan may decrease the excretion rate of Benserazide which could result in a higher serum level. Benzatropine Benzatropine may decrease the excretion rate of Topotecan which could result in a higher serum level. Benznidazole Topotecan may decrease the excretion rate of Benznidazole which could result in a higher serum level. Benzocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Benzocaine. Benzthiazide Benzthiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Benzydamine Benzydamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Benzyl alcohol The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Benzyl alcohol. Bepotastine Topotecan may decrease the excretion rate of Bepotastine which could result in a higher serum level. Berotralstat The serum concentration of Topotecan can be increased when it is combined with Berotralstat. Betamethasone The risk or severity of adverse effects can be increased when Betamethasone is combined with Topotecan. Betrixaban The serum concentration of Topotecan can be increased when it is combined with Betrixaban. Bexarotene The risk or severity of adverse effects can be increased when Bexarotene is combined with Topotecan. Bicisate Topotecan may decrease the excretion rate of Bicisate which could result in a higher serum level. Bictegravir The excretion of Topotecan can be decreased when combined with Bictegravir. Bimekizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Bimekizumab. Bismuth subgallate Topotecan may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level. Bisoprolol The serum concentration of Topotecan can be increased when it is combined with Bisoprolol. Bisoxatin Topotecan may decrease the excretion rate of Bisoxatin which could result in a higher serum level. Bivalirudin The risk or severity of bleeding can be increased when Bivalirudin is combined with Topotecan. Bleomycin The risk or severity of adverse effects can be increased when Bleomycin is combined with Topotecan. Blinatumomab The risk or severity of adverse effects can be increased when Topotecan is combined with Blinatumomab. Bordetella The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Topotecan. Bortezomib The risk or severity of adverse effects can be increased when Bortezomib is combined with Topotecan. Bosutinib The risk or severity of adverse effects can be increased when Topotecan is combined with Bosutinib. Brentuximab The risk or severity of adverse effects can be increased when Topotecan is combined with Brentuximab vedotin. Brexanolone Brexanolone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Brigatinib The excretion of Topotecan can be decreased when combined with Brigatinib. Brivaracetam Brivaracetam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Brodalumab The risk or severity of adverse effects can be increased when Topotecan is combined with Brodalumab. Bromazepam Topotecan may decrease the excretion rate of Bromazepam which could result in a higher serum level. Bromotheophylline Bromotheophylline may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Budesonide The risk or severity of adverse effects can be increased when Topotecan is combined with Budesonide. Bumadizone Bumadizone may decrease the excretion rate of Topotecan which could result in a higher serum level. Bumetanide Bumetanide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Bupivacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Bupivacaine. Buprenorphine Buprenorphine may decrease the excretion rate of Topotecan which could result in a higher serum level. Bupropion Topotecan may decrease the excretion rate of Bupropion which could result in a higher serum level. Buspirone Buspirone may decrease the excretion rate of Topotecan which could result in a higher serum level. Busulfan The risk or severity of adverse effects can be increased when Busulfan is combined with Topotecan. Butabarbital Butabarbital may decrease the excretion rate of Topotecan which could result in a higher serum level. Butacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Butacaine. Butalbital Butalbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Butamben The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Butamben. Cabazitaxel The risk or severity of adverse effects can be increased when Topotecan is combined with Cabazitaxel. Caffeine Caffeine may decrease the excretion rate of Topotecan which could result in a higher serum level. Canagliflozin The serum concentration of Topotecan can be increased when it is combined with Canagliflozin. Canakinumab The risk or severity of adverse effects can be increased when Topotecan is combined with Canakinumab. Cangrelor The risk or severity of bleeding can be increased when Cangrelor is combined with Topotecan. Cannabidiol Cannabidiol may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Canrenoic acid Canrenoic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Capecitabine The risk or severity of adverse effects can be increased when Topotecan is combined with Capecitabine. Caplacizumab The risk or severity of bleeding can be increased when Caplacizumab is combined with Topotecan. Capmatinib The serum concentration of Topotecan can be increased when it is combined with Capmatinib. Capreomycin Topotecan may decrease the excretion rate of Capreomycin which could result in a higher serum level. Capsaicin The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Capsaicin. Carbamazepine Carbamazepine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Carbidopa Carbidopa may decrease the excretion rate of Topotecan which could result in a higher serum level. Carboplatin The risk or severity of adverse effects can be increased when Carboplatin is combined with Topotecan. Carfilzomib The serum concentration of Topotecan can be increased when it is combined with Carfilzomib. Carmustine The risk or severity of adverse effects can be increased when Carmustine is combined with Topotecan. Carprofen Carprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Carvedilol The serum concentration of Topotecan can be increased when it is combined with Carvedilol. Cefaclor Cefaclor may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefadroxil Cefadroxil may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefalotin Cefalotin may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefamandole Cefamandole may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefapirin Cefapirin may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefazolin Cefazolin may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefdinir Cefdinir may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefditoren Cefditoren may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefepime Cefepime may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefmenoxime Cefmenoxime may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefmetazole Cefmetazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefonicid Cefonicid may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefoperazone Cefoperazone may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceforanide Ceforanide may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefotaxime Cefotaxime may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefotetan Cefotetan may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefotiam Cefotiam may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefoxitin Cefoxitin may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefpiramide Cefpiramide may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefpirome Cefpirome may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefpodoxime Cefpodoxime may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefprozil Cefprozil may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefradine The excretion of Topotecan can be decreased when combined with Cefradine. Ceftaroline Ceftaroline fosamil may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceftazidime Ceftazidime may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceftibuten Ceftibuten may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceftizoxime Ceftizoxime may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceftobiprole Ceftobiprole may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceftolozane Topotecan may decrease the excretion rate of Ceftolozane which could result in a higher serum level. Ceftriaxone Ceftriaxone may decrease the excretion rate of Topotecan which could result in a higher serum level. Cefuroxime Cefuroxime may decrease the excretion rate of Topotecan which could result in a higher serum level. Celecoxib Celecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level. Cenobamate Cenobamate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Cephalexin The excretion of Topotecan can be decreased when combined with Cephalexin. Cephaloglycin Cephaloglycin may decrease the excretion rate of Topotecan which could result in a higher serum level. Ceritinib The serum concentration of Topotecan can be increased when it is combined with Ceritinib. Certolizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Certolizumab pegol. Cetirizine Cetirizine may decrease the excretion rate of Topotecan which could result in a higher serum level. Cevimeline Cevimeline may decrease the excretion rate of Topotecan which could result in a higher serum level. Chloral hydrate Topotecan may decrease the excretion rate of Chloral hydrate which could result in a higher serum level. Chlorambucil The risk or severity of adverse effects can be increased when Chlorambucil is combined with Topotecan. Chloramphenicol The risk or severity of adverse effects can be increased when Chloramphenicol is combined with Topotecan. Chloroprocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Chloroprocaine. Chloroquine Chloroquine may decrease the excretion rate of Topotecan which could result in a higher serum level. Chlorothiazide Chlorothiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Chloroxylenol Topotecan may decrease the excretion rate of Chloroxylenol which could result in a higher serum level. Chlorpromazine Chlorpromazine may decrease the excretion rate of Topotecan which could result in a higher serum level. Chlorpropamide Chlorpropamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Chlorthalidone Chlorthalidone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Chlorzoxazone Chlorzoxazone may decrease the excretion rate of Topotecan which could result in a higher serum level. Cholesterol Cholesterol may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Choline C 11 Topotecan may decrease the excretion rate of Choline C 11 which could result in a higher serum level. Choline magnesium Choline magnesium trisalicylate may decrease the excretion rate of Topotecan which could result in a higher serum level. Choline salicylate Topotecan may decrease the excretion rate of Choline salicylate which could result in a higher serum level. Chondroitin sulfate Topotecan may decrease the excretion rate of Chondroitin sulfate which could result in a higher serum level. Chromic chloride Topotecan may decrease the excretion rate of Chromic chloride which could result in a higher serum level. Chromic nitrate Topotecan may decrease the excretion rate of Chromic nitrate which could result in a higher serum level. Chromium Topotecan may decrease the excretion rate of Chromium which could result in a higher serum level. Chromium Topotecan may decrease the excretion rate of Chromium gluconate which could result in a higher serum level. Chromium nic Topotecan may decrease the excretion rate of Chromium nicotinate which could result in a higher serum level. Chromous sulfate Topotecan may decrease the excretion rate of Chromous sulfate which could result in a higher serum level. Ciclesonide The risk or severity of adverse effects can be increased when Topotecan is combined with Ciclesonide. Cidofovir Cidofovir may decrease the excretion rate of Topotecan which could result in a higher serum level. Cilostazol The metabolism of Cilostazol can be decreased when combined with Topotecan. Cimetidine The excretion of Topotecan can be decreased when combined with Cimetidine. Cinchocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Cinchocaine. Ciprofloxacin The excretion of Topotecan can be decreased when combined with Ciprofloxacin. Cisplatin The risk or severity of adverse effects can be increased when Cisplatin is combined with Topotecan. Cladribine The risk or severity of adverse effects can be increased when Cladribine is combined with Topotecan. Clarithromycin The serum concentration of Topotecan can be increased when it is combined with Clarithromycin. Clevidipine Topotecan may decrease the excretion rate of Clevidipine which could result in a higher serum level. Clobazam Clobazam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Clobetasol pr The risk or severity of adverse effects can be increased when Clobetasol propionate is combined with Topotecan. Clofarabine The risk or severity of adverse effects can be increased when Clofarabine is combined with Topotecan. Clofazimine The serum concentration of Topotecan can be increased when it is combined with Clofazimine. Clomifene The serum concentration of Topotecan can be increased when it is combined with Clomifene. Clomipramine Topotecan may decrease the excretion rate of Clomipramine which could result in a higher serum level. Clonazepam Clonazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Clopidogrel The risk or severity of bleeding can be increased when Clopidogrel is combined with Topotecan. Clorazepic acid Clorazepic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Clostridium The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Clove oil Topotecan may decrease the excretion rate of Clove oil which could result in a higher serum