Irinotecan – Uses, Dosage, Side Effects, Interaction Irinotecan is a member of the class of pyranoindolizinoquinolines that is the carbamate ester obtained by formal condensation of the carboxy group of [1,4′-bipiperidine]-1′-carboxylic acid with the phenolic hydroxy group of (4S)-4,11-diethyl-4,9-dihydroxy-1H-pyrano[3′,4′:6,7]indolizino[1,2- hydrochloride]quinoline-3,14-dione. Used (in the form of its hydrochloride salt trihydrate) in combination with fluorouracil and leucovorin, for the treatment of patients with metastatic adenocarcinoma of the pancreas after disease progression following gemcitabine-based therapy. It is converted via hydrolysis of the carbamate linkage to its active metabolite, SN-38, which is ~1000 times more active. It has a role as an apoptosis inducer, an EC 5.99.1.2 (DNA topoisomerase) inhibitor, an antineoplastic agent, and a prodrug. It is a pyranoindolizinoquinoline, an N-acylpiperidine, a carbamate ester, a tertiary alcohol, a tertiary amine compound, a delta-lactone, and a ring assembly. It is functionally related to an SN-38. It is a conjugate base of an irinotecan(1+). Irinotecan is a semisynthetic derivative of camptothecin, a cytotoxic, quinoline-based alkaloid extracted from the Asian tree Camptotheca acuminate. Irinotecan, a prodrug, is converted to a biologically active metabolite 7-ethyl-10-hydroxy-camptothecin (SN-38) by a carboxylesterase-converting enzyme. One thousand-fold more potent than its parent compound irinotecan, SN-38 inhibits topoisomerase I activity by stabilizing the cleavable complex between topoisomerase I and DNA, resulting in DNA breaks that inhibit DNA replication and triggering apoptotic cell death. Because ongoing DNA synthesis is necessary for irinotecan to exert its cytotoxic effects, it is classified as an S-phase-specific agent. Irinotecan is an antineoplastic enzyme inhibitor primarily used in the treatment of colorectal cancer. It is a derivative of camptothecin that inhibits the action of topoisomerase I. Irinotecan prevents the religation of the DNA strand by binding to the topoisomerase I-DNA complex and causes double-strand DNA breakage and cell death. It is a derivative of camptothecin. Irinotecan was approved for the treatment of advanced pancreatic cancer in October 2015 (irinotecan liposome injection, trade name Onivyde) Irinotecan Hydrochloride is the hydrochloride salt of a semisynthetic derivative of camptothecin, a cytotoxic, quinoline-based alkaloid extracted from the Asian tree Camptotheca acuminate. Irinotecan, a prodrug, is converted to a biologically active metabolite 7-ethyl-10-hydroxy-camptothecin (SN-38) by a carboxylesterase-converting enzyme. One thousand-fold more potent than its parent compound irinotecan, SN-38 inhibits topoisomerase I activity by stabilizing the cleavable complex between topoisomerase I and DNA, resulting in DNA breaks that inhibit DNA replication and triggering apoptotic cell death. Because ongoing DNA synthesis is necessary for irinotecan to exert its cytotoxic effects, it is classified as an S-phase-specific agent. Irinotecan hydrochloride (anhydrous) is a hydrochloride obtained by combining irinotecan with one molar equivalent of hydrochloric acid. Used (in the form of its trihydrate) in combination with fluorouracil and leucovorin, for the treatment of patients with metastatic adenocarcinoma of the pancreas after disease progression following gemcitabine-based therapy. It is converted via hydrolysis of the carbamate linkage to its active metabolite, SN-38, which is ~1000 times more active. It has a role as an EC 5.99.1.2 (DNA topoisomerase) inhibitor, an antineoplastic agent, an apoptosis inducer, and a prodrug. It contains an irinotecan(1+). Mechanism of Action Irinotecan inhibits the action of topoisomerase I. Irinotecan prevents the religation of the DNA strand by binding to the topoisomerase I-DNA complex. The formation of this ternary complex interferes with the moving replication fork, which induces replication arrest and lethal double-stranded breaks in DNA. As a result, DNA damage is not efficiently repaired and apoptosis (programmed cell death) occurs. Irinotecan is a derivative of camptothecin. Camptothecins interact specifically with the enzyme topoisomerase I which relieves torsional strain in DNA by inducing reversible single-strand breaks. Irinotecan and its active metabolite SN-38 bind to the topoisomerase I-DNA complex and prevent the religation of these single-strand breaks. Current research suggests that the cytotoxicity of irinotecan is due to double-strand DNA damage produced during DNA synthesis when replication enzymes interact with the ternary complex formed by topoisomerase I, DNA, and either irinotecan or SN-38. Mammalian cells cannot efficiently repair these double-strand breaks. or Irinotecan is an antineoplastic enzyme inhibitor primarily used in the treatment of colorectal cancer. Irinotecan is a semisynthetic derivative of camptothecin. Camptothecins interact specifically with topoisomerase I, an enzyme in the cell nucleus that regulates DNA topology and facilitates nuclear processes such as DNA replication, recombination, and repair. During these processes, topoisomerase I relieve torsional strain in DNA by inducing reversible single-strand breaks, allowing single DNA strands to pass through the break. The 3′-DNA terminus of the broken DNA strands binds covalently with the topoisomerase enzyme to form a catalytic intermediate called a cleavable complex. After the DNA is sufficiently relaxed and the strand passage reaction is complete, DNA topoisomerase reattaches the broken DNA strands to form the chemically unaltered topoisomers that allow transcription to proceed. Irinotecan and its active metabolite SN-38 bind to the topoisomerase I-DNA complex and prevent the religation of these single-strand breaks. Current research suggests that the cytotoxicity of irinotecan is due to double-strand DNA damage produced during DNA synthesis when replication enzymes interact with the ternary complex formed by topoisomerase I, DNA, and either Irinotecan or SN-38. Mammalian cells cannot efficiently repair these double-strand breaks. The precise contribution of SN-38 to the activity of irinotecan in humans is not known. Irinotecan is cell cycle phase-specific (S-phase). Indications For the treatment of metastatic colorectal cancer (first-line therapy when administered with 5-fluorouracil and leucovorin). Also used in combination with cisplatin for the treatment of extensive small-cell lung cancer. Irinotecan is currently under investigation for the treatment of metastatic or recurrent cervical cancer. Also used in combination with fluorouracil and leucovorin for the treatment of patients with metastatic adenocarcinoma of the pancreas after disease progression following gemcitabine-based therapy Irinotecan hydrochloride is approved to be used alone or with other drugs to treat Colorectal cancer that has metastasized (spread to other parts of the body), including metastatic cancer that has recurred (come back) or has not gotten better with other chemotherapy. Irinotecan is used in combination with cisplatin for the initial treatment of extensive small-cell lung cancer. Irinotecan hydrochloride is used as a single agent for the treatment of metastatic carcinoma of the colon or rectum in patients whose disease has recurred or progressed following initial therapy with fluorouracil-based antineoplastic regimens. Irinotecan hydrochloride is used as a component of first-line therapy in combination with fluorouracil and leucovorin for the treatment of metastatic carcinoma of the colon or rectum. Esophageal Cancer Ewing’s Sarcoma Glioblastoma Multiforme (GBM) Malignant Neoplasm of Pancreas Malignant Neoplasm of Stomach Metastatic Cervical Cancer Metastatic Colorectal Carcinoma Non-Small Cell Lung Carcinoma (NSCLC) Ovarian Cancer Rhabdomyosarcomas Small Cell Lung Cancer (SCLC) Recurrent, metastatic Colorectal carcinoma Refractory, metastatic Pancreatic adenocarcinoma Use in Cancer Acalabrutinib is approved to treat: Chronic lymphocytic leukemia or small lymphocytic lymphoma in adults. Mantle cell lymphoma in adults who have received at least one other type of treatment.¹ ¹This use is approved under FDA’s Accelerated Approval Program. As a condition of approval, a confirmatory trial(s) must show that acalabrutinib provides a clinical benefit in these patients. Acalabrutinib is also being studied in the treatment of other types of cancer. FDA-approved Uses Colorectal Cancer Colorectal cancer is the third most common cause of cancer mortality in the United States. It constitutes about 10% of worldwide cancer deaths.[rx] Irinotecan is combined with 5-fluorouracil (5-FU) and leucovorin for maximum efficacy against colorectal cancer.[rx] It is considered more efficacious in combination with 5-FU/leucovorin than the separate individual use of the agents. This combination is also known as the FOLFIRI regimen.[rx] With therapy regimens like FOLFIRI, the median survival rate of a patient with metastatic colorectal cancer has improved from 8 months to 24 months.[rx] Capecitabine, the pro-drug of 5-FU, is also combined with irinotecan for a treatment regimen known as XELIRI. There is insufficient supporting evidence to state whether FOLFIRI or XELIRI works better against colorectal cancer.[rx] Both are considered first-line therapy, and both share similar side effect profiles. Cetuximab, a monoclonal antibody against epidermal growth factor receptor (EGFR), is combined with irinotecan for patients with wild-type K-Ras colorectal tumors.[rx] Pancreatic Cancer Pancreatic ductal adenocarcinoma has a poor prognosis due to its late stage of presentation, increased susceptibility to metastasizing, and resistance to treatments. Nanoliposomal irinotecan, combined with 5-FU/leucovorin, was approved for the treatment of pancreatic cancer in October 2015. Nanoliposomal irinotecan allows for better pharmacokinetics and biodistribution due to the drug’s encapsulation within liposome-based nanoparticles. Because of how aggressive pancreatic cancer is and how recently the approval of this regimen is, there is no set sequencing of therapy to be considered superior. It is up to the provider and the patient’s age and status.[rx] Non-FDA-approved Uses Ovarian Cancer Ovarian cancer is the second most common gynecologic malignancy in the United States. To treat ovarian cancer, irinotecan is combined with cisplatin, a platinum analog that cross-links DNA. It is still undergoing clinical trials, but early phase I and phase II trials show response rates of 20% to 25% in patients with recurrent or refractory disease.