Topotecan – Uses, Dosage, Side Effects, Interactions

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 114 min read
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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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Definition

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 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- 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, , or persistent cancer not amenable to curative treatment with surgery and/or .
  • 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 of the 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 recurrent after 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.
  • Myeloid (AML)
  • Ewing’s
  • Metastatic Cervical Cancer
  • Neuroblastoma
  • Metastatic Rhabdomyosarcoma
  • Refractory CNS
  • 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 .
  • 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 in patients who have a history of hypersensitivity reactions to topotecan. Reactions have included anaphylactoid reactions.
  • significantly decreased activity of the
  • 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 of the lung called interstitial pneumonitis
  • a condition where there is a formation of fibrous tissue in the lung called
  • pregnancy
  • a patient who is producing milk and breastfeeding
  • to severe impairment
  • a significant drop in a certain type of white blood cell called a
  • radiation therapy involving the lungs
  • neutropenic

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 , 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
  • 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.

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    Topotecan Eagle (EMEA/H/C/002261)
    https://www.ema.europa.eu/en/medicines/human/EPAR/topotecan-eagle
    Evotopin (EMEA/H/C/000124)
    https://www.ema.europa.eu/en/medicines/human/EPAR/evotopin
  34. EU Clinical Trials Register
    https://www.clinicaltrialsregister.eu/
  35. FDA Orange Book
    https://www.fda.gov/about-fda/about-website/website-policies#linking
    https://www.fda.gov/drugs/drug-approvals-and-databases/approved-drug-products-therapeutic-equivalence-evaluations-orange-book
  36. NORMAN Suspect List Exchange
    https://creativecommons.org/licenses/by/4.0/
    https://www.norman-network.com/nds/SLE/
  37. WHO Anatomical Therapeutic Chemical (ATC) Classification
    https://www.whocc.no/copyright_disclaimer/
    https://www.whocc.no/atc/
    ATC Code
    https://www.whocc.no/atc_ddd_index/
  38. National Drug Code (NDC) Directory
    https://www.fda.gov/about-fda/about-website/website-policies#linking
    TOPOTECAN
    https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory
  39. MassBank of North America (MoNA)
    https://mona.fiehnlab.ucdavis.edu/documentation/license
    Topotecan
    https://mona.fiehnlab.ucdavis.edu/spectra/browse?
  40. NCI Investigational Drugs
    LICENSE
    https://www.cancer.gov/policies/copyright-reuse
    TOPOTECAN
    http://dtp.nci.nih.gov/NCI-InvestigationalDrugsCI92/609699%20(1992).txt
  41. NIPH Clinical Trials Search of Japan
    https://rctportal.niph.go.jp/en/
  42. NLM RxNorm Terminology
    https://www.nlm.nih.gov/research/umls/rxnorm/docs/termsofservice.html
    topotecan
    https://rxnav.nlm.nih.gov/id/rxnorm/57308
  43. Protein Data Bank in Europe (PDBe)
    http://www.ebi.ac.uk/pdbe-srv/pdbechem/chemicalCompound/show/TTC
  44. PubChem
    https://pubchem.ncbi.nlm.nih.gov
  45. RCSB Protein Data Bank (RCSB PDB)
    https://www.rcsb.org/pages/policies
    https://www.rcsb.org/
  46. SpectraBase
    https://spectrabase.com/spectrum/EMerJUYmTE
    TOPOTECAN;TPT;FREE-BASE
    https://spectrabase.com/spectrum/Dgsen7gyeys
  47. Springer Nature
    https://pubchem.ncbi.nlm.nih.gov/substance/?source=15745&sourceid=31052335-830155548
  48. Thieme Chemistry
    https://creativecommons.org/licenses/by-nc-nd/4.0/
    https://pubchem.ncbi.nlm.nih.gov/substance/?source=22163&sourceid=31052335-830148304
  49. Wikidata
    https://creativecommons.org/publicdomain/zero/1.0/
    Topotecan
    https://www.wikidata.org/wiki/Q419953
  50. Wiley
    https://pubchem.ncbi.nlm.nih.gov/substance/?source=wiley&sourceid=142982
  51. Medical Subject Headings (MeSH)
    https://www.nlm.nih.gov/copyright.html
    Topotecan
    https://www.ncbi.nlm.nih.gov/mesh/68019772
    MeSH Tree
    http://www.nlm.nih.gov/mesh/meshhome.html
    Topoisomerase I Inhibitors
    https://www.ncbi.nlm.nih.gov/mesh/68059004
  52. KEGG
    https://www.kegg.jp/kegg/legal.html
    Anatomical Therapeutic Chemical (ATC) classification
    http://www.genome.jp/kegg-bin/get_htext?br08303.keg
    Target-based classification of drugs
    http://www.genome.jp/kegg-bin/get_htext?br08310.keg
    Drug Groups
    http://www.genome.jp/kegg-bin/get_htext?br08330.keg
  53. UN Globally Harmonized System of Classification and Labelling of Chemicals (GHS)
    GHS Classification Tree
    http://www.unece.org/trans/danger/publi/ghs/ghs_welcome_e.html
  54. ChEMBL
    http://www.ebi.ac.uk/Information/termsofuse.html
    ChEMBL Protein Target Tree
    https://www.ebi.ac.uk/chembl/g/#browse/targets
  55. PATENTSCOPE (WIPO)
    SID 388994251
    https://pubchem.ncbi.nlm.nih.gov/substance/388994251

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  4. Understand causes and risks Explore causes, risk factors, mechanisms, and contributing conditions.
  5. Explore tests and diagnosis Learn how clinicians assess the condition and which investigations may be discussed.
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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.