level. Clozapine The risk or severity of neutropenia can be increased when Topotecan is combined with Clozapine. Cobicistat The serum concentration of Topotecan can be increased when it is combined with Cobicistat. Cobimetinib The serum concentration of Topotecan can be increased when it is combined with Cobimetinib. Cocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Cocaine. Colchicine The metabolism of Colchicine can be decreased when combined with Topotecan. Colistimethate Colistimethate may decrease the excretion rate of Topotecan which could result in a higher serum level. Colistin Topotecan may decrease the excretion rate of Colistin which could result in a higher serum level. Conivaptan The serum concentration of Topotecan can be increased when it is combined with Conivaptan. Conjugated estr Conjugated estrogens may decrease the excretion rate of Topotecan which could result in a higher serum level. Copanlisib The excretion of Topotecan can be decreased when combined with Copanlisib. Corifollitropin alfa Topotecan may decrease the excretion rate of Corifollitropin alfa which could result in a higher serum level. Corticotropin The risk or severity of adverse effects can be increased when Topotecan is combined with Corticotropin. Cortisone acetate The risk or severity of adverse effects can be increased when Topotecan is combined with Cortisone acetate. Corynebacterium The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Crizotinib The serum concentration of Topotecan can be increased when it is combined with Crizotinib. Curcumin The serum concentration of Topotecan can be increased when it is combined with Curcumin. Cyanocobalamin The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Topotecan. Cyclopenthiazide Cyclopenthiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Cyclophosphamide The risk or severity of adverse effects can be increased when Cyclophosphamide is combined with Topotecan. Cyclosporine Topotecan may increase the immunosuppressive activities of Cyclosporine. Cyclothiazide Cyclothiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Cytarabine The risk or severity of adverse effects can be increased when Cytarabine is combined with Topotecan. Dabigatran The risk or severity of bleeding can be increased when Dabigatran is combined with Topotecan. Dabigatran The serum concentration of Topotecan can be increased when it is combined with Dabigatran etexilate. Dabrafenib Dabrafenib may decrease the excretion rate of Topotecan which could result in a higher serum level. Dacarbazine The risk or severity of adverse effects can be increased when Dacarbazine is combined with Topotecan. Daclatasvir The serum concentration of Topotecan can be increased when it is combined with Daclatasvir. Dacomitinib The serum concentration of Topotecan can be increased when it is combined with Dacomitinib. Dactinomycin The risk or severity of adverse effects can be increased when Dactinomycin is combined with Topotecan. Dalfampridine Topotecan may decrease the excretion rate of Dalfampridine which could result in a higher serum level. Dalteparin The risk or severity of bleeding can be increased when Dalteparin is combined with Topotecan. Danaparoid The risk or severity of bleeding can be increased when Danaparoid is combined with Topotecan. Dapagliflozin Dapagliflozin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Daptomycin The serum concentration of Topotecan can be increased when it is combined with Daptomycin. Darbepoetin alfa The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Topotecan. Darolutamide The serum concentration of Topotecan can be increased when it is combined with Darolutamide. Darunavir The serum concentration of Topotecan can be increased when it is combined with Darunavir. Dasabuvir Dasabuvir may decrease the excretion rate of Topotecan which could result in a higher serum level. Dasatinib The risk or severity of adverse effects can be increased when Topotecan is combined with Dasatinib. Daunorubicin The risk or severity of adverse effects can be increased when Daunorubicin is combined with Topotecan. Decitabine The risk or severity of adverse effects can be increased when Topotecan is combined with Decitabine. Deferiprone Topotecan may decrease the excretion rate of Deferiprone which could result in a higher serum level. Defibrotide The risk or severity of bleeding can be increased when Defibrotide is combined with Topotecan. Deflazacort The risk or severity of adverse effects can be increased when Topotecan is combined with Deflazacort. Delafloxacin Topotecan may decrease the excretion rate of Delafloxacin which could result in a higher serum level. Denosumab The risk or severity of adverse effects can be increased when Denosumab is combined with Topotecan. Desipramine Topotecan may decrease the excretion rate of Desipramine which could result in a higher serum level. Desirudin The risk or severity of bleeding can be increased when Desirudin is combined with Topotecan. Desmopressin Desmopressin may decrease the excretion rate of Topotecan which could result in a higher serum level. Desoximetasone The risk or severity of adverse effects can be increased when Desoximetasone is combined with Topotecan. Desvenlafaxine Topotecan may decrease the excretion rate of Desvenlafaxine which could result in a higher serum level. Deucravacitinib The risk or severity of adverse effects can be increased when Topotecan is combined with Deucravacitinib. Deutetrabenazine Topotecan may decrease the excretion rate of Deutetrabenazine which could result in a higher serum level. Dexamethasone The risk or severity of adverse effects can be increased when Topotecan is combined with Dexamethasone. Dexamethasone The serum concentration of Topotecan can be decreased when it is combined with Dexamethasone acetate. Dexibuprofen Dexibuprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Dexketoprofen Dexketoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Dexmedetomidine Dexmedetomidine may decrease the excretion rate of Topotecan which could result in a higher serum level. Dexpanthenol Topotecan may decrease the excretion rate of Dexpanthenol which could result in a higher serum level. Dexrazoxane The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Topotecan. Dextran Topotecan may decrease the excretion rate of Dextran which could result in a higher serum level. Diatrizoate Diatrizoate may decrease the excretion rate of Topotecan which could result in a higher serum level. Diazepam Diazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Dichlorobenzyl Topotecan may decrease the excretion rate of Dichlorobenzyl alcohol which could result in a higher serum level. Diclofenac Diclofenac may decrease the excretion rate of Topotecan which could result in a higher serum level. Diclofenamide Diclofenamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Dicoumarol The risk or severity of bleeding can be increased when Dicoumarol is combined with Topotecan. Dicyclomine Dicyclomine may decrease the excretion rate of Topotecan which could result in a higher serum level. Didanosine Didanosine may decrease the excretion rate of Topotecan which could result in a higher serum level. Dienogest Topotecan may decrease the excretion rate of Dienogest which could result in a higher serum level. Diethylstilbestrol Diethylstilbestrol may decrease the excretion rate of Topotecan which could result in a higher serum level. Diflunisal Diflunisal may decrease the excretion rate of Topotecan which could result in a higher serum level. Difluocortolone The risk or severity of adverse effects can be increased when Topotecan is combined with Difluocortolone. Digitoxin The serum concentration of Topotecan can be increased when it is combined with Digitoxin. Digoxin Topotecan may decrease the excretion rate of Digoxin which could result in a higher serum level. Dihydrostrepto Dihydrostreptomycin may decrease the excretion rate of Topotecan which could result in a higher serum level. Dimercaprol Topotecan may decrease the excretion rate of Dimercaprol which could result in a higher serum level. Dimethyl fu The risk or severity of adverse effects can be increased when Topotecan is combined with Dimethyl fumarate. Dimethyl sulfo Topotecan may decrease the excretion rate of Dimethyl sulfoxide which could result in a higher serum level. Dinutuximab The risk or severity of adverse effects can be increased when Topotecan is combined with Dinutuximab. Diosmin The serum concentration of Topotecan can be increased when it is combined with Diosmin. Diphenhydra The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Diphenhydramine. Dipyridamole The risk or severity of bleeding can be increased when Dipyridamole is combined with Topotecan. Diroximel fum The risk or severity of adverse effects can be increased when Topotecan is combined with Diroximel fumarate. Disopyramide Disopyramide may decrease the excretion rate of Topotecan which could result in a higher serum level. DMethylephedrine Topotecan may decrease the excretion rate of DL-Methylephedrine which could result in a higher serum level. Dobutamine Dobutamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Docetaxel The risk or severity of adverse effects can be increased when Topotecan is combined with Docetaxel. Dolutegravir The serum concentration of Topotecan can be increased when it is combined with Dolutegravir. Dopamine Dopamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Doripenem Topotecan may decrease the excretion rate of Doripenem which could result in a higher serum level. Doxacurium Topotecan may decrease the excretion rate of Doxacurium which could result in a higher serum level. Doxepin Topotecan may decrease the excretion rate of Doxepin which could result in a higher serum level. Doxorubicin The risk or severity of adverse effects can be increased when Doxorubicin is combined with Topotecan. Doxycycline Doxycycline may decrease the excretion rate of Topotecan which could result in a higher serum level. Dronabinol The serum concentration of Dronabinol can be increased when it is combined with Topotecan. Dronedarone The serum concentration of Topotecan can be increased when it is combined with Dronedarone. Drospirenone Drospirenone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Drotrecogin alfa The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Topotecan. Droxidopa Topotecan may decrease the excretion rate of Droxidopa which could result in a higher serum level. Duloxetine Duloxetine may decrease the excretion rate of Topotecan which could result in a higher serum level. Duvelisib The serum concentration of Topotecan can be increased when it is combined with Duvelisib. Dyclonine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Dyclonine. Dyphylline Dyphylline may decrease the excretion rate of Topotecan which could result in a higher serum level. Ebola Zaire The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Topotecan. Eculizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Eculizumab. Edetic acid The risk or severity of bleeding can be increased when Edetic acid is combined with Topotecan. Edoxaban The serum concentration of Topotecan can be increased when it is combined with Edoxaban. Edrophonium Edrophonium may decrease the excretion rate of Topotecan which could result in a higher serum level. Efalizumab The risk or severity of adverse effects can be increased when Efalizumab is combined with Topotecan. Eflapegrastim The risk or severity of neutropenia can be increased when Eflapegrastim is combined with Topotecan. Elagolix The serum concentration of Topotecan can be increased when it is combined with Elagolix. Elbasvir Elbasvir may decrease the excretion rate of Topotecan which could result in a higher serum level. Eliglustat The metabolism of Eliglustat can be decreased when combined with Topotecan. Eltrombopag Eltrombopag may decrease the excretion rate of Topotecan which could result in a higher serum level. Emapalumab The risk or severity of adverse effects can be increased when Topotecan is combined with Emapalumab. Emtricitabine The excretion of Topotecan can be decreased when combined with Emtricitabine. Enalaprilat Topotecan may decrease the excretion rate of Enalaprilat which could result in a higher serum level. Enasidenib The serum concentration of Topotecan can be increased when it is combined with Enasidenib. Enfortumab The serum concentration of Topotecan can be increased when it is combined with Enfortumab vedotin. Enoxaparin The risk or severity of bleeding can be increased when Enoxaparin is combined with Topotecan. Entrectinib The serum concentration of Topotecan can be increased when it is combined with Entrectinib. Enzalutamide The serum concentration of Enzalutamide can be increased when it is combined with Topotecan. Epirubicin The risk or severity of adverse effects can be increased when Epirubicin is combined with Topotecan. Eplerenone Eplerenone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Epoprostenol The risk or severity of bleeding can be increased when Epoprostenol is combined with Topotecan. Eptifibatide The risk or severity of bleeding can be increased when Eptifibatide is combined with Topotecan. Erdafitinib The serum concentration of Topotecan can be increased when it is combined with Erdafitinib. Eribulin The risk or severity of adverse effects can be increased when Topotecan is combined with Eribulin. Erlotinib Erlotinib may decrease the excretion rate of Topotecan which could result in a higher serum level. Ertapenem Ertapenem may decrease the excretion rate of Topotecan which could result in a higher serum level. Ertugliflozin Ertugliflozin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Erythromycin The serum concentration of Topotecan can be increased when it is combined