[rx] Lung Cancer The current chemotherapy regimen for small-cell lung cancer is etoposide and cisplatin. Recent studies have been demonstrating the efficacy of irinotecan with cisplatin. Myelosuppression is the most common side effect with either regimen researchers note it to be worse in patients receiving etoposide and cisplatin. Using irinotecan in place of etoposide, a topoisomerase II inhibitor could allow patients to tolerate the regimen longer and thus improve outcomes. Contraindication dehydration decreased function of bone marrow anemia decreased blood platelets low levels of a type of white blood cell called neutrophils obstruction of a blood vessel by a blood clot a type of inflammation of the lung called interstitial pneumonitis inflammatory bowel disease blocked bowels with decreased peristaltic movement liver problems high amount of bilirubin in the blood diarrhea pregnancy a patient who is producing milk and breastfeeding chronic obstructive pulmonary disease reduced UGT1A1 enzyme activity due to *28 polymorphism sepsis Dosage Strengths: 20 mg/mL Colorectal Cancer COMBINATION REGIMEN 1: 125 mg/m2 IV over 90 minutes on Days 1, 8,15, and 22 with LV 20 mg/m2 IV bolus on Days 1, 8, 15, and 22 followed by 5-FU 500 mg/m2 IV bolus on Days 1, 8, 15, and 22 every 6 weeks COMBINATION REGIMEN 2: 180 mg/m2 IV over 90 minutes on Days 1, 15, and 29 with LV 200 mg/m2 IV over 2 hours on Days 1, 2, 15, 16, 29, and 30 followed by 5-FU 400 mg/m2 IV bolus on Days 1, 2, 15, 16, 29, and 30 and 5-FU 600 mg/m2 IV over 22 hours on Days 1, 2, 15, 16, 29, 30 (NOTE: 5-FU IV follows 5-FU bolus) SINGLE AGENT REGIMEN 1: 125 mg/m2 IV over 90 minutes on Days 1, 8, 15, and 22 then 2-week rest SINGLE AGENT REGIMEN 2: 350 mg/m2 IV over 90 minutes on Day 1 every 3 weeks It is recommended that patients receive premedication with antiemetics (e.g., 10 mg dexamethasone given in conjunction with another antiemetic agent, such as a 5-HT 3 blocker [e.g., ondansetron or granisetron]). Antiemetic agents should be given at least 30 minutes before this drug. Physicians should consider providing patients with an antiemetic regimen (e.g., prochlorperazine) for subsequent use as needed. A similar antiemetic regimen should be used with combination therapy. Prophylactic or therapeutic administration of atropine should be considered in patients experiencing cholinergic symptoms. First-line therapy in combination with 5-fluorouracil (5-fu) and leucovorin (LV) for patients with metastatic carcinoma of the colon or rectum Patients with metastatic carcinoma of the colon or rectum whose disease has recurred or progressed following initial fluorouracil-based therapy Dose Adjustments DOSE REGIMEN MODIFICATIONS FOR COMBINATION REGIMEN 1: IRINOTECAN: Starting dose: 125 mg/m2 Adjusted dose level -1: 100 mg/m2 Adjusted dose level -2: 75 mg/m2 LV: Starting dose: 20 mg/m2 Adjusted dose level -1: 20 mg/m2 Adjusted dose level -2: 20 mg/m2 5FU: Starting dose: 500 mg/m2 Adjusted dose level -1: 400 mg/m2 Adjusted dose level -2: 300 mg/m2 NOTE: Dose beyond dose level -2 by decrements of about 20% may be warranted for patients continuing to experience toxicity. Provided intolerable toxicity does not develop, treatment with additional cycles may be continued indefinitely if patients continue to experience clinical benefit. DOSE REGIMEN MODIFICATIONS FOR COMBINATION REGIMEN 2: IRINOTECAN: Starting dose: 180 mg/m2 Adjusted dose level -1: 150 mg/m2 Adjusted dose level -2: 120 mg/m2 LV: Starting dose: 200 mg/m2 Adjusted dose level -1: 200 mg/m2 Adjusted dose level -2: 200 mg/m2 5FU bolus: Starting dose: 400 mg/m2 Adjusted dose level -1: 320 mg/m2 Adjusted dose level -2: 240 mg/m2 5FU IV (NOTE: 5-FU IV follows 5-FU bolus): Starting dose: 600 mg/m2 Adjusted dose level -1: 480 mg/m2 Adjusted dose level -2: 360 mg/m2 NOTE: Dose beyond dose level -2 by decrements of about 20% may be warranted for patients continuing to experience toxicity. Provided intolerable toxicity does not develop, treatment with additional cycles may be continued indefinitely if patients continue to experience clinical benefit. RECOMMENDED DOSE MODIFICATIONS FOR IRINOTECAN HYDROCHLORIDE INJECTION /5-FLUOROURACIL (5-FU)/LEUCOVORIN (LV) COMBINATION SCHEDULES: Patients should return to pretreatment bowel function without requiring antidiarrhea medications for at least 24 hours before the next chemotherapy administration. A new cycle of therapy should not begin until the granulocyte count has recovered to 1500/mm 3 or greater and the platelet count has recovered to 100,000/mm 3 or greater and treatment-related diarrhea is fully resolved. Therapy should be delayed 1 to 2 weeks to allow for recovery from therapy-related toxicities. If the patient has not recovered after a 2-week delay, consideration should be given to discontinuing therapy. NEUTROPENIA No toxicity: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 1500 to 1999/mm3: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 1000 to 1499/mm3: Decrease by 1 dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 500 to 999/mm3: Omit dose until resolved to Grade 2 or less than decrease by 1 dose level during a cycle of therapy; decrease 1 dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils less than 500/mm3: Omit dose until resolved to Grade 2 or less than decrease by 2 dose levels during a cycle of therapy; decrease 2 dose levels at the start of subsequent cycles relative to the starting dose used in the previous cycle. NEUTROPENIC FEVER: Omit dose until resolved then decrease 2 dose levels. OTHER HEMATOLOGIC TOXICITIES: Dose modifications for leukopenia or thrombocytopenia during a cycle of therapy and at the start of subsequent cycles of therapy are the same as recommended for neutropenia. DIARRHEA: Two to 3 stools/day greater than pretreatment: Delay dose until resolved to baseline, then give same dose; maintenance dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Four to 6 stools/day greater than pretreatment: Omit dose until resolved to baseline, then decrease by 1 dose level; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Seven to 9 stools/day greater than pretreatment: Omit dose until resolved to baseline, then decrease by 1 dose level; decrease by 1 dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Greater than 10 stools/day greater than pretreatment: Omit dose until resolved to baseline, then decrease by 2 dose levels; decrease by 2 dose levels at the start of subsequent cycles relative to the starting dose used in the previous cycle. OTHER NONHEMATOLOGIC TOXICITIES (excluding alopecia, anorexia, and asthenia): First toxicity: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Second toxicity: Omit dose until resolved to Grade 1 or less than decrease by 1 dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Third toxicity: Omit dose until resolved to Grade 2 or less than decrease by 1 dose level during a cycle of therapy; decrease by 1 dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Fourth toxicity: Omit dose until resolved to Grade 2 or less than decrease by 2 dose levels during a cycle of therapy; decrease by 2 dose levels at the start of subsequent cycles relative to the starting dose used in the previous cycle. * For mucositis/stomatitis decrease only 5-FU, not irinotecan during a cycle of therapy. * For mucositis/stomatitis decrease only 5-FU, not irinotecan at the start of subsequent cycles relative to the starting dose used in the previous cycle. DOSE REGIMEN MODIFICATIONS FOR SINGLE AGENT REGIMEN 1: IRINOTECAN: Starting dose: 125 mg/m2 Adjusted dose level -1: 100 mg/m2 Adjusted dose level -2: 75 mg/m2 NOTE: Subsequent doses may be adjusted to as high as 150 mg/m2 or to as low as 50 mg/m2 in 25 to 50 mg increments depending on individual patient tolerance. Provided intolerable toxicity does not develop, therapy with additional cycles may be continued indefinitely if patients continue to experience clinical benefit. DOSE REGIMEN MODIFICATIONS FOR SINGLE AGENT REGIMEN 2: IRINOTECAN: Starting dose: 350 mg/m2 Adjusted dose level -1: 300 mg/m2 Adjusted dose level -2: 250 mg/m2 NOTE: Subsequent doses may be adjusted to as low as 200 mg/m2 in 50 mg/m2 decrements depending on individual patient tolerance. Provided intolerable toxicity does not develop, therapy with additional cycles may be continued indefinitely if patients continue to experience clinical benefit. RECOMMENDED DOSE MODIFICATIONS FOR SINGLE-AGENT SCHEDULES: A new cycle of therapy should not begin until the granulocyte count has recovered to 1500/mm3 or greater and the platelet count has recovered to 100,000/mm3 or greater and therapy-related diarrhea is fully resolved. Therapy should be delayed 1 to 2 weeks to allow for recovery from therapy-related toxicities. If the patient has not recovered after a 2-week delay, consideration should be given to discontinuing this drug. NEUTROPENIA: Weekly Schedule: No toxicity: Maintain dose level during a cycle of therapy; increase by 25 mg/m2 up to a maximum dose of 150 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 1500 to 1999/mm3: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 1000 to 1499/mm3: Decrease by 25 mg/m2 during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 500 to 999/mm3: Omit dose until resolved to Grade 2 or less then decrease by 25 mg/m2; decrease 25 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils less than 500/mm3: Omit dose until resolved to Grade 2 or less then decrease by 50 mg/m2; decrease 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Once Every Three Weeks Schedule: No toxicity: Maintain dose level during a cycle of therapy; increase by 25 mg/m2 up to a maximum dose of 150 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 1500 to 1999/mm3: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 1000 to 1499/mm3: Decrease by 25 mg/m2 during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils 500 to 999/mm3: Omit dose until resolved to Grade 2 or less then decrease by 25 mg/m2; decrease 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Neutrophils less than 500/mm3: Omit dose until resolved to Grade 2 or less then decrease by 25 mg/m2; decrease by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. OTHER HEMATOLOGIC TOXICITIES: Dose modifications for leukopenia, thrombocytopenia, and anemia during a cycle of therapy and at the start of subsequent cycles of therapy are the same as recommended for neutropenia. DIARRHEA: Weekly Schedule: Two to 3 stools/day greater than pretreatment: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Four to 6 stools/day greater than pretreatment: Decrease dose by 25 mg/m2 during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Seven to 9 stools/day greater than pretreatment: Omit dose until resolved to Grade 2 or less, then decrease dose by 25 mg/m2 during a cycle of therapy; decrease dose by 25 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Greater than 10 stools/day greater than pretreatment: Omit dose until resolved to Grade 2 or less, then decrease dose by 50 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Once Every Three Weeks Schedule: Two to 3 stools/day greater than pretreatment: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Four to 6 stools/day greater than pretreatment: Decrease dose by 25 mg/m2 during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Seven to 9 stools/day greater than pretreatment: Omit dose until resolved to Grade 2 or less, then decrease dose by 25 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Greater than 10 stools/day greater than pretreatment: Omit dose until resolved to Grade 2 or less, then decrease dose by 50 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. OTHER NONHEMATOLOGIC TOXICITIES (excluding alopecia, anorexia, asthenia): Weekly Schedule: First toxicity: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Second toxicity: Decrease dose by 25 mg/m2 during a cycle of therapy; decrease dose by 25 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Third toxicity: Omit dose until resolved to Grade 2 or less then decrease by 25 mg/m2 during a cycle of therapy; decrease dose by 25 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Fourth toxicity: Omit dose until resolved to Grade 2 or less then decrease by 50 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Once Every Three Weeks Schedule: First toxicity: Maintain dose level during a cycle of therapy; maintain dose level at the start of subsequent cycles relative to the starting dose used in the previous cycle. Second toxicity: Decrease dose by 25 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Third toxicity: Omit dose until resolved to Grade 2 or less than decrease by 25 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. Fourth toxicity: Omit dose until resolved to Grade 2 or less than decrease by 50 mg/m2 during a cycle of therapy; decrease dose by 50 mg/m2 at the start of subsequent cycles relative to the starting dose used in the previous cycle. DOSE IN PATIENTS WITH REDUCED UGT1A1 ACTIVITY: When administered in combination with other agents, or as a single agent, a reduction in the starting dose by at least one level should be considered for patients known to be homozygous for the UGT1A1 28 alleles; however, the precise dose reduction in this patient population is not known, and subsequent dose modifications should be considered based on individual patient tolerance to therapy. Side Effects The Most Common nausea vomiting constipation swelling and sores in the mouth heartburn loss of appetite weight loss hair loss weakness sleepiness pain, especially back pain chest pain yellowing of the skin or eyes swollen stomach unexpected or unusual weight gain swelling of the arms, hands, feet, ankles, or lower legs rash hives itching difficulty breathing or swallowing More Common severe or ongoing vomiting or diarrhea; black or bloody stools; nausea or vomiting that keeps you from drinking enough fluids; sores or white patches in or around your mouth; new or worsening cough or shortness of breath; dehydration symptoms–feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; low blood cell counts–fever, tiredness, skin sores, easy bruising, unusual bleeding, pale skin, cold hands, and feet, feeling light-headed; symptoms of sepsis–confusion, fever or chills, severe drowsiness, fast heartbeats, rapid breathing, feeling very ill. fever, pain, mouth sores, or other signs of infection; low blood cell counts, abnormal liver function tests; diarrhea, constipation; nausea, vomiting, stomach pain; loss of appetite, weight loss; weakness; or hair loss. Rare loss of appetite, constipation, cough, drowsiness, mouth sores, weakness, trouble sleeping, and temporary hair loss. hives, difficulty breathing, swelling of the face, lips, tongue, or throat, pain, redness, or swelling at the injection site or arms or legs, numbness, tingling, burning of arms or legs, back or bloody stools, change in the amount of urine, shortness of breath, cough, chest pain, weakness on one side of the body, trouble speaking, confusion, rash, itching, and severe dizziness. Drug interaction DRUG INTERACTION Abametapir The serum concentration of Irinotecan can be increased when it is combined with Abametapir. Abatacept The metabolism of Irinotecan can be increased when combined with Abatacept. Abciximab The risk or severity of bleeding can be increased when Abciximab is combined with Irinotecan. Abemaciclib Abemaciclib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Acalabrutinib The metabolism of Irinotecan can be decreased when combined with Acalabrutinib. Acenocoumarol The risk or severity of bleeding can be increased when Acenocoumarol is combined with Irinotecan. Acetaminophen The metabolism of Irinotecan can be increased when combined with Acetaminophen. Acetazolamide The metabolism of Irinotecan can be decreased when combined with Acetazolamide. Acetylsalicylic acid The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Irinotecan. Aclidinium The serum concentration of Aclidinium can be increased when it is combined with Irinotecan. Adalimumab The metabolism of Irinotecan can be increased when combined with Adalimumab. Adenine The risk or severity of neutropenia can be increased when Adenine is combined with Irinotecan. Adenovirus The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Irinotecan. Afatinib Afatinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Albendazole The metabolism of Irinotecan can be decreased when combined with Albendazole. Aldesleukin The metabolism of Irinotecan can be decreased when combined with Aldesleukin. Alectinib Alectinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Alefacept The risk or severity of adverse effects can be increased when Alefacept is combined with Irinotecan. Alemtuzumab The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Irinotecan. Alfentanil The metabolism of Alfentanil can be decreased when combined with Irinotecan. Allogeneic processed The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Irinotecan. Allopurinol The risk or severity of adverse effects can be increased when Allopurinol is combined with Irinotecan. Alpelisib The metabolism of Irinotecan can be increased when combined with Alpelisib. Alprazolam The metabolism of Irinotecan can be decreased when combined with Alprazolam. Alteplase The risk or severity of bleeding can be increased when Alteplase is combined with Irinotecan. Altretamine The risk or severity of adverse effects can be increased when Altretamine is combined with Irinotecan. Ambenonium Ambenonium may increase the neuromuscular blocking activities of Irinotecan. Ambrisentan The excretion of Ambrisentan can be decreased when combined with Irinotecan. Aminoglutethimide The metabolism of Irinotecan can be increased when combined with Aminoglutethimide. Amiodarone The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Amiodarone. Amitriptyline The risk or severity of neutropenia can be increased when Amitriptyline is combined with Irinotecan. Amobarbital The metabolism of Irinotecan can be increased when combined with Amobarbital. Amprenavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Amprenavir. Amsacrine The risk or severity of adverse effects can be increased when Amsacrine is combined with Irinotecan. Anagrelide The risk or severity of bleeding can be increased when Anagrelide is combined with Irinotecan. Anakinra The metabolism of Irinotecan can be increased when combined with Anakinra. Ancrod The risk or severity of bleeding can be increased when Ancrod is combined with Irinotecan. Anifrolumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Anifrolumab. Anistreplase The risk or severity of bleeding can be increased when Anistreplase is combined with Irinotecan. Anthrax globulin human The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Irinotecan. Anthrax vaccine The risk or severity of infection can be increased when Anthrax vaccine is combined with Irinotecan. Antilymphocyte The risk or severity of adverse effects can be increased when Irinotecan is combined with Antilymphocyte immunoglobulin (horse). Antipyrine The metabolism of Antipyrine can be decreased when combined with Irinotecan. Antithrombin Alfa The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Irinotecan. Antithrombin III human The risk or severity of bleeding can be increased when Antithrombin III human is combined with Irinotecan. Antithymocyte The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Irinotecan. Apalutamide The metabolism of Irinotecan can be increased when combined with Apalutamide. Apixaban The metabolism of Apixaban can be decreased when combined with Irinotecan. Apomorphine The metabolism of Irinotecan can be decreased when combined with Apomorphine. Apremilast The metabolism of Irinotecan can be increased when combined with Apremilast. Aprepitant The metabolism of Irinotecan can be decreased when combined with Aprepitant. Aprotinin Aprotinin may increase the neuromuscular blocking activities of Irinotecan. Ardeparin The risk or severity of bleeding can be increased when Ardeparin is combined with Irinotecan. Argatroban The risk or severity of bleeding can be increased when Argatroban is combined with Irinotecan. Aripiprazole The metabolism of Aripiprazole can be decreased when combined with Irinotecan. Aripiprazole lauroxil The metabolism of Aripiprazole lauroxil can be decreased when combined with Irinotecan. Armodafinil The metabolism of Irinotecan can be increased when combined with Armodafinil. Arsenic trioxide The risk or severity of adverse effects can be increased when Irinotecan is combined with Arsenic trioxide. Artemether The metabolism of Artemether can be decreased when combined with Irinotecan. Articaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Articaine. Asciminib The risk or severity of neutropenia can be increased when Asciminib is combined with Irinotecan. Astemizole The metabolism of Irinotecan can be decreased when combined with Astemizole. COVID-19 Vaccine The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Irinotecan. Asunaprevir The metabolism of Irinotecan can be increased when combined with Asunaprevir. Atazanavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Atazanavir. Atogepant The serum concentration of Atogepant can be increased when it is combined with Irinotecan. Atorvastatin The excretion of Atorvastatin can be decreased when combined with Irinotecan. Avacopan The metabolism of Irinotecan can be decreased when combined with Avacopan. Avanafil The serum concentration of Avanafil can be increased when it is combined with Irinotecan. Avatrombopag Avatrombopag may decrease the excretion rate of Irinotecan which could result in a higher serum level. Axitinib The metabolism of Axitinib can be decreased when combined with Irinotecan. Azacitidine The risk or severity of adverse effects can be increased when Irinotecan is combined with Azacitidine. Azathioprine The risk or severity of adverse effects can be increased when Irinotecan is combined with Azathioprine. Azelastine The metabolism of Azelastine can be decreased when combined with Irinotecan. Azithromycin The metabolism of Irinotecan can be decreased when combined with Azithromycin. Bacillus calmette- The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Irinotecan. BCG-I live antigen The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Irinotecan. Bacillus calmette-guerin The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Irinotecan. Baricitinib The risk or severity of adverse effects can be increased when Irinotecan is combined with Baricitinib. Basiliximab The risk or severity of adverse effects can be increased when Basiliximab is combined with Irinotecan. BCG vaccine The risk or severity of infection can be increased when BCG vaccine is combined with Irinotecan. Beclomethasone dipropionate The metabolism of Irinotecan can be increased when combined with Beclomethasone dipropionate. Belantamab mandolin The excretion of Belantamab mafodotin can be decreased when combined with Irinotecan. Belatacept The risk or severity of adverse effects can be increased when Irinotecan is combined with Belatacept. Belimumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Belimumab. Belinostat The risk or severity of adverse effects can be increased when Irinotecan is combined with Belinostat. Belumosudil The risk or severity of adverse effects can be increased when Irinotecan is combined with Belumosudil. Belzutifan The serum concentration of Irinotecan can be decreased when it is combined with Belzutifan. Bemiparin The risk or severity of bleeding can be increased when Bemiparin is combined with Irinotecan. Bendamustine The risk or severity of adverse effects can be increased when Irinotecan is combined with Bendamustine. Bendroflumethiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Irinotecan. Benzocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Benzocaine. Benzonatate The serum concentration of Benzonatate can be increased when it is combined with Irinotecan. Benzphetamine The metabolism of Benzphetamine can be decreased when combined with Irinotecan. Benzthiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Irinotecan. Benzyl alcohol The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Benzyl alcohol. Benzylpenicillin The excretion of Benzylpenicillin can be decreased when combined with Irinotecan. Berotralstat The serum concentration of Irinotecan can be increased when it is combined with Berotralstat. Betaine Betaine may increase the neuromuscular blocking activities of Irinotecan. Betamethasone The metabolism of Irinotecan can be