with Erythromycin. Erythropoietin The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Topotecan. Eslicarbazepine Eslicarbazepine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Eslicarbazepine Eslicarbazepine acetate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Estazolam Estazolam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Estradiol Estradiol may decrease the excretion rate of Topotecan which could result in a higher serum level. Estradiol acetate Estradiol acetate may decrease the excretion rate of Topotecan which could result in a higher serum level. Estradiol benzoate Estradiol benzoate may decrease the excretion rate of Topotecan which could result in a higher serum level. Estradiol cypie Estradiol cypionate may decrease the excretion rate of Topotecan which could result in a higher serum level. Estradiol diena Estradiol dienanthate may decrease the excretion rate of Topotecan which could result in a higher serum level. Estradiol valerate Estradiol valerate may decrease the excretion rate of Topotecan which could result in a higher serum level. Estramustine The risk or severity of adverse effects can be increased when Topotecan is combined with Estramustine. Estrone sulfate The excretion of Topotecan can be decreased when combined with Estrone sulfate. Eszopiclone The metabolism of Eszopiclone can be decreased when combined with Topotecan. Etacrynic acid Etacrynic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Etafedrine Topotecan may decrease the excretion rate of Etafedrine which could result in a higher serum level. Etanercept The risk or severity of adverse effects can be increased when Etanercept is combined with Topotecan. Ethambutol Ethambutol may decrease the excretion rate of Topotecan which could result in a higher serum level. Ethosuximide Ethosuximide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Ethotoin Ethotoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Ethyl chloride The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Ethyl chloride. Etidocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Etidocaine. Etodolac Etodolac may decrease the excretion rate of Topotecan which could result in a higher serum level. Etomidate Etomidate may decrease the excretion rate of Topotecan which could result in a higher serum level. Etonogestrel Etonogestrel may decrease the excretion rate of Topotecan which could result in a higher serum level. Etoposide The risk or severity of adverse effects can be increased when Etoposide is combined with Topotecan. Etoricoxib Etoricoxib may decrease the excretion rate of Topotecan which could result in a higher serum level. Eucalyptus oil Topotecan may decrease the excretion rate of Eucalyptus oil which could result in a higher serum level. Everolimus The serum concentration of Topotecan can be increased when it is combined with Everolimus. Ezogabine Ezogabine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Famotidine The excretion of Topotecan can be decreased when combined with Famotidine. Famtozinameran The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Topotecan. Favipiravir The serum concentration of Topotecan can be increased when it is combined with Favipiravir. Febuxostat The excretion of Topotecan can be decreased when combined with Febuxostat. Fedratinib The serum concentration of Topotecan can be increased when it is combined with Fedratinib. Felbamate Felbamate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Fenbufen Fenbufen may decrease the excretion rate of Topotecan which could result in a higher serum level. Fenfluramine Fenfluramine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Fenofibrate Topotecan may decrease the excretion rate of Fenofibrate which could result in a higher serum level. Fenofibric acid Topotecan may decrease the excretion rate of Fenofibric acid which could result in a higher serum level. Fenoldopam Fenoldopam may decrease the excretion rate of Topotecan which could result in a higher serum level. Fenoprofen Fenoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Fentanyl The metabolism of Fentanyl can be decreased when combined with Topotecan. Fesoterodine Topotecan may decrease the excretion rate of Fesoterodine which could result in a higher serum level. Fexinidazole The excretion of Topotecan can be decreased when combined with Fexinidazole. Fexofenadine The serum concentration of Topotecan can be increased when it is combined with Fexofenadine. Filgotinib The serum concentration of Topotecan can be increased when it is combined with Filgotinib. Filgrastim The risk or severity of neutropenia can be increased when Filgrastim is combined with Topotecan. Finerenone The serum concentration of Finerenone can be increased when it is combined with Topotecan. Fingolimod Topotecan may increase the immunosuppressive activities of Fingolimod. Flavoxate Topotecan may decrease the excretion rate of Flavoxate which could result in a higher serum level. Flecainide The excretion of Topotecan can be decreased when combined with Flecainide. Flibanserin The serum concentration of Topotecan can be increased when it is combined with Flibanserin. Floctafenine Floctafenine may decrease the excretion rate of Topotecan which could result in a higher serum level. Florbetaben Topotecan may decrease the excretion rate of Florbetaben (18F) which could result in a higher serum level. Florbetapir Topotecan may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level. Floxuridine The risk or severity of adverse effects can be increased when Floxuridine is combined with Topotecan. Fluconazole The serum concentration of Topotecan can be increased when it is combined with Fluconazole. Flucytosine The risk or severity of adverse effects can be increased when Topotecan is combined with Flucytosine. Fludarabine The risk or severity of adverse effects can be increased when Topotecan is combined with Fludarabine. Fludeoxyglucos Topotecan may decrease the excretion rate of Fludeoxyglucose (18F) which could result in a higher serum level. Fludrocortisone The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Topotecan. Fluindione The risk or severity of bleeding can be increased when Fluindione is combined with Topotecan. Flumazenil Topotecan may decrease the excretion rate of Flumazenil which could result in a higher serum level. Flunarizine Flunarizine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Flunisolide The risk or severity of adverse effects can be increased when Flunisolide is combined with Topotecan. Fluocinolone The risk or severity of adverse effects can be increased when Fluocinolone acetonide is combined with Topotecan. Fluocinonide The risk or severity of adverse effects can be increased when Topotecan is combined with Fluocinonide. Fluocortolone The risk or severity of adverse effects can be increased when Topotecan is combined with Fluocortolone. Fluoromethol The risk or severity of adverse effects can be increased when Fluorometholone is combined with Topotecan. Fluorouracil The risk or severity of adverse effects can be increased when Fluorouracil is combined with Topotecan. Flupentixol The risk or severity of myelosuppression can be increased when Flupentixol is combined with Topotecan. Fluprednisolone The risk or severity of adverse effects can be increased when Topotecan is combined with Fluprednisolone. Flurazepam Flurazepam may decrease the excretion rate of Topotecan which could result in a higher serum level. Flurbiprofen Flurbiprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Flutamide Flutamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Fluticasone The risk or severity of adverse effects can be increased when Topotecan is combined with Fluticasone. Fluticasone fur The risk or severity of adverse effects can be increased when Topotecan is combined with Fluticasone furoate. Fluticasone The risk or severity of adverse effects can be increased when Fluticasone propionate is combined with Topotecan. Fluvoxamine Fluvoxamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Folic acid Folic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Fomepizole Topotecan may decrease the excretion rate of Fomepizole which could result in a higher serum level. Fondaparinux Fondaparinux may decrease the excretion rate of Topotecan which could result in a higher serum level. Formestane Topotecan may decrease the excretion rate of Formestane which could result in a higher serum level. Foscarnet Foscarnet may decrease the excretion rate of Topotecan which could result in a higher serum level. Fosfomycin Fosfomycin may decrease the excretion rate of Topotecan which could result in a higher serum level. Fosinopril Fosinopril may decrease the excretion rate of Topotecan which could result in a higher serum level. Fosphenytoin Fosphenytoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Fostamatinib Fostamatinib may decrease the excretion rate of Topotecan which could result in a higher serum level. Fostemsavir Fostemsavir may decrease the excretion rate of Topotecan which could result in a higher serum level. Framycetin Framycetin may decrease the excretion rate of Topotecan which could result in a higher serum level. Furosemide Furosemide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Fusidic acid Fusidic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Futibatinib The serum concentration of Topotecan can be increased when it is combined with Futibatinib. Gabapentin Gabapentin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Gabapentin Topotecan may decrease the excretion rate of Gabapentin enacarbil which could result in a higher serum level. Gadobenic acid Gadobenic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Gadodiamide Gadodiamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Gadofosveset Topotecan may decrease the excretion rate of Gadofosveset trisodium which could result in a higher serum level. Gadopentetic Gadopentetic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Gadoteric acid Topotecan may decrease the excretion rate of Gadoteric acid which could result in a higher serum level. Gadoteridol Gadoteridol may decrease the excretion rate of Topotecan which could result in a higher serum level. Gallium nitrate The risk or severity of adverse effects can be increased when Topotecan is combined with Gallium nitrate. Ganciclovir The excretion of Topotecan can be decreased when combined with Ganciclovir. Gefitinib Gefitinib may decrease the excretion rate of Topotecan which could result in a higher serum level. Gemcitabine The risk or severity of adverse effects can be increased when Gemcitabine is combined with Topotecan. Gemfibrozil Topotecan may decrease the excretion rate of Gemfibrozil which could result in a higher serum level. Gemtuzumab The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Topotecan. Gentamicin Topotecan may decrease the excretion rate of Gentamicin which could result in a higher serum level. Gilteritinib The excretion of Topotecan can be decreased when combined with Gilteritinib. Gimeracil Topotecan may decrease the excretion rate of Gimeracil which could result in a higher serum level. Givosiran Givosiran may decrease the excretion rate of Topotecan which could result in a higher serum level. Glasdegib The serum concentration of Topotecan can be increased when it is combined with Glasdegib. Glatiramer The risk or severity of adverse effects can be increased when Topotecan is combined with Glatiramer. Glecaprevir The serum concentration of Topotecan can be increased when it is combined with Glecaprevir. Glipizide Topotecan may decrease the excretion rate of Glipizide which could result in a higher serum level. Glycerol Topotecan may decrease the excretion rate of Glycerol phenylbutyrate which could result in a higher serum level. Golimumab The risk or severity of adverse effects can be increased when Topotecan is combined with Golimumab. Golodirsen Topotecan may decrease the excretion rate of Golodirsen which could result in a higher serum level. Goserelin Goserelin may decrease the excretion rate of Topotecan which could result in a higher serum level. Grazoprevir Grazoprevir may decrease the excretion rate of Topotecan which could result in a higher serum level. Guanethidine Topotecan may decrease the excretion rate of Guanethidine which could result in a higher serum level. Guanfacine Guanfacine may decrease the excretion rate of Topotecan which could result in a higher serum level. Guanidine The excretion of Topotecan can be decreased when combined with Guanidine. Guselkumab The risk or severity of adverse effects can be increased when Topotecan is combined with Guselkumab. Haemophilus The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Topotecan. Haloperidol The serum concentration of Haloperidol can be increased when it is combined with Topotecan. Heparin The risk or severity of bleeding can be increased when Heparin is combined with Topotecan. Hepatitis A Vaccine The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Topotecan. Hepatitis B Vacci The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Topotecan. Human adenovirus The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Topotecan. Hydralazine Topotecan may decrease the excretion rate of Hydralazine which could result in a higher serum level. Hydrochlorothiazide Hydrochlorothiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Hydrocortisone The risk or severity of adverse effects can be increased when Topotecan is combined with Hydrocortisone acetate. Hydrocortisone but The risk or severity of adverse effects can be increased when Topotecan is combined with Hydrocortisone butyrate. Hydrocortisone suc The risk or severity of adverse effects can be increased when Topotecan is combined with Hydrocortisone succinate. Hydroflumethiazide Hydroflumethiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Hydromorphone Hydromorphone may decrease the excretion rate of Topotecan which could result in a higher serum level. Hydroxocobalamin Hydroxocobalamin may decrease the excretion rate of Topotecan which could result in a higher serum level. Hydroxychloroquine The risk or severity of adverse effects can be increased when Topotecan is combined with Hydroxychloroquine. Hydroxyethyl Starch Topotecan may decrease the excretion rate of Hydroxyethyl Starch which could result in a higher serum level. Hydroxyurea The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Topotecan. Ibritumomab The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Topotecan. Ibrutinib The metabolism of Ibrutinib can be decreased when combined with Topotecan. Ibuprofen Ibuprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Ibutilide Ibutilide may decrease the excretion rate of Topotecan which could result in a higher serum level. Icatibant Topotecan may decrease the excretion rate of Icatibant which could result in a higher serum level. Icosapent Icosapent may decrease the excretion rate of Topotecan which could result in a higher serum level. Icosapent ethyl The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Topotecan. Idarubicin The risk or severity of adverse effects can be increased when Topotecan is combined with Idarubicin. Idarucizumab Topotecan may decrease the excretion rate of Idarucizumab which could result in a higher serum level. Idebenone Topotecan may decrease the excretion rate of Idebenone which could result in a higher serum level. Idelalisib The risk or severity of adverse effects can be increased when Topotecan is combined with Idelalisib. Ifosfamide The risk or severity of adverse effects can be increased when Topotecan is combined with Ifosfamide. Iloperidone The metabolism of Iloperidone can be decreased when combined with Topotecan. Iloprost The risk or severity of bleeding can be increased when Iloprost is combined with Topotecan. Imatinib The risk or severity of adverse effects can be increased when Imatinib is combined with Topotecan. Imipramine Imipramine may decrease the excretion rate of Topotecan which could result in a higher serum level. Indacaterol The serum concentration of Topotecan can be increased when it is combined with Indacaterol. Indapamide Indapamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Indigotindisulfo Topotecan may decrease the excretion rate of Indigotindisulfonic acid which could result in a higher serum level. Indomethacin The risk or severity of adverse effects can be increased when Indomethacin is combined with Topotecan. Inebilizumab The risk or severity of infection can be increased when Topotecan is combined with Inebilizumab. Infliximab The risk or severity of adverse effects can be increased when Infliximab is combined with Topotecan. Influenza A The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Influenza A virus The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Influenza A virus The therapeutic efficacy of Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen can be decreased when used in combination with Topotecan. Influenza The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Influenza A vir The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Influenza A The therapeutic efficacy of Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen can be decreased when used in combination with Topotecan. Influenza A virus The therapeutic efficacy of Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Influenza A The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Influenza A The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Influenza B The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Influenza B The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Influenza B The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Influenza The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan. Inosine Topotecan may decrease the excretion rate of Inosine pranobex which could result in a higher serum level. Inositol Topotecan may decrease the excretion rate of Inositol which could result in a higher serum level. Inotersen Inotersen may decrease the excretion rate of Topotecan which could result in a higher serum level. Inotuzumab The serum concentration of Topotecan can be increased when it is combined with Inotuzumab ozogamicin. Interferon a The risk or severity of adverse effects can be increased when Interferon alfa-2a is combined with Topotecan. Interferon The risk or severity of adverse effects can be increased when Interferon alfa-2b is combined with Topotecan. Interferon The risk or severity of adverse effects can be increased when Interferon alfa-n1 is combined with Topotecan. Interferon alfa The risk or severity of adverse effects can be increased when Interferon alfa-n3 is combined with Topotecan. Interferon The risk or severity of adverse effects can be increased when Interferon alfacon-1 is combined with Topotecan. Interferon The risk or severity of adverse effects can be increased when Interferon beta-1b is combined with Topotecan. Interferon gamma The risk or severity of adverse effects can be increased when Interferon gamma-1b is combined with Topotecan. Iobenguane Topotecan may decrease the excretion rate of Iobenguane sulfate I-123 which could result in a higher serum level. Iodixanol Topotecan may decrease the excretion rate of Iodixanol which could result in a higher serum level. Ioflupane Topotecan may decrease the excretion rate of Ioflupane I-123 which could result in a higher serum level. Iopromide Topotecan may decrease the excretion rate of Iopromide which could result in a higher serum level. Iothalamic acid Topotecan may decrease the excretion rate of Iothalamic acid which could result in a higher serum level. Ioversol Topotecan may decrease the excretion rate of Ioversol which could result in a higher serum level. Ioxilan Topotecan may decrease the excretion rate of Ioxilan which could result in a higher serum level. Ipecac Topotecan may decrease the excretion rate of Ipecac which could result in a higher serum level. Ipilimumab Topotecan may decrease the excretion rate of Ipilimumab which could result in a higher serum level. Irinotecan The risk or severity of adverse effects can be increased when Irinotecan is combined with Topotecan. Isavuconazole The serum concentration of Topotecan can be increased when it is combined with Isavuconazole. Isavuconazonium The serum concentration of Topotecan can be increased when it is combined with Isavuconazonium. Isoniazid Isoniazid may decrease the excretion rate of Topotecan which could result in a higher serum level. Isosorbide Isosorbide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Isosorbide mon Isosorbide mononitrate may decrease the excretion rate of Topotecan which could result in a higher serum level. Isosulfan blue Topotecan may decrease the excretion rate of Isosulfan blue which could result in a higher serum level. Isotretinoin Isotretinoin may decrease the excretion rate of Topotecan which could result in a higher serum level. Isoxicam Isoxicam may decrease the excretion rate of Topotecan which could result in a higher serum level. Isradipine Isradipine may decrease the excretion rate of Topotecan which could result in a higher serum level. Istradefylline The serum concentration of Topotecan can be increased when it is combined with Istradefylline. Itraconazole The serum concentration of Topotecan can be increased when it is combined with Itraconazole. Ivacaftor The serum concentration of Topotecan can be increased when it is combined with Ivacaftor. Ixabepilone The serum concentration of Topotecan can be increased when it is combined with Ixabepilone. Ixazomib Topotecan may decrease the excretion rate of Ixazomib which could result in a higher serum level. Ixekizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Ixekizumab. JCOVID-19 Vaccine The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Topotecan. Japa encephalitis The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan. Kanamycin Topotecan may decrease the excretion rate of Kanamycin which could result in a higher serum level. Ketamine Topotecan may decrease the excretion rate of Ketamine which could result in a higher serum level. Ketazolam Topotecan may decrease the excretion rate of Ketazolam which could result in a higher serum level. Ketoconazole The serum concentration of Topotecan can be increased when it is combined with Ketoconazole. Ketoprofen Ketoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Ketorolac Ketorolac may decrease the excretion rate of Topotecan which could result in a higher serum level. Labetalol Labetalol may decrease the excretion rate of Topotecan which could result in a higher serum level. Lacosamide Lacosamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Lamivudine Lamivudine may decrease the excretion rate of Topotecan which could result in a higher serum level. Lamotrigine Lamotrigine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Lansoprazole Lansoprazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Lapatinib The serum concentration of Topotecan can be increased when it is combined with Lapatinib. Larotrectinib The serum concentration of Topotecan can be increased when it is combined with Larotrectinib. Lasmiditan The serum concentration of Topotecan can be increased when it is combined with Lasmiditan. Latamoxef Latamoxef may decrease the excretion rate of Topotecan which could result in a higher serum level. Ledipasvir The serum concentration of Topotecan can be increased when it is combined with Ledipasvir. Lefamulin The serum concentration of Topotecan can be increased when it is combined with Lefamulin. Leflunomide The risk or severity of adverse effects can be increased when Topotecan is combined with Leflunomide. Lemborexant The serum concentration of Topotecan can be increased when it is combined with Lemborexant. Lenalidomide The risk or severity of adverse effects can be increased when Lenalidomide is combined with Topotecan. Lenograstim The risk or severity of neutropenia can be increased when Lenograstim is combined with Topotecan. Lenvatinib The serum concentration of Topotecan can be increased when it is combined with Lenvatinib. Lepirudin The risk or severity of bleeding can be increased when Lepirudin is combined with Topotecan. Lesinurad Topotecan may decrease the excretion rate of Lesinurad which could result in a higher serum level. Letermovir Letermovir may decrease the excretion rate of Topotecan which could result in a higher serum level. Leuprolide Leuprolide may decrease the excretion rate of Topotecan which could result in a higher serum level. Levamlodipine The serum concentration of Levamlodipine can be increased when it is combined with Topotecan. Levetiracetam Levetiracetam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Levobupivacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Levobupivacaine. Levocarnitine Levocarnitine may decrease the excretion rate of Topotecan which could result in a higher serum level. Levocetirizine Topotecan may decrease the excretion rate of Levocetirizine which could result in a higher serum level. Levofloxacin The excretion of Topotecan can be decreased when combined with Levofloxacin. Levoketoconazole The serum concentration of Topotecan can be increased when it is combined with Levoketoconazole. Levomilnacipran Topotecan may decrease the excretion rate of Levomilnacipran which could result in a higher serum level. Levosalbutamol Topotecan may decrease the excretion rate of Levosalbutamol which could result in a higher serum level. Levothyroxine The serum concentration of Topotecan can be decreased when it is combined with Levothyroxine. Lidocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Lidocaine. Linagliptin The serum concentration of Topotecan can be increased when it is combined with Linagliptin. Linezolid The risk or severity of adverse effects can be increased when Linezolid is combined with Topotecan. Liothyronine Liothyronine may decrease the excretion rate of Topotecan which could result in a higher serum level. Lipegfilgrastim Topotecan may increase the myelosuppressive activities of Lipegfilgrastim. Lisinopril Lisinopril may decrease the excretion rate of Topotecan which could result in a higher serum level. Lithium carbonate Topotecan may decrease the excretion rate of Lithium carbonate which could result in a higher serum level. Lithium citrate Lithium citrate may decrease the excretion rate of Topotecan which could result in a higher serum level. Lixisenatide Topotecan may decrease the excretion rate of Lixisenatide which could result in a higher serum level. Lofexidine The excretion of Topotecan can be decreased when combined with Lofexidine. Lomitapide The serum concentration of Topotecan can be increased when it is combined with Lomitapide. Lomustine The risk or severity of adverse effects can be increased when Topotecan is combined with Lomustine. Lonafarnib The serum concentration of Topotecan can be increased when it is combined with Lonafarnib. Loncastuximab The serum concentration of Topotecan can be increased when it is combined with Loncastuximab tesirine. Loperamide The serum concentration of Topotecan can be increased when it is combined with Loperamide. Lopinavir The serum concentration of Topotecan can be increased when it is combined with Lopinavir. Loracarbef Loracarbef may decrease the excretion rate of Topotecan which could result in a higher serum level. Lorazepam Lorazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Lorcaserin Topotecan may decrease the excretion rate of Lorcaserin which could result in a higher serum level. Lorlatinib The serum concentration of Topotecan can be decreased when it is combined with Lorlatinib. Lornoxicam Lornoxicam may decrease the excretion rate of Topotecan which could result in a higher serum level. Lorpiprazole Topotecan may decrease the excretion rate of Lorpiprazole which could result in a higher serum level. Lovastatin The metabolism of Lovastatin can be decreased when combined with Topotecan. Loxapine The serum concentration of Topotecan can be increased when it is combined with Loxapine. Loxoprofen Loxoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level. Lubiprostone Topotecan may decrease the excretion rate of Lubiprostone which could result in a higher serum level. Lumacaftor The serum concentration of Topotecan can be increased when it is combined with Lumacaftor. Lumiracoxib Lumiracoxib may decrease the excretion rate of Topotecan which could result in a higher serum level. Lusutrombopag The serum concentration of Topotecan can be increased when it is combined with Lusutrombopag. Macitentan Topotecan may decrease the excretion rate of Macitentan which could result in a higher serum level. Magnesium The serum concentration of Magnesium can be decreased when it is combined with Topotecan. Magnesium carb Topotecan may decrease the excretion rate of Magnesium carbonate which could result in a higher serum level. Magnesium chl Topotecan may decrease the excretion rate of Magnesium chloride which could result in a higher serum level. Magnesium hydr Topotecan may decrease the excretion rate of Magnesium hydroxide which could result in a higher serum level. Magnesium sulfa Magnesium sulfate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Magnesium trisi Topotecan may decrease the excretion rate of Magnesium trisilicate which could result in a higher serum level. Mangafodipir Topotecan may decrease the excretion rate of Mangafodipir which could result in a higher serum level. Mannitol Mannitol may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Maprotiline Maprotiline may decrease the excretion rate of Topotecan which could result in a higher serum level. Maribavir The serum concentration of Topotecan can be increased when it is combined with Maribavir. Measles vir The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Topotecan. Mecamylamine Mecamylamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Mechlorethamine The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Topotecan. Meclofenamic acid Meclofenamic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Medroxyproges Medroxyprogesterone acetate may decrease the excretion rate of Topotecan which could result in a higher serum level. Mefenamic acid Mefenamic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Mefloquine The serum concentration of Topotecan can be increased when it is combined with Mefloquine. Megestrol acetate Megestrol acetate may decrease the excretion rate of Topotecan which could result in a higher serum level. Meloxicam The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Meloxicam. Melphalan The risk or severity of adverse effects can be increased when Topotecan is combined with Melphalan. Memantine Topotecan may decrease the excretion rate of Memantine which could result in a higher serum level. Meningococcal The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Topotecan. Meperidine Meperidine may decrease the excretion rate of Topotecan which could result in a higher serum level. Mephenytoin Mephenytoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Mepivacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Mepivacaine. Mepolizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Mepolizumab. Meprednisone The risk or severity of adverse effects can be increased when Topotecan is combined with Meprednisone. Mercaptopurine The risk or severity of adverse effects can be increased when Topotecan is combined with Mercaptopurine. Meropenem Meropenem may decrease the excretion rate of Topotecan which could result in a higher serum level. Mesalazine Mesalazine may decrease the excretion rate of Topotecan which could result in a higher serum level. Metamfetamine Topotecan may decrease the excretion rate of Metamfetamine which could result in a higher serum level. Metamizole The risk or severity of myelosuppression can be increased when Metamizole is combined with Topotecan. Metaxalone Metaxalone may decrease the excretion rate of Topotecan which could result in a higher serum level. Metformin The excretion of Topotecan can be decreased when combined with Metformin. Methadone Methadone may decrease the excretion rate of Topotecan which could result in a higher serum level. Methazolamide Methazolamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Methimazole The risk or severity of adverse effects can be increased when Methimazole is combined with Topotecan. Methohexital Methohexital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Methotrexate The risk or severity of adverse effects can be increased when Methotrexate is combined with Topotecan. Methoxsalen Methoxsalen may decrease the excretion rate of Topotecan which could result in a higher serum level. Methoxy The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Topotecan. Methsuximide Methsuximide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Methyldopa Methyldopa may decrease the excretion rate of Topotecan which could result in a higher serum level. Methylene blue The serum concentration of Topotecan can be increased when it is combined with Methylene blue. Methylnaltrexone Topotecan may decrease the excretion rate of Methylnaltrexone which could result in a higher serum level. Methylphenobarb Methylphenobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Methylprednisol The risk or severity of adverse effects can be increased when Methylprednisolone is combined with Topotecan. Methyltestoster Topotecan may decrease the excretion rate of Methyltestosterone which could result in a higher serum level. Meticrane Meticrane may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Metoclopramide Topotecan may decrease the excretion rate of Metoclopramide which could result in a higher serum level. Metolazone Metolazone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Metoprolol Metoprolol may decrease the excretion rate of Topotecan which could result in a higher serum level. Metyrapone Metyrapone may decrease the excretion rate of Topotecan which could result in a higher serum level. Midazolam The serum concentration of Midazolam can be increased when it is combined with Topotecan. Mifepristone The serum concentration of Topotecan can be increased when it is combined with Mifepristone. Migalastat Topotecan may decrease the excretion rate of Migalastat which could result in a higher serum level. Milnacipran Topotecan may decrease the excretion rate of Milnacipran which could result in a higher serum level. Milrinone Milrinone may decrease the excretion rate of Topotecan which could result in a higher serum level. Mirabegron The serum concentration of Topotecan can be increased when it is combined with Mirabegron. Mitapivat The serum concentration of Topotecan can be increased when it is combined with Mitapivat. Mitomycin The risk or severity of adverse effects can be increased when Mitomycin is combined with Topotecan. Mitoxantrone The risk or severity of adverse effects can be increased when Topotecan is combined with Mitoxantrone. MCOVID-19 Vacc The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Topotecan. Modified vacci The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Topotecan. Mometasone The risk or severity of adverse effects can be increased when Topotecan is combined with Mometasone furoate. Monomethyl The risk or severity of adverse effects can be increased when Topotecan is combined with Monomethyl fumarate. Morphine The serum concentration of Topotecan can be increased when it is combined with Morphine. Mosunetuzumab The risk or severity of adverse effects can be increased when Topotecan is combined with Mosunetuzumab. Moxisylyte Topotecan may decrease the excretion rate of Moxisylyte which could result in a higher serum level. Mumps virus The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Topotecan. Muromonab The risk or severity of adverse effects can be increased when Muromonab is combined with Topotecan. Muzolimine Muzolimine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Mycophenolate The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Topotecan. Mycophenolic acid The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Topotecan. N-acetyltyrosine Topotecan may decrease the excretion rate of N-acetyltyrosine which could result in a higher serum level. Nabumetone Nabumetone may decrease the excretion rate of Topotecan which could result in a higher serum level. Nadolol The excretion of Topotecan can be decreased when combined with Nadolol. Nadroparin The risk or severity of bleeding can be increased when Nadroparin is combined with Topotecan. Naldemedine Topotecan may decrease the excretion rate of Naldemedine which could result in a higher serum level. Nalmefene Topotecan may decrease the excretion rate of Nalmefene which could result in a higher serum level. Naloxone Topotecan may decrease the excretion rate of Naloxone which could result in a higher serum level. Naproxen Naproxen may decrease the excretion rate of Topotecan which could result in a higher serum level. Natalizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Natalizumab. Nateglinide Nateglinide may decrease the excretion rate of Topotecan which could result in a higher serum level. Nedaplatin The risk or severity of adverse effects can be increased when Nedaplatin is combined with Topotecan. Nedocromil Nedocromil may decrease the excretion rate of Topotecan which could result in a higher serum level. Nefazodone Topotecan may decrease the excretion rate of Nefazodone which could result in a higher serum level. Nelarabine The risk or severity of adverse effects can be increased when Topotecan is combined with Nelarabine. Nelfinavir Nelfinavir may decrease the excretion rate of Topotecan which could result in a higher serum level. Neomycin Topotecan may decrease the excretion rate of Neomycin which could result in a higher serum level. Neratinib The serum concentration of Topotecan can be increased when it is combined with Neratinib. Netilmicin Topotecan may decrease the excretion rate of Netilmicin which could result in a higher serum level. Netupitant The serum concentration of Topotecan can be increased when it is combined with Netupitant. Nicorandil Topotecan may decrease the excretion rate of Nicorandil which could result in a higher serum level. Nifedipine Topotecan may decrease the excretion rate of Nifedipine which could result in a higher serum level. Nilotinib The serum concentration of Topotecan can be increased when it is combined with Nilotinib. Nilutamide Nilutamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Nimesulide The risk or severity of bleeding can be increased when Nimesulide is combined with Topotecan. Nintedanib The serum concentration of Topotecan can be increased when it is combined with Nintedanib. Nisoldipine Nisoldipine may decrease the excretion rate of Topotecan which could result in a higher serum level. Nitrazepam Nitrazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Nitric Oxide Nitric Oxide may decrease the excretion rate of Topotecan which could result in a higher serum level. Nitrofurantoin Nitrofurantoin may decrease the excretion rate of Topotecan which could result in a higher serum level. Nitroprusside Nitroprusside may decrease the excretion rate of Topotecan which could result in a higher serum level. Norgestimate The serum concentration of Topotecan can be increased when it is combined with Norgestimate. Novobiocin Novobiocin may decrease the excretion rate of Topotecan which could result in a higher serum level. Nuvaxovid The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Topotecan. Obinutuzumab The risk or severity of adverse effects can be increased when Topotecan is combined with Obinutuzumab. Ocrelizumab Ocrelizumab may increase the immunosuppressive activities of Topotecan. Octinoxate Topotecan may decrease the excretion rate of Octinoxate which could result in a higher serum level. Ofatumumab The risk or severity of adverse effects can be increased when Topotecan is combined with Ofatumumab. Olaparib The risk or severity of adverse effects can be increased when Topotecan is combined with Olaparib. Olsalazine Olsalazine may decrease the excretion rate of Topotecan which could result in a higher serum level. Omadacycline The serum concentration of Topotecan can be increased when it is combined with Omadacycline. Ombitasvir The serum concentration of Topotecan can be increased when it is combined with Ombitasvir. Omeprazole Omeprazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Opium Topotecan may decrease the excretion rate of Opium which could result in a higher serum level. Oseltamivir Oseltamivir may decrease the excretion rate of Topotecan which could result in a higher serum level. Osimertinib Osimertinib may decrease the excretion rate of Topotecan which could result in a higher serum level. Oteseconazole The serum concentration of Topotecan can be increased when it is combined with Oteseconazole. Oxacillin Oxacillin may decrease the excretion rate of Topotecan which could result in a higher serum level. Oxaliplatin The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Topotecan. Oxaprozin Oxaprozin may decrease the excretion rate of Topotecan which could result in a higher serum level. Oxazepam Oxazepam may decrease the excretion rate of Topotecan which could result in a higher serum level. Oxcarbazepine