increased when combined with Betamethasone. You Might Also Read Canagliflozin; Uses, Dosage, Side Effects, Drug Interactions Betamethasone The metabolism of Irinotecan can be increased when combined with Betamethasone phosphate. Betrixaban The risk or severity of bleeding can be increased when Betrixaban is combined with Irinotecan. Bexarotene The metabolism of Irinotecan can be increased when combined with Bexarotene. Bicalutamide The metabolism of Irinotecan can be decreased when combined with Bicalutamide. Bifonazole The metabolism of Irinotecan can be decreased when combined with Bifonazole. Bimekizumab The metabolism of Irinotecan can be increased when combined with Bimekizumab. Bivalirudin The risk or severity of bleeding can be increased when Bivalirudin is combined with Irinotecan. Bleomycin The risk or severity of adverse effects can be increased when Bleomycin is combined with Irinotecan. Blinatumomab The risk or severity of adverse effects can be increased when Irinotecan is combined with Blinatumomab. Boceprevir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Boceprevir. Bordetella pertussis The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Irinotecan. Bortezomib The risk or severity of adverse effects can be increased when Bortezomib is combined with Irinotecan. Bosentan The metabolism of Irinotecan can be increased when combined with Bosentan. Bosutinib The metabolism of Irinotecan can be decreased when combined with Bosutinib. Brentuximab vedotin The metabolism of Irinotecan can be decreased when combined with Brentuximab vedotin. Brigatinib Brigatinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Brincidofovir The serum concentration of Brincidofovir can be increased when it is combined with Irinotecan. Brivaracetam The metabolism of Brivaracetam can be decreased when combined with Irinotecan. Brodalumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Brodalumab. Brompheniramine The metabolism of Brompheniramine can be decreased when combined with Irinotecan. Budesonide The metabolism of Irinotecan can be increased when combined with Budesonide. Bupivacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Bupivacaine. Buprenorphine The metabolism of Irinotecan can be decreased when combined with Buprenorphine. Bupropion The metabolism of Bupropion can be decreased when combined with Irinotecan. Buspirone The metabolism of Irinotecan can be decreased when combined with Buspirone. Busulfan The risk or severity of adverse effects can be increased when Irinotecan is combined with Busulfan. Butacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Butacaine. Butalbital The metabolism of Irinotecan can be increased when combined with Butalbital. Butamben The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Butamben. Cabazitaxel The metabolism of Cabazitaxel can be decreased when combined with Irinotecan. Caffeine Caffeine may decrease the excretion rate of Irinotecan which could result in a higher serum level. Calcitriol The metabolism of Irinotecan can be increased when combined with Calcitriol. Canakinumab The metabolism of Irinotecan can be increased when combined with Canakinumab. Candicidin The metabolism of Irinotecan can be decreased when combined with Candicidin. Cangrelor The risk or severity of bleeding can be increased when Cangrelor is combined with Irinotecan. Cannabidiol The metabolism of Irinotecan can be decreased when combined with Cannabidiol. Capecitabine The risk or severity of adverse effects can be increased when Irinotecan is combined with Capecitabine. Caplacizumab The risk or severity of bleeding can be increased when Caplacizumab is combined with Irinotecan. Capmatinib The serum concentration of Irinotecan can be increased when it is combined with Capmatinib. Capsaicin The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Capsaicin. Carbamazepine The metabolism of Irinotecan can be increased when combined with Carbamazepine. Carboplatin The risk or severity of adverse effects can be increased when Irinotecan is combined with Carboplatin. Carfilzomib The risk or severity of adverse effects can be increased when Irinotecan is combined with Carfilzomib. Carmustine The risk or severity of adverse effects can be increased when Carmustine is combined with Irinotecan. Caspofungin The excretion of Caspofungin can be decreased when combined with Irinotecan. Cefradine The metabolism of Irinotecan can be increased when combined with Cefradine. Cenobamate The serum concentration of Irinotecan can be decreased when it is combined with Cenobamate. Cephalexin The metabolism of Irinotecan can be decreased when combined with Cephalexin. Ceritinib The metabolism of Irinotecan can be decreased when combined with Ceritinib. Cerivastatin The metabolism of Irinotecan can be increased when combined with Cerivastatin. Certolizumab pegol The metabolism of Irinotecan can be increased when combined with Certolizumab pegol. Chlorambucil The risk or severity of adverse effects can be increased when Chlorambucil is combined with Irinotecan. Chloramphenicol The metabolism of Irinotecan can be decreased when combined with Chloramphenicol. Chloroprocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Chloroprocaine. Chloroquine The metabolism of Irinotecan can be decreased when combined with Chloroquine. Chlorothiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Irinotecan. Chlorpheniramine The metabolism of Chlorpheniramine can be decreased when combined with Irinotecan. Chlorpromazine The metabolism of Irinotecan can be increased when combined with Chlorpromazine. Cholecystokinin The excretion of Cholecystokinin can be decreased when combined with Irinotecan. Cholesterol Cholesterol may increase the excretion rate of Irinotecan which could result in a lower serum level and potentially a reduction in efficacy. Cholic Acid The excretion of Cholic Acid can be decreased when combined with Irinotecan. Ciclesonide The risk or severity of adverse effects can be increased when Irinotecan is combined with Ciclesonide. Cilostazol The risk or severity of bleeding can be increased when Cilostazol is combined with Irinotecan. Cimetidine The metabolism of Irinotecan can be decreased when combined with Cimetidine. Cinchocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Cinchocaine. Cinnarizine The metabolism of Irinotecan can be decreased when combined with Cinnarizine. Ciprofloxacin The metabolism of Irinotecan can be decreased when combined with Ciprofloxacin. Cisapride The metabolism of Irinotecan can be decreased when combined with Cisapride. Cisplatin The risk or severity of adverse effects can be increased when Cisplatin is combined with Irinotecan. Citalopram The metabolism of Irinotecan can be decreased when combined with Citalopram. Cladribine The risk or severity of adverse effects can be increased when Cladribine is combined with Irinotecan. Clarithromycin The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Clarithromycin. Clevidipine The metabolism of Irinotecan can be increased when combined with Clevidipine. Clindamycin The metabolism of Clindamycin can be decreased when combined with Irinotecan. Clobazam The metabolism of Irinotecan can be increased when combined with Clobazam. Clobetasol propionate The metabolism of Irinotecan can be increased when combined with Clobetasol propionate. Clofarabine The risk or severity of adverse effects can be increased when Clofarabine is combined with Irinotecan. Clofazimine The metabolism of Irinotecan can be decreased when combined with Clofazimine. Clofibrate The metabolism of Irinotecan can be increased when combined with Clofibrate. Clonidine The metabolism of Clonidine can be decreased when combined with Irinotecan. Clopidogrel The metabolism of Irinotecan can be decreased when combined with Clopidogrel. Clostridium tetani The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Irinotecan. Clotiazepam The metabolism of Clotiazepam can be decreased when combined with Irinotecan. Clozapine The risk or severity of neutropenia can be increased when Irinotecan is combined with Clozapine. Cobicistat The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Cobicistat. Cobimetinib The metabolism of Irinotecan can be decreased when combined with Cobimetinib. Cocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Cocaine. Conivaptan The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Conivaptan. Conjugated estrogens The excretion of Conjugated estrogens can be decreased when combined with Irinotecan. Copanlisib The metabolism of Copanlisib can be decreased when combined with Irinotecan. Corticotropin The metabolism of Irinotecan can be increased when combined with Corticotropin. Cortisone acetate The metabolism of Irinotecan can be increased when combined with Cortisone acetate. Corynebacterium The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Irinotecan. Crizotinib The metabolism of Irinotecan can be decreased when combined with Crizotinib. Curcumin The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Curcumin. Cyanocobalamin The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Irinotecan. Cyclopenthiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Irinotecan. Cyclophosphamide The metabolism of Irinotecan can be increased when combined with Cyclophosphamide. Cyclosporine Irinotecan may increase the immunosuppressive activities of Cyclosporine. Cyclothiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Irinotecan. Dabigatran The risk or severity of bleeding can be increased when Dabigatran is combined with Irinotecan. Dabigatran etexilate The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Irinotecan. Dabrafenib The risk or severity of neutropenia can be increased when Dabrafenib is combined with Irinotecan. Dacarbazine The risk or severity of adverse effects can be increased when Irinotecan is combined with Dacarbazine. Daclatasvir Daclatasvir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Dacomitinib The risk or severity of neutropenia can be increased when Dacomitinib is combined with Irinotecan. Dactinomycin The risk or severity of adverse effects can be increased when Irinotecan is combined with Dactinomycin. Dalfopristin The metabolism of Irinotecan can be decreased when combined with Dalfopristin. Dalteparin The risk or severity of bleeding can be increased when Dalteparin is combined with Irinotecan. Danaparoid The risk or severity of bleeding can be increased when Danaparoid is combined with Irinotecan. Danazol The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Danazol. Dapsone The metabolism of Irinotecan can be decreased when combined with Dapsone. Darbepoetin alfa The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Irinotecan. Darolutamide Darolutamide may decrease the excretion rate of Irinotecan which could result in a higher serum level. Darunavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Darunavir. Dasabuvir The risk or severity of neutropenia can be increased when Dasabuvir is combined with Irinotecan. Dasatinib The metabolism of Irinotecan can be decreased when combined with Dasatinib. Daunorubicin The metabolism of Irinotecan can be decreased when combined with Daunorubicin. Decamethonium Decamethonium may increase the neuromuscular blocking activities of Irinotecan. Decitabine The risk or severity of adverse effects can be increased when Irinotecan is combined with Decitabine. Deferasirox The risk or severity of neutropenia can be increased when Deferasirox is combined with Irinotecan. Defibrotide The risk or severity of bleeding can be increased when Defibrotide is combined with Irinotecan. Deflazacort The metabolism of Irinotecan can be increased when combined with Deflazacort. Delavirdine The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Delavirdine. Demecarium Demecarium may increase the neuromuscular blocking activities of Irinotecan. Denosumab The risk or severity of adverse effects can be increased when Denosumab is combined with Irinotecan. Desipramine The metabolism of Irinotecan can be decreased when combined with Desipramine. Desirudin The risk or severity of bleeding can be increased when Desirudin is combined with Irinotecan. Desogestrel The metabolism of Irinotecan can be increased when combined with Desogestrel. Desoximetasone The risk or severity of adverse effects can be increased when Desoximetasone is combined with Irinotecan. Desvenlafaxine The metabolism of Irinotecan can be decreased when combined with Desvenlafaxine. Deucravacitinib The risk or severity of adverse effects can be increased when Irinotecan is combined with Deucravacitinib. Deutetrabenazine The metabolism of Deutetrabenazine can be decreased when combined with Irinotecan. Dexamethasone The metabolism of Irinotecan can be increased when combined with Dexamethasone. Dexamethasone acetate The metabolism of Irinotecan can be increased when combined with Dexamethasone acetate. Dexrazoxane The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Irinotecan. Dextran The risk or severity of bleeding can be increased when Dextran is combined with Irinotecan. Dextromethorphan The metabolism of Irinotecan can be decreased when combined with Dextromethorphan. Dextropropoxyphene The metabolism of Irinotecan can be decreased when combined with Dextropropoxyphene. Diazepam The metabolism of Diazepam can be decreased when combined with Irinotecan. Diclofenac The metabolism of Irinotecan can be decreased when combined with Diclofenac. Dicloxacillin The metabolism of Irinotecan can be increased when combined with Dicloxacillin. Dicoumarol The risk or severity of bleeding can be increased when Dicoumarol is combined with Irinotecan. Diethylcarbamazine Diethylcarbamazine may increase the neuromuscular blocking activities of Irinotecan. Diethylstilbestrol The metabolism of Irinotecan can be decreased when combined with Diethylstilbestrol. Diflunisal The metabolism of Irinotecan can be decreased when combined with Diflunisal. Difluocortolone The metabolism of Irinotecan can be increased when combined with Difluocortolone. Digoxin The excretion of Digoxin can be decreased when combined with Irinotecan. Dihydroergocornine The metabolism of Irinotecan can be decreased when combined with Dihydroergocornine. Dihydroergocristine The metabolism of Irinotecan can be decreased when combined with Dihydroergocristine. Dihydroergotamine The metabolism of Irinotecan can be decreased when combined with Dihydroergotamine. Diltiazem The metabolism of Irinotecan can be decreased when combined with Diltiazem. Dimethyl fumarate The risk or severity of adverse effects can be increased when Irinotecan is combined with Dimethyl fumarate. Dimethyl sulfoxide The metabolism of Irinotecan can be decreased when combined with Dimethyl sulfoxide. Dinoprostone The excretion of Dinoprostone can be decreased when combined with Irinotecan. Dinutuximab The risk or severity of adverse effects can be increased when Irinotecan is combined with Dinutuximab. Diosmin The metabolism of Irinotecan can be decreased when combined with Diosmin. Diphenhydramine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Diphenhydramine. Dipyridamole The risk or severity of bleeding can be increased when Dipyridamole is combined with Irinotecan. Diroximel fumarate The risk or severity of adverse effects can be increased when Irinotecan is combined with Diroximel fumarate. Disulfiram The metabolism of Disulfiram can be decreased when combined with Irinotecan. Docetaxel The metabolism of Irinotecan can be decreased when combined with Docetaxel. Domperidone The metabolism of Domperidone can be decreased when combined with Irinotecan. Donepezil Donepezil may increase the neuromuscular blocking activities of Irinotecan. Doravirine The metabolism of Doravirine can be decreased when combined with Irinotecan. Dosulepin The metabolism of Dosulepin can be decreased when combined with Irinotecan. Doxacurium The serum concentration of Doxacurium can be increased when it is combined with Irinotecan. Doxazosin The metabolism of Irinotecan can be decreased when combined with Doxazosin. Doxorubicin The metabolism of Irinotecan can be decreased when combined with Doxorubicin. Dronabinol The metabolism of Irinotecan can be decreased when combined with Dronabinol. Dronedarone The metabolism of Irinotecan can be decreased when combined with Dronedarone. Drospirenone The metabolism of Irinotecan can be decreased when combined with Drospirenone. Drotrecogin alfa The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Irinotecan. Dutasteride The metabolism of Dutasteride can be decreased when combined with Irinotecan. Duvelisib The metabolism of Irinotecan can be decreased when combined with Duvelisib. Dyclonine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Dyclonine. Ebastine The metabolism of Irinotecan can be decreased when combined with Ebastine. Ebola Zaire The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Irinotecan. Echinacea The metabolism of Irinotecan can be increased when combined with Echinacea. Eculizumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Eculizumab. Edetic acid The risk or severity of bleeding can be increased when Edetic acid is combined with Irinotecan. Edoxaban The risk or severity of bleeding can be increased when Edoxaban is combined with Irinotecan. Edrophonium Edrophonium may increase the neuromuscular blocking activities of Irinotecan. Efalizumab The risk or severity of adverse effects can be increased when Efalizumab is combined with Irinotecan. Efavirenz The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Efavirenz. Elagolix The excretion of Elagolix can be decreased when combined with Irinotecan. Elbasvir Elbasvir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Elexacaftor The metabolism of Irinotecan can be decreased when combined with Elexacaftor. Eltrombopag The risk or severity of neutropenia can be increased when Eltrombopag is combined with Irinotecan. Eluxadoline The serum concentration of Eluxadoline can be increased when it is combined with Irinotecan. Elvitegravir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Elvitegravir. Emapalumab The metabolism of Irinotecan can be increased when combined with Emapalumab. Enalapril The excretion of Enalapril can be decreased when combined with Irinotecan. Enasidenib The risk or severity of neutropenia can be increased when Enasidenib is combined with Irinotecan. Enoxaparin The risk or severity of bleeding can be increased when Enoxaparin is combined with Irinotecan. Enzalutamide The metabolism of Irinotecan can be increased when combined with Enzalutamide. Ephedrine The serum concentration of Ephedrine can be increased when it is combined with Irinotecan. Epinastine The metabolism of Irinotecan can be decreased when combined with Epinastine You Might Also Read Sulfadiazine Silver Salt - Indications, Contraindications Epirubicin The risk or severity of adverse effects can be increased when Epirubicin is combined with Irinotecan. Eplerenone The metabolism of Irinotecan can be decreased when combined with Eplerenone. Epoprostenol The risk or severity of bleeding can be increased when Epoprostenol is combined with Irinotecan. Eptifibatide The risk or severity of bleeding can be increased when Eptifibatide is combined with Irinotecan. Ergotamine The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Ergotamine. Eribulin The risk or severity of adverse effects can be increased when Irinotecan is combined with Eribulin. Erlotinib The risk or severity of neutropenia can be increased when Erlotinib is combined with Irinotecan. Ertugliflozin The risk or severity of neutropenia can be increased when Ertugliflozin is combined with Irinotecan. Erythromycin The metabolism of Irinotecan can be decreased when combined with Erythromycin. Erythropoietin The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Irinotecan. Esketamine The metabolism of Irinotecan can be increased when combined with Esketamine. Eslicarbazepine The metabolism of Irinotecan can be increased when combined with Eslicarbazepine. Eslicarbazepine acetate The metabolism of Irinotecan can be increased when combined with Eslicarbazepine acetate. Estetrol The metabolism of Irinotecan can be decreased when combined with Estetrol. Estradiol Estradiol may decrease the excretion rate of Irinotecan which could result in a higher serum level. Estradiol acetate The metabolism of Irinotecan can be increased when combined with Estradiol acetate. Estradiol benzoate The metabolism of Irinotecan can be increased when combined with Estradiol benzoate. Estradiol cypionate The metabolism of Irinotecan can be increased when combined with Estradiol cypionate. Estradiol dienanthate The metabolism of Irinotecan can be increased when combined with Estradiol dienanthate. Estradiol valerate The metabolism of Irinotecan can be increased when combined with Estradiol valerate. Estramustine The risk or severity of adverse effects can be increased when Irinotecan is combined with Estramustine. Etanercept The metabolism of Irinotecan can be increased when combined with Etanercept. Ethambutol The metabolism of Irinotecan can be decreased when combined with Ethambutol. Ethanol The metabolism of Irinotecan can be increased when combined with Ethanol. Ethinylestradiol The metabolism of Irinotecan can be increased when combined with Ethinylestradiol. Ethyl chloride The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Ethyl chloride. Etidocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Etidocaine. Etoposide The metabolism of Etoposide can be decreased when combined with Irinotecan. Etoricoxib The metabolism of Irinotecan can be decreased when combined with Etoricoxib. Etravirine The metabolism of Irinotecan can be increased when combined with Etravirine. Everolimus The risk or severity of adverse effects can be increased when Irinotecan is combined with Everolimus. Ezetimibe The excretion of Ezetimibe can be decreased when combined with Irinotecan. Famtozinameran The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Irinotecan. Febuxostat The excretion of Irinotecan can be decreased when combined with Febuxostat. Fedratinib Fedratinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Felbamate The metabolism of Irinotecan can be increased when combined with Felbamate. Felodipine The metabolism of Felodipine can be decreased when combined with Irinotecan. Fenfluramine The metabolism of Irinotecan can be decreased when combined with Fenfluramine. Fenofibrate The metabolism of Irinotecan can be decreased when combined with Fenofibrate. Fentanyl The metabolism of Fentanyl can be decreased when combined with Irinotecan. Fexinidazole The metabolism of Irinotecan can be decreased when combined with Fexinidazole. Fexofenadine The excretion of Fexofenadine can be decreased when combined with Irinotecan. Filgotinib The risk or severity of adverse effects can be increased when Irinotecan is combined with Filgotinib. Finasteride The metabolism of Finasteride can be decreased when combined with Irinotecan. Fingolimod Irinotecan may increase the immunosuppressive activities of Fingolimod. Floxuridine The risk or severity of adverse effects can be increased when Floxuridine is combined with Irinotecan. Flucloxacillin The metabolism of Irinotecan can be increased when combined with Flucloxacillin. Fluconazole The metabolism of Irinotecan can be decreased when combined with Fluconazole. Flucytosine The risk or severity of adverse effects can be increased when Irinotecan is combined with Flucytosine. Fludarabine The