Oxcarbazepine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Oxetacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Oxetacaine. Oxybenzone Topotecan may decrease the excretion rate of Oxybenzone which could result in a higher serum level. Oxybuprocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Oxybuprocaine. Oxyphenbutazone Oxyphenbutazone may decrease the excretion rate of Topotecan which could result in a higher serum level. Oxyquinoline Topotecan may decrease the excretion rate of Oxyquinoline which could result in a higher serum level. Ozanimod The risk or severity of adverse effects can be increased when Topotecan is combined with Ozanimod. Paclitaxel The risk or severity of adverse effects can be increased when Topotecan is combined with Paclitaxel. Pacritinib The serum concentration of Topotecan can be increased when it is combined with Pacritinib. Palbociclib The serum concentration of Topotecan can be increased when it is combined with Palbociclib. Palifermin The therapeutic efficacy of Palifermin can be decreased when used in combination with Topotecan. Paliperidone The serum concentration of Topotecan can be increased when it is combined with Paliperidone. Palonosetron Palonosetron may decrease the excretion rate of Topotecan which could result in a higher serum level. Pamidronic acid Pamidronic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Panobinostat The risk or severity of adverse effects can be increased when Topotecan is combined with Panobinostat. Pantoprazole Pantoprazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Paraldehyde Paraldehyde may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Paramethadione Paramethadione may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Parecoxib Parecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level. Paritaprevir Paritaprevir may decrease the excretion rate of Topotecan which could result in a higher serum level. Parnaparin The risk or severity of bleeding can be increased when Parnaparin is combined with Topotecan. Paromomycin Paromomycin may decrease the excretion rate of Topotecan which could result in a higher serum level. Patent Blue Topotecan may decrease the excretion rate of Patent Blue which could result in a higher serum level. Pazopanib The risk or severity of adverse effects can be increased when Topotecan is combined with Pazopanib. Pegaptanib Topotecan may decrease the excretion rate of Pegaptanib which could result in a higher serum level. Pegaspargase The risk or severity of adverse effects can be increased when Pegaspargase is combined with Topotecan. Pegcetacoplan The risk or severity of adverse effects can be increased when Topotecan is combined with Pegcetacoplan. Pegfilgrastim The risk or severity of neutropenia can be increased when Pegfilgrastim is combined with Topotecan. Peginesatide The risk or severity of Thrombosis can be increased when Peginesatide is combined with Topotecan. Peginterferon al The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Topotecan. Peginterferon alf The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Topotecan. Peginterferon beta The risk or severity of adverse effects can be increased when Topotecan is combined with Peginterferon beta-1a. Pemetrexed The risk or severity of adverse effects can be increased when Pemetrexed is combined with Topotecan. Penbutolol Topotecan may decrease the excretion rate of Penbutolol which could result in a higher serum level. Penicillamine The risk or severity of adverse effects can be increased when Penicillamine is combined with Topotecan. Pentaerythritol Topotecan may decrease the excretion rate of Pentaerythritol tetranitrate which could result in a higher serum level. Pentamidine Pentamidine may decrease the excretion rate of Topotecan which could result in a higher serum level. Pentastarch Topotecan may decrease the excretion rate of Pentastarch which could result in a higher serum level. Pentetic acid Topotecan may decrease the excretion rate of Pentetic acid which could result in a higher serum level. Pentobarbital Pentobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Pentosan polysul The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Topotecan. Pentostatin The risk or severity of adverse effects can be increased when Pentostatin is combined with Topotecan. Pentoxifylline The risk or severity of bleeding can be increased when Pentoxifylline is combined with Topotecan. Perampanel Perampanel may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Perindopril Perindopril may decrease the excretion rate of Topotecan which could result in a higher serum level. Permethrin Topotecan may decrease the excretion rate of Permethrin which could result in a higher serum level. Pertussis vaccine The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Topotecan. Pexidartinib The excretion of Topotecan can be decreased when combined with Pexidartinib. Phenacemide Phenacemide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Phenazopyridine Phenazopyridine may decrease the excretion rate of Topotecan which could result in a higher serum level. Phenelzine Phenelzine may decrease the excretion rate of Topotecan which could result in a higher serum level. Phenindione The risk or severity of bleeding can be increased when Phenindione is combined with Topotecan. Phenobarbital Phenobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Phenol The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Phenol. Phenprocoumon The risk or severity of bleeding can be increased when Phenprocoumon is combined with Topotecan. Phensuximide Phensuximide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Phentolamine Phentolamine may decrease the excretion rate of Topotecan which could result in a higher serum level. Phenylalanine The risk or severity of adverse effects can be increased when Phenylalanine is combined with Topotecan. Phenylbutazone Phenylbutazone may decrease the excretion rate of Topotecan which could result in a higher serum level. Phenytoin Phenytoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Pholcodine Topotecan may decrease the excretion rate of Pholcodine which could result in a higher serum level. Phosphoric acid Topotecan may decrease the excretion rate of Phosphoric acid which could result in a higher serum level. Phylloquinone Phylloquinone may decrease the excretion rate of Topotecan which could result in a higher serum level. Pibrentasvir The serum concentration of Topotecan can be increased when it is combined with Pibrentasvir. Picosulfuric acid Topotecan may decrease the excretion rate of Picosulfuric acid which could result in a higher serum level. Pimecrolimus The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Topotecan. Pindolol Pindolol may decrease the excretion rate of Topotecan which could result in a higher serum level. Piperacillin Piperacillin may decrease the excretion rate of Topotecan which could result in a higher serum level. Piracetam Topotecan may decrease the excretion rate of Piracetam which could result in a higher serum level. Piretanide Piretanide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Pirfenidone The risk or severity of adverse effects can be increased when Topotecan is combined with Pirfenidone. Piroxicam Piroxicam may decrease the excretion rate of Topotecan which could result in a higher serum level. Pitolisant Topotecan may decrease the excretion rate of Pitolisant which could result in a higher serum level. Plazomicin The excretion of Topotecan can be decreased when combined with Plazomicin. Plerixafor Topotecan may decrease the excretion rate of Plerixafor which could result in a higher serum level. Polythiazide Polythiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Pomalidomide The risk or severity of adverse effects can be increased when Topotecan is combined with Pomalidomide. Ponatinib The serum concentration of Topotecan can be increased when it is combined with Ponatinib. Ponesimod The risk or severity of adverse effects can be increased when Topotecan is combined with Ponesimod. Posaconazole The serum concentration of Topotecan can be increased when it is combined with Posaconazole. Potassium Potassium may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Potassium acetate Topotecan may decrease the excretion rate of Potassium acetate which could result in a higher serum level. Potassium bica Topotecan may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level. Potassium cation Potassium cation may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Potassium chloride Potassium chloride may decrease the excretion rate of Topotecan which could result in a higher serum level. Potassium citrate Potassium citrate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Potassium nitrate Topotecan may decrease the excretion rate of Potassium nitrate which could result in a higher serum level. Potassium per Topotecan may decrease the excretion rate of Potassium perchlorate which could result in a higher serum level. Potassium sulfate Topotecan may decrease the excretion rate of Potassium sulfate which could result in a higher serum level. Pralatrexate The risk or severity of adverse effects can be increased when Topotecan is combined with Pralatrexate. Pralidoxime Pralidoxime may decrease the excretion rate of Topotecan which could result in a higher serum level. Pralsetinib The serum concentration of Topotecan can be increased when it is combined with Pralsetinib. Pramipexole Pramipexole may decrease the excretion rate of Topotecan which could result in a higher serum level. Pramocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Pramocaine. Prasugrel The risk or severity of bleeding can be increased when Prasugrel is combined with Topotecan. Pravastatin Pravastatin may decrease the excretion rate of Topotecan which could result in a higher serum level. Prednisolone The risk or severity of adverse effects can be increased when Prednisolone is combined with Topotecan. Prednisolone The serum concentration of Topotecan can be decreased when it is combined with Prednisolone phosphate. Prednisone The risk or severity of adverse effects can be increased when Prednisone is combined with Topotecan. Pregabalin Pregabalin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Prilocaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Prilocaine. Primidone Primidone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Probenecid Topotecan may decrease the excretion rate of Probenecid which could result in a higher serum level. Procainamide The excretion of Procainamide can be decreased when combined with Topotecan. Procaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Procaine. Procaine benzylp Topotecan may decrease the excretion rate of Procaine benzylpenicillin which could result in a higher serum level. Procarbazine The risk or severity of adverse effects can be increased when Topotecan is combined with Procarbazine. Progesterone Progesterone may decrease the excretion rate of Topotecan which could result in a higher serum level. Promethazine Topotecan may decrease the excretion rate of Promethazine which could result in a higher serum level. Propafenone The serum concentration of Topotecan can be increased when it is combined with Propafenone. Propantheline Propantheline may decrease the excretion rate of Topotecan which could result in a higher serum level. Proparacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Proparacaine. Propiverine Topotecan may decrease the excretion rate of Propiverine which could result in a higher serum level. Propoxycaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Propoxycaine. Propranolol Propranolol may decrease the excretion rate of Topotecan which could result in a higher serum level. Propylthiouracil The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Topotecan. Protein C The risk or severity of bleeding can be increased when Protein C is combined with Topotecan. Protein S The risk or severity of bleeding can be increased when Protein S human is combined with Topotecan. Prucalopride The metabolism of Prucalopride can be decreased when combined with Topotecan. Pyrantel Topotecan may decrease the excretion rate of Pyrantel which could result in a higher serum level. Pyrazinamide Pyrazinamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Pyridoxine Pyridoxine may decrease the excretion rate of Topotecan which could result in a higher serum level. Pyrimethamine The excretion of Topotecan can be decreased when combined with Pyrimethamine. Pyrithione Topotecan may decrease the excretion rate of Pyrithione which could result in a higher serum level. Quetiapine Topotecan may decrease the excretion rate of Quetiapine which could result in a higher serum level. Quinethazone Quinethazone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Quinidine The serum concentration of Topotecan can be increased when it is combined with Quinidine. Quinine The serum concentration of Topotecan can be increased when it is combined with Quinine. Rabeprazole Rabeprazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Rabies immune The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Topotecan. Rabies antigen, A The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Topotecan. Rabies antigen, B The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Topotecan. Raltitrexed The risk or severity of adverse effects can be increased when Raltitrexed is combined with Topotecan. Ramelteon Ramelteon may decrease the excretion rate of Topotecan which could result in a higher serum level. Ranitidine Ranitidine may decrease the excretion rate of Topotecan which could result in a higher serum level. Ranolazine The serum concentration of Topotecan can be increased when it is combined with Ranolazine. Rasagiline Topotecan may decrease the excretion rate of Rasagiline which could result in a higher serum level. Ravulizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Ravulizumab. Regorafenib The serum concentration of Topotecan can be increased when it is combined with Regorafenib. Relebactam The excretion of Topotecan can be decreased when combined with Relebactam. Relugolix The serum concentration of Topotecan can be increased when it is combined with Relugolix. Remdesivir The excretion of Topotecan can be decreased when combined with Remdesivir. Reserpine The serum concentration of Topotecan can be increased when it is combined with Reserpine. Resorcinol Topotecan may decrease the excretion rate of Resorcinol which could result in a higher serum level. Retapamulin The metabolism of Retapamulin can be decreased when combined with Topotecan. Reteplase The risk or severity of bleeding can be increased when Reteplase is combined with Topotecan. Revefenacin The serum concentration of Topotecan can be increased when it is combined with Revefenacin. Reviparin The risk or severity of bleeding can be increased when Reviparin is combined with Topotecan. Ribavirin Ribavirin may decrease the excretion rate of Topotecan which could result in a higher serum level. Ribostamycin Topotecan may decrease the excretion rate of Ribostamycin which could result in a higher serum level. Rifampicin The serum concentration of Topotecan can be decreased when it is combined with Rifampicin. Rifamycin The serum concentration of Topotecan can be increased when it is combined with Rifamycin. Rilonacept The risk or severity of adverse effects can be increased when Topotecan is combined with Rilonacept. Rilpivirine Rilpivirine may decrease the excretion rate of Topotecan which could result in a higher serum level. Riluzole Riluzole may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Rimegepant The serum concentration of Topotecan can be increased when it is combined with Rimegepant. Riociguat The serum concentration of Topotecan can be increased when it is combined with Riociguat. Ripretinib The serum concentration of Topotecan can be increased when it is combined with Ripretinib. Risankizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Risankizumab. Risdiplam The serum concentration of Topotecan can be increased when it is combined with Risdiplam. Ritonavir The serum concentration of Topotecan can be increased when it is combined with Ritonavir. Rituximab The risk or severity of adverse effects can be increased when Rituximab is combined with Topotecan. Rivaroxaban The serum concentration of Topotecan can be increased when it is combined with Rivaroxaban. Rizatriptan Rizatriptan may decrease the excretion rate of Topotecan which could result in a higher serum level. Rofecoxib Rofecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level. Roflumilast The serum concentration of Roflumilast can be increased when it is combined with Topotecan. Rolapitant The serum concentration of Topotecan can be increased when it is combined with Rolapitant. Romidepsin The serum concentration of Topotecan can be increased when it is combined with Romidepsin. Ropeginterferon The risk or severity of adverse effects can be increased when Topotecan is combined with Ropeginterferon alfa-2b. Ropivacaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Ropivacaine. Rosiglitazone Rosiglitazone may decrease the excretion rate of Topotecan which could result in a higher serum level. Rotavirus vaccine The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Topotecan. Roxadustat The serum concentration of Topotecan can be increased when it is combined with Roxadustat. Rubella virus The risk or severity of infection can be increased when Rubella virus vaccine is combined with Topotecan. Rucaparib Rucaparib may decrease the excretion rate of Topotecan which could result in a higher serum level. Rufinamide Rufinamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Ruxolitinib The risk or severity of adverse effects can be increased when Topotecan is combined with Ruxolitinib. Sacubitril Topotecan may decrease the excretion rate of Sacubitril which could result in a higher serum level. Safinamide Safinamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Salbutamol Salbutamol may decrease the excretion rate of Topotecan which could result in a higher serum level. Salicylamide Salicylamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Salicylic acid Salicylic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Salmon calcitonin Salmon calcitonin may decrease the excretion rate of Topotecan which could result in a higher serum level. Salsalate Salsalate may decrease the excretion rate of Topotecan which could result in a higher serum level. Sapropterin The serum concentration of Topotecan can be increased when it is combined with Sapropterin. Saquinavir The serum concentration of Topotecan can be increased when it is combined with Saquinavir. Sarecycline The serum concentration of Topotecan can be increased when it is combined with Sarecycline. Sarilumab The risk or severity of adverse effects can be increased when Topotecan is combined with Sarilumab. Satralizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Satralizumab. Saxagliptin Topotecan may decrease the excretion rate of Saxagliptin which could result in a higher serum level. Secobarbital Secobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Secukinumab The risk or severity of adverse effects can be increased when Topotecan is combined with Secukinumab. Selenious acid Topotecan may decrease the excretion rate of Selenious acid which could result in a higher serum level. Selenium Topotecan may decrease the excretion rate of Selenium which could result in a higher serum level. Selexipag The serum concentration of Topotecan can be increased when it is combined with Selexipag. Selpercatinib The excretion of Topotecan can be decreased when combined with Selpercatinib. Selumetinib The serum concentration of Topotecan can be increased when it is combined with Selumetinib. Sibutramine Topotecan may decrease the excretion rate of Sibutramine which could result in a higher serum level. Sildenafil The serum concentration of Topotecan can be increased when it is combined with Sildenafil. Silodosin The serum concentration of Topotecan can be increased when it is combined with Silodosin. Siltuximab The risk or severity of adverse effects can be increased when Topotecan is combined with Siltuximab. Simeprevir The serum concentration of Topotecan can be increased when it is combined with Simeprevir. Simvastatin The serum concentration of Topotecan can be increased when it is combined with Simvastatin. Siponimod The risk or severity of adverse effects can be increased when Topotecan is combined with Siponimod. Sipuleucel-T The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Topotecan. Sirolimus The risk or severity of adverse effects can be increased when Sirolimus is combined with Topotecan. Sitagliptin The serum concentration of Topotecan can be increased when it is combined with Sitagliptin. Smallpox The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Topotecan. Sodium acetate Topotecan may decrease the excretion rate of Sodium acetate which could result in a higher serum level. Sodium aurothio Topotecan may decrease the excretion rate of Sodium aurothiomalate which could result in a higher serum level. Sodium citrate The risk or severity of bleeding can be increased when Sodium citrate is combined with Topotecan. Sodium fluoride Topotecan may decrease the excretion rate of Sodium fluoride which could result in a higher serum level. Sodium sulfate Topotecan may decrease the excretion rate of Sodium sulfate which could result in a higher serum level. Sofosbuvir The serum concentration of Topotecan can be increased when it is combined with Sofosbuvir. Solriamfetol The excretion of Topotecan can be decreased when combined with Solriamfetol. Sorafenib The serum concentration of Topotecan can be increased when it is combined with Sorafenib. Sorbitol Topotecan may decrease the excretion rate of Sorbitol which could result in a higher serum level. Sotagliflozin The serum concentration of Topotecan can be increased when it is combined with Sotagliflozin. Sotorasib The serum concentration of Topotecan can be increased when it is combined with Sotorasib. Spesolimab The risk or severity of adverse effects can be increased when Topotecan is combined with Spesolimab. Spironolactone Spironolactone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. St. John's Wort The serum concentration of Topotecan can be decreased when it is combined with St. John's Wort. Stiripentol The excretion of Topotecan can be decreased when combined with Stiripentol. Streptokinase The risk or severity of bleeding can be increased when Streptokinase is combined with Topotecan. Streptomycin Topotecan may decrease the excretion rate of Streptomycin which could result in a higher serum level. Streptozocin The risk or severity of adverse effects can be increased when Streptozocin is combined with Topotecan. Strontium chloride Topotecan may decrease the excretion rate of Strontium chloride which could result in a higher serum level. Sucralfate Sucralfate may decrease the excretion rate of Topotecan which could result in a higher serum level. Sulbactam Topotecan may decrease the excretion rate of Sulbactam which could result in a higher serum level. Sulfadiazine Sulfadiazine may decrease the excretion rate of Topotecan which could result in a higher serum level. Sulfamethoxazole The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Topotecan. Sulfasalazine The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Topotecan. Sulfinpyrazone The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Topotecan. Sulindac Sulindac may decrease the excretion rate of Topotecan which could result in a higher serum level. Sulodexide The risk or severity of bleeding can be increased when Sulodexide is combined with Topotecan. Sulthiame Sulthiame may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Sumatriptan Sumatriptan may decrease the excretion rate of Topotecan which could result in a higher serum level. Sunitinib The risk or severity of adverse effects can be increased when Topotecan is combined with Sunitinib. Suvorexant The serum concentration of Topotecan can be increased when it is combined with Suvorexant. SynEstrogens, A Topotecan may decrease the excretion rate of Synthetic Conjugated Estrogens, A which could result in a higher serum level. SyntEstrogens, B Topotecan may decrease the excretion rate of Synthetic Conjugated Estrogens, B which could result in a higher serum level. Tacrolimus The serum concentration of Tacrolimus can be increased when it is combined with Topotecan. Tadalafil Tadalafil may decrease the excretion rate of Topotecan which could result in a higher serum level. Tafamidis The serum concentration of Topotecan can be increased when it is combined with Tafamidis. Tafenoquine The excretion of Topotecan can be decreased when combined with Tafenoquine. Talazoparib The serum concentration of Topotecan can be increased when it is combined with Talazoparib. Tamoxifen The serum concentration of Topotecan can be increased when it is combined with Tamoxifen. Tamsulosin Tamsulosin may decrease the excretion rate of Topotecan which could result in a higher serum level. Tasimelteon Topotecan may decrease the excretion rate of Tasimelteon which could result in a higher serum level. Taurocholic acid Taurocholic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Tazemetostat The excretion of Topotecan can be decreased when combined with Tazemetostat. Technetium Topotecan may decrease the excretion rate of Technetium Tc-99m exametazime which could result in a higher serum level. Technetium T Topotecan may decrease the excretion rate of Technetium Tc-99m mebrofenin which could result in a higher serum level. Technetium Tc Topotecan may decrease the excretion rate of Technetium Tc-99m oxidronate which could result in a higher serum level. Technetium Tc Topotecan may decrease the excretion rate of Technetium Tc-99m pyrophosphate which could result in a higher serum level. Technetium The serum concentration of Topotecan can be increased when it is combined with Technetium Tc-99m sestamibi. Tedizolid The risk or severity of myelosuppression can be increased when Topotecan is combined with Tedizolid phosphate. Teduglutide Topotecan may decrease the excretion rate of Teduglutide which could result in a higher serum level. Tegafur Topotecan may decrease the excretion rate of Tegafur which could result in a higher serum level. Tegaserod The serum concentration of Topotecan can be increased when it is combined with Tegaserod. Telaprevir The serum concentration of Topotecan can be increased when it is combined with Telaprevir. Telavancin Topotecan may decrease the excretion rate of Telavancin which could result in a higher serum level. Telmisartan Telmisartan may decrease the excretion rate of Topotecan which could result in a higher serum level. Temazepam Temazepam may decrease the excretion rate of Topotecan which could result in a higher serum level. Temozolomide The risk or severity of adverse effects can be increased when Temozolomide is combined with Topotecan. Temsirolimus The serum concentration of Topotecan can be increased when it is combined with Temsirolimus. Tenecteplase The risk or severity of bleeding can be increased when Tenecteplase is combined with Topotecan. Teniposide The risk or severity of adverse effects can be increased when Teniposide is combined with Topotecan. Tenofovir The serum concentration of Tenofovir alafenamide can be increased when it is combined with Topotecan. Tenofovir The serum concentration of Topotecan can be increased when it is combined with Tenofovir disoproxil. Tenoxicam Tenoxicam may decrease