risk or severity of adverse effects can be increased when Irinotecan is combined with Fludarabine. Fludrocortisone The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Irinotecan. Fluindione The risk or severity of bleeding can be increased when Fluindione is combined with Irinotecan. Flunisolide The metabolism of Irinotecan can be increased when combined with Flunisolide. Flunitrazepam The risk or severity of neutropenia can be increased when Flunitrazepam is combined with Irinotecan. Fluocinolone acetonide The metabolism of Irinotecan can be increased when combined with Fluocinolone acetonide. Fluocinonide The metabolism of Irinotecan can be increased when combined with Fluocinonide. Fluocortolone The metabolism of Irinotecan can be increased when combined with Fluocortolone. Fluorometholone The risk or severity of adverse effects can be increased when Fluorometholone is combined with Irinotecan. Fluorouracil The risk or severity of adverse effects can be increased when Fluorouracil is combined with Irinotecan. Fluoxetine The metabolism of Irinotecan can be decreased when combined with Fluoxetine. Flupentixol The risk or severity of myelosuppression can be increased when Flupentixol is combined with Irinotecan. Fluprednisolone The risk or severity of adverse effects can be increased when Irinotecan is combined with Fluprednisolone. Flurbiprofen The risk or severity of neutropenia can be increased when Flurbiprofen is combined with Irinotecan. Flutamide The metabolism of Irinotecan can be decreased when combined with Flutamide. Fluticasone The metabolism of Irinotecan can be increased when combined with Fluticasone. Fluticasone furoate The metabolism of Irinotecan can be increased when combined with Fluticasone furoate. Fluticasone propionate The metabolism of Irinotecan can be decreased when combined with Fluticasone propionate. Fluvastatin The metabolism of Irinotecan can be increased when combined with Fluvastatin. Fluvoxamine The metabolism of Irinotecan can be decreased when combined with Fluvoxamine. Fondaparinux The risk or severity of bleeding can be increased when Fondaparinux is combined with Irinotecan. Formestane The metabolism of Irinotecan can be increased when combined with Formestane. Fosamprenavir The metabolism of Irinotecan can be decreased when combined with Fosamprenavir. Fosaprepitant The metabolism of Irinotecan can be increased when combined with Fosaprepitant. Fosnetupitant The metabolism of Irinotecan can be decreased when combined with Fosnetupitant. Fosphenytoin The metabolism of Irinotecan can be increased when combined with Fosphenytoin. Fostamatinib The risk or severity of neutropenia can be increased when Fostamatinib is combined with Irinotecan. Fostemsavir Fostemsavir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Fusidic acid The metabolism of Irinotecan can be decreased when combined with Fusidic acid. Gadoxetic acid The excretion of Gadoxetic acid can be decreased when combined with Irinotecan. Galantamine Galantamine may increase the neuromuscular blocking activities of Irinotecan. Gallamine triethiodide Gallamine triethiodide may increase the neuromuscular blocking activities of Irinotecan. Gallium nitrate The risk or severity of adverse effects can be increased when Irinotecan is combined with Gallium nitrate. Gefitinib Gefitinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Gemcitabine The risk or severity of adverse effects can be increased when Gemcitabine is combined with Irinotecan. Gemfibrozil The risk or severity of neutropenia can be increased when Gemfibrozil is combined with Irinotecan. Gemtuzumab ozogamicin The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Irinotecan. Gilteritinib The metabolism of Irinotecan can be decreased when combined with Gilteritinib. Ginkgo biloba The metabolism of Irinotecan can be decreased when combined with Ginkgo biloba. Glasdegib Glasdegib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Glatiramer The risk or severity of adverse effects can be increased when Irinotecan is combined with Glatiramer. Glecaprevir The risk or severity of neutropenia can be increased when Glecaprevir is combined with Irinotecan. Glyburide The metabolism of Irinotecan can be decreased when combined with Glyburide. Glycerol The metabolism of Irinotecan can be increased when combined with Glycerol phenylbutyrate. Golimumab The metabolism of Irinotecan can be increased when combined with Golimumab. Grazoprevir Grazoprevir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Griseofulvin The metabolism of Irinotecan can be increased when combined with Griseofulvin. Guselkumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Guselkumab. Ketazolam The metabolism of Irinotecan can be decreased when combined with Ketazolam. Ketoconazole The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Ketoconazole. Lacosamide The metabolism of Irinotecan can be decreased when combined with Lacosamide. Lamotrigine The metabolism of Irinotecan can be increased when combined with Lamotrigine. Lanreotide The metabolism of Irinotecan can be decreased when combined with Lanreotide. Lansoprazole Lansoprazole may decrease the excretion rate of Irinotecan which could result in a higher serum level. Lapatinib The metabolism of Irinotecan can be decreased when combined with Lapatinib. Lasmiditan The serum concentration of Irinotecan can be increased when it is combined with Lasmiditan. Ledipasvir Ledipasvir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Lefamulin The serum concentration of Irinotecan can be increased when it is combined with Lefamulin. Leflunomide The risk or severity of adverse effects can be increased when Irinotecan is combined with Leflunomide. Lemborexant The serum concentration of Irinotecan can be decreased when it is combined with Lemborexant. Lenalidomide The risk or severity of adverse effects can be increased when Lenalidomide is combined with Irinotecan. Lepirudin The risk or severity of bleeding can be increased when Lepirudin is combined with Irinotecan. Lercanidipine The metabolism of Irinotecan can be decreased when combined with Lercanidipine. Lesinurad The metabolism of Irinotecan can be increased when combined with Lesinurad. Letermovir The metabolism of Irinotecan can be decreased when combined with Letermovir. Levacetylmethadol The metabolism of Levacetylmethadol can be decreased when combined with Irinotecan. Levamlodipine The metabolism of Levamlodipine can be decreased when combined with Irinotecan. Levobupivacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Levobupivacaine. Levoketoconazole The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Levoketoconazole. Levonorgestrel The metabolism of Irinotecan can be decreased when combined with Levonorgestrel. Levosalbutamol The excretion of Levosalbutamol can be decreased when combined with Irinotecan. Lidocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Lidocaine. Linagliptin The metabolism of Irinotecan can be decreased when combined with Linagliptin. Linezolid The risk or severity of adverse effects can be increased when Linezolid is combined with Irinotecan. Liothyronine The excretion of Liothyronine can be decreased when combined with Irinotecan. Liotrix The excretion of Liotrix can be decreased when combined with Irinotecan. Lipegfilgrastim Irinotecan may increase the myelosuppressive activities of Lipegfilgrastim. Lomitapide The metabolism of Irinotecan can be decreased when combined with Lomitapide. Lomustine The risk or severity of adverse effects can be increased when Irinotecan is combined with Lomustine. Lonafarnib The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Lonafarnib. Lopinavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Lopinavir. Lorcaserin The metabolism of Lorcaserin can be decreased when combined with Irinotecan. Lorlatinib The metabolism of Irinotecan can be increased when combined with Lorlatinib. Losartan The metabolism of Irinotecan can be decreased when combined with Losartan. Lovastatin The metabolism of Irinotecan can be decreased when combined with Lovastatin. Lumacaftor The metabolism of Irinotecan can be increased when combined with Lumacaftor. Magnesium The serum concentration of Magnesium can be decreased when it is combined with Irinotecan. Manidipine The metabolism of Irinotecan can be decreased when combined with Manidipine. Maribavir Maribavir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Mavacamten The serum concentration of Irinotecan can be decreased when it is combined with Mavacamten. Measles virus vaccine The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Irinotecan. Mechlorethamine The risk or severity of adverse effects can be increased when Irinotecan is combined with Mechlorethamine. Medroxyprogesterone The metabolism of Irinotecan can be increased when combined with Medroxyprogesterone acetate. Mefenamic acid The metabolism of Irinotecan can be decreased when combined with Mefenamic acid. Mefloquine Mefloquine may increase the neuromuscular blocking activities of Irinotecan. Meloxicam The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Meloxicam. Melphalan The risk or severity of adverse effects can be increased when Irinotecan is combined with Melphalan. Memantine The metabolism of Irinotecan can be decreased when combined with Memantine. 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 Irinotecan. Meperidine The metabolism of Irinotecan can be decreased when combined with Meperidine. Mephenytoin The metabolism of Irinotecan can be decreased when combined with Mephenytoin. Mepivacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Mepivacaine. Mepolizumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Mepolizumab. Meprednisone The metabolism of Irinotecan can be increased when combined with Meprednisone. Mercaptopurine The risk or severity of adverse effects can be increased when Irinotecan is combined with Mercaptopurine. Methadone The metabolism of Irinotecan can be decreased when combined with Methadone. Methimazole The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Methimazole. Methotrexate The risk or severity of adverse effects can be increased when Methotrexate is combined with Irinotecan. Methoxy The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Irinotecan. Methoxyflurane The metabolism of Methoxyflurane can be decreased when combined with Irinotecan. Methylene blue The metabolism of Irinotecan can be decreased when combined with Methylene blue. Methylergometrine The metabolism of Irinotecan can be decreased when combined with Methylergometrine. Methylphenobarbital The metabolism of Irinotecan can be increased when combined with Methylphenobarbital. Methylprednisolone The metabolism of Irinotecan can be increased when combined with Methylprednisolone. Methylprednisone The metabolism of Irinotecan can be decreased when combined with Methylprednisone. Methyltestosterone The metabolism of Methyltestosterone can be decreased when combined with Irinotecan. Methysergide The metabolism of Irinotecan can be decreased when combined with Methysergide. Metoclopramide Metoclopramide may increase the neuromuscular blocking activities of Irinotecan. Metreleptin The metabolism of Irinotecan can be increased when combined with Metreleptin. Metronidazole The metabolism of Irinotecan can be decreased when combined with Metronidazole. Metyrapone The metabolism of Irinotecan can be increased when combined with Metyrapone. Mexiletine The metabolism of Irinotecan can be decreased when combined with Mexiletine. Mianserin The metabolism of Mianserin can be decreased when combined with Irinotecan. Miconazole The metabolism of Irinotecan can be decreased when combined with Miconazole. Midazolam The metabolism of Irinotecan can be decreased when combined with Midazolam. Midostaurin The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Midostaurin. Mifepristone The metabolism of Irinotecan can be increased when combined with Mifepristone. Milnacipran The metabolism of Irinotecan can be decreased when combined with Milnacipran. Minaprine Minaprine may increase the neuromuscular blocking activities of Irinotecan. Miocamycin The metabolism of Irinotecan can be decreased when combined with Miocamycin. Mirabegron The serum concentration of Mirabegron can be increased when it is combined with Irinotecan. Mirtazapine The metabolism of Irinotecan can be decreased when combined with Mirtazapine. Mitapivat The metabolism of Irinotecan can be increased when combined with Mitapivat. Mitomycin The risk or severity of adverse effects can be increased when Mitomycin is combined with Irinotecan. Mitotane The metabolism of Irinotecan can be increased when combined with Mitotane. Mitoxantrone The risk or severity of adverse effects can be increased when Irinotecan is combined with Mitoxantrone. Mobocertinib The serum concentration of Irinotecan can be decreased when it is combined with Mobocertinib. Modafinil The metabolism of Irinotecan can be increased when combined with Modafinil. COVID-19 Vaccine The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Irinotecan. Modified vaccinia ankara The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Irinotecan. Mometasone furoate The metabolism of Irinotecan can be increased when combined with Mometasone furoate. Monomethyl fumarate The risk or severity of adverse effects can be increased when Irinotecan is combined with Monomethyl fumarate. Mosunetuzumab The metabolism of Irinotecan can be decreased when combined with Mosunetuzumab. Moxisylyte The serum concentration of Moxisylyte can be increased when it is combined with Irinotecan. Mumps virus strain The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Irinotecan. Muromonab The risk or severity of adverse effects can be increased when Muromonab is combined with Irinotecan. Mycophenolate mofetil The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Irinotecan. Mycophenolic acid The risk or severity of adverse effects can be increased when Irinotecan is combined with Mycophenolic acid. Nadroparin The risk or severity of bleeding can be increased when Nadroparin is combined with Irinotecan. Nafcillin The metabolism of Irinotecan can be increased when combined with Nafcillin. Naloxone The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Naloxone. Natalizumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Natalizumab. Nateglinide The metabolism of Irinotecan can be decreased when combined with Nateglinide. Nefazodone The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Nefazodone. Nelarabine The risk or severity of adverse effects can be increased when Irinotecan is combined with Nelarabine. Nelfinavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Nelfinavir. Neostigmine Neostigmine may increase the neuromuscular blocking activities of Irinotecan. Netupitant The metabolism of Irinotecan can be decreased when combined with Netupitant. Nevirapine The metabolism of Irinotecan can be increased when combined with Nevirapine. Niacin The metabolism of Irinotecan can be decreased when combined with Niacin. Nicardipine The metabolism of Irinotecan can be decreased when combined with Nicardipine. Nicotine The metabolism of Irinotecan can be decreased when combined with Nicotine. Nifedipine The metabolism of Nifedipine can be decreased when combined with Irinotecan. Nilotinib The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Nilotinib. Nilvadipine The metabolism of Irinotecan can be decreased when combined with Nilvadipine. Nimesulide The risk or severity of bleeding can be increased when Nimesulide is combined with Irinotecan. Nintedanib The metabolism of Irinotecan can be decreased when combined with Nintedanib. Nisoldipine The metabolism of Irinotecan can be decreased when combined with Nisoldipine. Nitrendipine The metabolism of Nitrendipine can be decreased when combined with Irinotecan. Nizatidine Nizatidine may increase the neuromuscular blocking activities of Irinotecan. Norethisterone The metabolism of Irinotecan can be decreased when combined with Norethisterone. Norgestimate The metabolism of Irinotecan can be increased when combined with Norgestimate. Noscapine The metabolism of Irinotecan can be decreased when combined with Noscapine. Obinutuzumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Obinutuzumab. Ocrelizumab Ocrelizumab may increase the immunosuppressive activities of Irinotecan. Octreotide The serum concentration of Irinotecan can be increased when it is combined with Octreotide. Ofatumumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Ofatumumab. Olaparib The metabolism of Irinotecan can be decreased when combined with Olaparib. Ombitasvir The risk or severity of neutropenia can be increased when Ombitasvir is combined with Irinotecan. Omeprazole The metabolism of Irinotecan can be increased when combined with Omeprazole. Ondansetron The metabolism of Ondansetron can be decreased when combined with Irinotecan. Oritavancin The metabolism of Irinotecan can be increased when combined with Oritavancin. Orphenadrine The metabolism of Irinotecan can be decreased when combined with Orphenadrine. Osilodrostat The metabolism of Irinotecan can be decreased when combined with Osilodrostat. Osimertinib The metabolism of Irinotecan can be decreased when combined with Osimertinib. Ospemifene The metabolism of Ospemifene can be decreased when combined with Irinotecan. Oteseconazole The serum concentration of Irinotecan can be increased when it is combined with Oteseconazole. Ouabain The excretion of Ouabain can be decreased when combined with Irinotecan. Oxaliplatin The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Irinotecan. Oxcarbazepine The metabolism of Irinotecan can be increased when combined with Oxcarbazepine. Oxetacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Oxetacaine. Oxybuprocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Oxybuprocaine. Oxybutynin The metabolism of Irinotecan can be decreased when combined with Oxybutynin. Oxycodone The metabolism of Irinotecan can be decreased when combined with Oxycodone. Ozanimod The risk or severity of adverse effects can be increased when Irinotecan is combined with Ozanimod. Paclitaxel The metabolism of Irinotecan can be increased when combined with Paclitaxel. Pacritinib The serum concentration of Irinotecan can be increased when it is combined with Pacritinib. Palbociclib The metabolism of Irinotecan can be decreased when combined with Palbociclib. Palifermin The therapeutic efficacy of Palifermin can be decreased when used in combination with Irinotecan. Paliperidone The metabolism of Paliperidone can be decreased when combined with Irinotecan. Pancuronium Pancuronium may increase the neuromuscular blocking activities of Irinotecan. Panobinostat The risk or severity of adverse effects can be increased when Irinotecan is combined with Panobinostat. Pantoprazole Pantoprazole may decrease the excretion rate of Irinotecan which could result in a higher serum level. Paritaprevir The risk or severity of neutropenia can be increased when Paritaprevir is combined with Irinotecan. Parnaparin The risk or severity of bleeding can be increased when Parnaparin is combined with Irinotecan. Paroxetine The metabolism of Irinotecan can be decreased when combined with Paroxetine. Pasireotide The metabolism of Irinotecan can be decreased when combined with Pasireotide. Pazopanib The risk or severity of neutropenia can be increased when Pazopanib is combined with Irinotecan. Pegaspargase The risk or severity of adverse effects can be increased when Pegaspargase is combined with Irinotecan. Pegcetacoplan The risk or severity of adverse effects can be increased when Irinotecan is combined with Pegcetacoplan. Peginesatide The risk or severity of Thrombosis can be increased when Peginesatide is combined with Irinotecan. Peginterferon alfa-2a The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Irinotecan. Peginterferon alfa-2b The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Irinotecan. Peginterferon beta-1a The risk or severity of adverse effects can be increased when Irinotecan is combined with Peginterferon beta-1a. Pegvisomant Pegvisomant may increase the neuromuscular blocking activities of Irinotecan. Pemetrexed The risk or severity of adverse effects can be increased when Pemetrexed is combined with Irinotecan. Penicillamine The risk or severity of adverse effects can be increased when Irinotecan is combined with Penicillamine. Pentamidine The metabolism of Irinotecan can be decreased when combined with Pentamidine. Pentobarbital The metabolism of Irinotecan can be increased when combined with Pentobarbital. Pentosan polysulfate The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Irinotecan. Pentostatin The risk or severity of adverse effects can be increased when Pentostatin is combined with Irinotecan. Pentoxifylline The risk or severity of bleeding can be increased when Pentoxifylline is combined with Irinotecan. Perampanel The metabolism of Irinotecan can be increased when combined with Perampanel. Perhexiline The metabolism of Perhexiline can be decreased when combined with Irinotecan. Pertussis vaccine The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Irinotecan. Pexidartinib The risk or severity of neutropenia can be increased when Pexidartinib is combined with Irinotecan. Phenindione The risk or severity of bleeding can be increased when Phenindione is combined with Irinotecan. Phenobarbital The metabolism of Irinotecan can be increased when combined with Phenobarbital. Phenol The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Phenol. Phenprocoumon The risk or severity of bleeding can be increased when Phenprocoumon is combined with Irinotecan. Phenylalanine The risk or severity of adverse effects can be increased when Phenylalanine is combined with Irinotecan. Phenylbutazone The metabolism of Irinotecan can be increased when combined with Phenylbutazone. Phenytoin The metabolism of Irinotecan can be increased when combined with Phenytoin. Physostigmine Physostigmine may increase the neuromuscular blocking activities of Irinotecan. Pibrentasvir The risk or severity of neutropenia can be increased when Pibrentasvir is combined with Irinotecan. Pimavanserin The metabolism of Irinotecan can be decreased when combined with Pimavanserin. Pimecrolimus The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Irinotecan. Pimozide The metabolism of Pimozide can be decreased when combined with Irinotecan. Pipecuronium Pipecuronium may increase the neuromuscular blocking activities of Irinotecan. Piperaquine The metabolism of Irinotecan can be decreased when combined with Piperaquine. Pirfenidone The risk or severity of adverse effects can be increased when Irinotecan is combined with Pirfenidone. Pitavastatin The excretion of Pitavastatin can be decreased when combined with Irinotecan. Pitolisant The serum concentration of Irinotecan can be decreased when it is combined with Pitolisant. Polythiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Irinotecan. Pomalidomide The risk or severity of adverse effects can be increased when Irinotecan is combined with Pomalidomide. Ponatinib The metabolism of Ponatinib can be decreased when combined with Irinotecan. Ponesimod The risk or severity of adverse effects can be increased when Irinotecan is combined with Ponesimod. Posaconazole The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Posaconazole. Pralatrexate The risk or severity of adverse effects can be increased when Irinotecan is combined