the excretion rate of Topotecan which could result in a higher serum level. Tepotinib The serum concentration of Topotecan can be increased when it is combined with Tepotinib. Teprotumumab The risk or severity of adverse effects can be increased when Topotecan is combined with Teprotumumab. Terbutaline Terbutaline may decrease the excretion rate of Topotecan which could result in a higher serum level. Teriflunomide The risk or severity of adverse effects can be increased when Topotecan is combined with Teriflunomide. Testolactone Testolactone may decrease the excretion rate of Topotecan which could result in a higher serum level. Testosterone Testosterone may decrease the excretion rate of Topotecan which could result in a higher serum level. Testosterone cyp Topotecan may decrease the excretion rate of Testosterone cypionate which could result in a higher serum level. Testosterone en Topotecan may decrease the excretion rate of Testosterone enanthate which could result in a higher serum level. Testosterone pro Topotecan may decrease the excretion rate of Testosterone propionate which could result in a higher serum level. Testosterone unde Topotecan may decrease the excretion rate of Testosterone undecanoate which could result in a higher serum level. Tetracaine The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Tetracaine. Tetracycline Tetracycline may decrease the excretion rate of Topotecan which could result in a higher serum level. Tetradecyl Topotecan may decrease the excretion rate of Tetradecyl hydrogen sulfate (ester) which could result in a higher serum level. Tezacaftor The serum concentration of Topotecan can be increased when it is combined with Tezacaftor. Thalidomide The risk or severity of adverse effects can be increased when Topotecan is combined with Thalidomide. Thiabendazole Thiabendazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Thiamylal Thiamylal may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Thiethylperazine Thiethylperazine may decrease the excretion rate of Topotecan which could result in a higher serum level. Thiopental Thiopental may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Thiotepa The risk or severity of adverse effects can be increased when Topotecan is combined with Thiotepa. Tiagabine Tiagabine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Tiaprofenic acid Tiaprofenic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Ticagrelor The serum concentration of Topotecan can be increased when it is combined with Ticagrelor. Tick-borne The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Topotecan. Ticlopidine The risk or severity of bleeding can be increased when Ticlopidine is combined with Topotecan. Tiludronic acid Topotecan may decrease the excretion rate of Tiludronic acid which could result in a higher serum level. Timolol Timolol may decrease the excretion rate of Topotecan which could result in a higher serum level. Tinidazole Tinidazole may decrease the excretion rate of Topotecan which could result in a higher serum level. Tinzaparin The risk or severity of bleeding can be increased when Tinzaparin is combined with Topotecan. Tioguanine The risk or severity of adverse effects can be increased when Tioguanine is combined with Topotecan. Tiopronin Topotecan may decrease the excretion rate of Tiopronin which could result in a higher serum level. Tiotropium Topotecan may decrease the excretion rate of Tiotropium which could result in a higher serum level. Tipranavir The serum concentration of Topotecan can be increased when it is combined with Tipranavir. Tirofiban The risk or severity of bleeding can be increased when Tirofiban is combined with Topotecan. Tivozanib Tivozanib may decrease the excretion rate of Topotecan which could result in a higher serum level. Tixocortol The risk or severity of adverse effects can be increased when Topotecan is combined with Tixocortol. Tizanidine Tizanidine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Tobramycin Topotecan may decrease the excretion rate of Tobramycin which could result in a higher serum level. Tocilizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Tocilizumab. Tocopherol Topotecan may decrease the excretion rate of Tocopherol which could result in a higher serum level. Tofacitinib The metabolism of Tofacitinib can be decreased when combined with Topotecan. Tolazamide Tolazamide may decrease the excretion rate of Topotecan which could result in a higher serum level. Tolbutamide Topotecan may decrease the excretion rate of Tolbutamide which could result in a higher serum level. Tolcapone Tolcapone may decrease the excretion rate of Topotecan which could result in a higher serum level. Tolfenamic acid Tolfenamic acid may decrease the excretion rate of Topotecan which could result in a higher serum level. Tolmetin Tolmetin may decrease the excretion rate of Topotecan which could result in a higher serum level. Tolterodine Topotecan may decrease the excretion rate of Tolterodine which could result in a higher serum level. Tolvaptan Tolvaptan may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Topiramate Topiramate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Torasemide Torasemide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Toremifene The serum concentration of Topotecan can be increased when it is combined with Toremifene. Tositumomab The risk or severity of adverse effects can be increased when Tositumomab is combined with Topotecan. Trabectedin The risk or severity of adverse effects can be increased when Topotecan is combined with Trabectedin. Tramadol The metabolism of Tramadol can be decreased when combined with Topotecan. Trametinib Topotecan may decrease the excretion rate of Trametinib which could result in a higher serum level. Trastuzumab Trastuzumab may increase the neutropenic activities of Topotecan. Trastuzumab The risk or severity of adverse effects can be increased when Topotecan is combined with Trastuzumab emtansine. Trazodone The serum concentration of Topotecan can be decreased when it is combined with Trazodone. Tretinoin The risk or severity of adverse effects can be increased when Tretinoin is combined with Topotecan. Triamcinolone The risk or severity of adverse effects can be increased when Triamcinolone is combined with Topotecan. Triamterene Triamterene may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Triazolam Triazolam may decrease the excretion rate of Topotecan which could result in a higher serum level. Trichlormethia Trichlormethiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Triethylenetetr Topotecan may decrease the excretion rate of Triethylenetetramine which could result in a higher serum level. Trifluridine The risk or severity of adverse effects can be increased when Trifluridine is combined with Topotecan. Triflusal The risk or severity of bleeding can be increased when Triflusal is combined with Topotecan. Trilaciclib The excretion of Topotecan can be decreased when combined with Trilaciclib. Trilostane The risk or severity of adverse effects can be increased when Topotecan is combined with Trilostane. Trimebutine Topotecan may decrease the excretion rate of Trimebutine which could result in a higher serum level. Trimethadione Trimethadione may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Trimethoprim The excretion of Topotecan can be decreased when combined with Trimethoprim. Trimetrexate Topotecan may decrease the excretion rate of Trimetrexate which could result in a higher serum level. Tropisetron Topotecan may decrease the excretion rate of Tropisetron which could result in a higher serum level. Tucatinib The serum concentration of Topotecan can be increased when it is combined with Tucatinib. Typhoid vaccine The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Topotecan. Typhoid Vaccine The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Topotecan. Typhoid Vi The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Topotecan. Ubrogepant The serum concentration of Topotecan can be increased when it is combined with Ubrogepant. Umbralisib The serum concentration of Topotecan can be increased when it is combined with Umbralisib. Umeclidinium The serum concentration of Topotecan can be increased when it is combined with Umeclidinium. Upadacitinib The risk or severity of adverse effects can be increased when Topotecan is combined with Upadacitinib. Urokinase The risk or severity of bleeding can be increased when Urokinase is combined with Topotecan. Vaborbactam Topotecan may decrease the excretion rate of Vaborbactam which could result in a higher serum level. Valaciclovir Valaciclovir may decrease the excretion rate of Topotecan which could result in a higher serum level. Valbenazine Topotecan may decrease the excretion rate of Valbenazine which could result in a higher serum level. Valdecoxib Valdecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level. Valganciclovir Topotecan may decrease the excretion rate of Valganciclovir which could result in a higher serum level. Valproic acid Valproic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Vancomycin Topotecan may decrease the excretion rate of Vancomycin which could result in a higher serum level. Vandetanib The serum concentration of Topotecan can be increased when it is combined with Vandetanib. Vardenafil The metabolism of Vardenafil can be decreased when combined with Topotecan. Varenicline Topotecan may decrease the excretion rate of Varenicline which could result in a higher serum level. Varicella zoster The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Topotecan. Varicella The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Topotecan. Vedolizumab The risk or severity of adverse effects can be increased when Topotecan is combined with Vedolizumab. Velpatasvir The serum concentration of Topotecan can be increased when it is combined with Velpatasvir. Vemurafenib The serum concentration of Topotecan can be increased when it is combined with Vemurafenib. Venetoclax The serum concentration of Topotecan can be increased when it is combined with Venetoclax. Venlafaxine Venlafaxine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Verapamil The serum concentration of Topotecan can be increased when it is combined with Verapamil. Vibrio antigen The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Topotecan. Vigabatrin Vigabatrin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Vilanterol The risk or severity of adverse effects can be increased when Topotecan is combined with Vilanterol. Viloxazine Topotecan may decrease the excretion rate of Viloxazine which could result in a higher serum level. Vinblastine The risk or severity of adverse effects can be increased when Vinblastine is combined with Topotecan. Vincristine The risk or severity of adverse effects can be increased when Vincristine is combined with Topotecan. Vindesine The risk or severity of adverse effects can be increased when Vindesine is combined with Topotecan. Vinflunine The serum concentration of Topotecan can be increased when it is combined with Vinflunine. Vinorelbine The risk or severity of adverse effects can be increased when Vinorelbine is combined with Topotecan. Vismodegib Vismodegib may decrease the excretion rate of Topotecan which could result in a higher serum level. Voclosporin The serum concentration of Topotecan can be increased when it is combined with Voclosporin. Vorapaxar The serum concentration of Topotecan can be increased when it is combined with Vorapaxar. Vorinostat The risk or severity of adverse effects can be increased when Topotecan is combined with Vorinostat. Vortioxetine Topotecan may decrease the excretion rate of Vortioxetine which could result in a higher serum level. Voxelotor The serum concentration of Voxelotor can be increased when it is combined with Topotecan. Voxilaprevir The serum concentration of Topotecan can be increased when it is combined with Voxilaprevir. Warfarin The serum concentration of Warfarin can be increased when it is combined with Topotecan. Ximelagatran The risk or severity of bleeding can be increased when Ximelagatran is combined with Topotecan. Yellow fever vaccine The risk or severity of infection can be increased when Yellow fever vaccine is combined with Topotecan. Zaleplon Zaleplon may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy. Zanamivir Zanamivir may decrease the excretion rate of Topotecan which could result in a higher serum level. Zidovudine The risk or severity of adverse effects can be increased when Zidovudine is combined with Topotecan. Zonisamide The serum concentration of Topotecan can be increased when it is combined with Zonisamide. Zopiclone The metabolism of Zopiclone can be decreased when combined with Topotecan Pregnancy and Lactation AU TGA pregnancy category: D US FDA pregnancy category: D Pregnancy There is a possibility of birth defects with topotecan if it is taken during pregnancy. Effective birth control should be practiced while using this medication. If you become pregnant while taking this medication, contact your doctor immediately. Lactation A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Excreted into human milk: Unknown Excreted into animal milk: Yes There is a potential for serious adverse reactions in nursing infants. Animal models excreted this drug into milk at concentrations up to 48 fold higher than those in plasma. How should this medicine be used?

Topotecan comes as a capsule to take by mouth. It may be taken with or without food. It is usually taken once a day for 5 days in a row every 21 days. Your doctor will decide how many times you should repeat this cycle. Take topotecan at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take topotecan exactly as…

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