with Pralatrexate. Pralsetinib The metabolism of Irinotecan can be increased when combined with Pralsetinib. Pramocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Pramocaine. Prasugrel The metabolism of Prasugrel can be decreased when combined with Irinotecan. Pravastatin Pravastatin may decrease the excretion rate of Irinotecan which could result in a higher serum level. Praziquantel The metabolism of Praziquantel can be decreased when combined with Irinotecan. Prednisolone The metabolism of Irinotecan can be increased when combined with Prednisolone. Prednisolone acetate The metabolism of Irinotecan can be increased when combined with Prednisolone acetate. Prednisolone phosphate The metabolism of Irinotecan can be increased when combined with Prednisolone phosphate. Prednisone The risk or severity of adverse effects can be increased when Prednisone is combined with Irinotecan. Prednisone acetate The metabolism of Irinotecan can be increased when combined with Prednisone acetate. Pretomanid The metabolism of Irinotecan can be decreased when combined with Pretomanid. Prilocaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Prilocaine. Primaquine The metabolism of Irinotecan can be decreased when combined with Primaquine. Primidone The metabolism of Irinotecan can be increased when combined with Primidone. Probenecid The risk or severity of neutropenia can be increased when Probenecid is combined with Irinotecan. Procainamide Procainamide may increase the neuromuscular blocking activities of Irinotecan. Procaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Procaine. Procarbazine The risk or severity of adverse effects can be increased when Irinotecan is combined with Procarbazine. Profenamine Profenamine may increase the neuromuscular blocking activities of Irinotecan. Progesterone Progesterone may decrease the excretion rate of Irinotecan which could result in a higher serum level. Promethazine The metabolism of Promethazine can be decreased when combined with Irinotecan. Proparacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Proparacaine. You Might Also Read Ulipristal Oral - Uses, Dosage, Side Effects, Interactions Propoxycaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Propoxycaine. Propranolol The metabolism of Irinotecan can be decreased when combined with Propranolol. Propylthiouracil The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Irinotecan. Protein C The risk or severity of bleeding can be increased when Protein C is combined with Irinotecan. Protein S human The risk or severity of bleeding can be increased when Protein S human is combined with Irinotecan. Pyridostigmine Pyridostigmine may increase the neuromuscular blocking activities of Irinotecan. Quazepam The metabolism of Irinotecan can be decreased when combined with Quazepam. Quetiapine The metabolism of Quetiapine can be decreased when combined with Irinotecan. Quinidine The metabolism of Irinotecan can be decreased when combined with Quinidine. Quinine The metabolism of Irinotecan can be increased when combined with Quinine. Quinupristin The metabolism of Irinotecan can be decreased when combined with Quinupristin. Rabeprazole Rabeprazole may decrease the excretion rate of Irinotecan which could result in a higher serum level. Rabies immune globulin The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Irinotecan. Rabies virus inactivated The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Irinotecan. Rabies virus inactivated The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Irinotecan. Raloxifene The metabolism of Irinotecan can be decreased when combined with Raloxifene. Raltitrexed The risk or severity of adverse effects can be increased when Raltitrexed is combined with Irinotecan. Ranolazine The metabolism of Irinotecan can be decreased when combined with Ranolazine. Ravulizumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Ravulizumab. Regorafenib The risk or severity of neutropenia can be increased when Regorafenib is combined with Irinotecan. Relugolix The metabolism of Relugolix can be decreased when combined with Irinotecan. Remdesivir The metabolism of Irinotecan can be decreased when combined with Remdesivir. Repaglinide The excretion of Repaglinide can be decreased when combined with Irinotecan. Reserpine The metabolism of Irinotecan can be increased when combined with Reserpine. Reteplase The risk or severity of bleeding can be increased when Reteplase is combined with Irinotecan. Revefenacin Irinotecan may decrease the excretion rate of Revefenacin which could result in a higher serum level. Reviparin The risk or severity of bleeding can be increased when Reviparin is combined with Irinotecan. Ribociclib The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Ribociclib. Rifabutin The metabolism of Irinotecan can be increased when combined with Rifabutin. Rifampicin The metabolism of Irinotecan can be increased when combined with Rifampicin. Rifamycin The metabolism of Irinotecan can be increased when combined with Rifamycin. Rifapentine The metabolism of Irinotecan can be increased when combined with Rifapentine. Rilonacept The metabolism of Irinotecan can be increased when combined with Rilonacept. Rilpivirine The metabolism of Irinotecan can be decreased when combined with Rilpivirine. Ripretinib Ripretinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Risankizumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Risankizumab. Risperidone The metabolism of Irinotecan can be decreased when combined with Risperidone. Ritonavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Ritonavir. Rituximab The risk or severity of adverse effects can be increased when Rituximab is combined with Irinotecan. Rivaroxaban The metabolism of Rivaroxaban can be decreased when combined with Irinotecan. Rivastigmine Rivastigmine may increase the neuromuscular blocking activities of Irinotecan. Rofecoxib The metabolism of Irinotecan can be increased when combined with Rofecoxib. Roflumilast Roflumilast may increase the immunosuppressive activities of Irinotecan. Rolapitant Rolapitant may decrease the excretion rate of Irinotecan which could result in a higher serum level. Romidepsin The metabolism of Romidepsin can be decreased when combined with Irinotecan. Ropeginterferon alfa-2b The risk or severity of adverse effects can be increased when Irinotecan is combined with Ropeginterferon alfa-2b. Ropivacaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Ropivacaine. Rosuvastatin The metabolism of Irinotecan can be decreased when combined with Rosuvastatin. Rotavirus vaccine The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Irinotecan. Roxadustat The serum concentration of Irinotecan can be increased when it is combined with Roxadustat. Roxithromycin The metabolism of Irinotecan can be decreased when combined with Roxithromycin. Rubella virus vaccine The risk or severity of infection can be increased when Rubella virus vaccine is combined with Irinotecan. Rucaparib The metabolism of Irinotecan can be decreased when combined with Rucaparib. Rufinamide The metabolism of Irinotecan can be increased when combined with Rufinamide. Ruxolitinib The risk or severity of adverse effects can be increased when Irinotecan is combined with Ruxolitinib. Safinamide Safinamide may decrease the excretion rate of Irinotecan which could result in a higher serum level. Salmeterol The metabolism of Salmeterol can be decreased when combined with Irinotecan. Saquinavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Saquinavir. Sarilumab The metabolism of Irinotecan can be increased when combined with Sarilumab. Satralizumab The serum concentration of Irinotecan can be decreased when it is combined with Satralizumab. Saxagliptin The metabolism of Saxagliptin can be decreased when combined with Irinotecan. Secobarbital The metabolism of Irinotecan can be increased when combined with Secobarbital. Secukinumab The metabolism of Irinotecan can be increased when combined with Secukinumab. Selegiline The metabolism of Selegiline can be decreased when combined with Irinotecan. Selexipag The excretion of Selexipag can be decreased when combined with Irinotecan. Selumetinib The metabolism of Selumetinib can be decreased when combined with Irinotecan. Sertraline The metabolism of Irinotecan can be decreased when combined with Sertraline. Sevoflurane The metabolism of Sevoflurane can be decreased when combined with Irinotecan. Sildenafil The metabolism of Irinotecan can be decreased when combined with Sildenafil. Siltuximab The metabolism of Irinotecan can be increased when combined with Siltuximab. Simeprevir The metabolism of Irinotecan can be decreased when combined with Simeprevir. Simvastatin The metabolism of Irinotecan can be increased when combined with Simvastatin. Siponimod The risk or severity of adverse effects can be increased when Irinotecan is combined with Siponimod. Sipuleucel-T The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Irinotecan. Sirolimus The metabolism of Sirolimus can be decreased when combined with Irinotecan. Sitaxentan The metabolism of Irinotecan can be decreased when combined with Sitaxentan. Smallpox (Vaccinia) The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Irinotecan. Sodium aurothiomalate The risk or severity of neutropenia can be increased when Sodium aurothiomalate is combined with Irinotecan. Sodium citrate The risk or severity of bleeding can be increased when Sodium citrate is combined with Irinotecan. Somatostatin The metabolism of Irinotecan can be decreased when combined with Somatostatin. Somatrogon The metabolism of Irinotecan can be increased when combined with Somatrogon. Sorafenib The risk or severity of neutropenia can be increased when Sorafenib is combined with Irinotecan. Sotagliflozin Sotagliflozin may decrease the excretion rate of Irinotecan which could result in a higher serum level. Sotorasib The serum concentration of Irinotecan can be decreased when it is combined with Sotorasib. Spesolimab The risk or severity of adverse effects can be increased when Irinotecan is combined with Spesolimab. St. John’s Wort The metabolism of Irinotecan can be increased when combined with St. John’s Wort. Stiripentol The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Stiripentol. Streptokinase The risk or severity of bleeding can be increased when Streptokinase is combined with Irinotecan. Streptozocin The risk or severity of adverse effects can be increased when Streptozocin is combined with Irinotecan. Succinylcholine The serum concentration of Irinotecan can be increased when it is combined with Succinylcholine. Sulfamethoxazole The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Irinotecan. Sulfaphenazole The metabolism of Irinotecan can be decreased when combined with Sulfaphenazole. Sulfasalazine The risk or severity of adverse effects can be increased when Irinotecan is combined with Sulfasalazine. Sulfinpyrazone The metabolism of Irinotecan can be increased when combined with Sulfinpyrazone. Sulodexide The risk or severity of bleeding can be increased when Sulodexide is combined with Irinotecan. Sulpiride Sulpiride may increase the neuromuscular blocking activities of Irinotecan. Sumatriptan The excretion of Sumatriptan can be decreased when combined with Irinotecan. Sunitinib The metabolism of Sunitinib can be decreased when combined with Irinotecan. Suvorexant The metabolism of Irinotecan can be decreased when combined with Suvorexant. Tacrolimus Tacrolimus may increase the immunosuppressive activities of Irinotecan. Tadalafil The metabolism of Tadalafil can be decreased when combined with Irinotecan. Tafamidis The serum concentration of Irinotecan can be increased when it is combined with Tafamidis. Tamoxifen The metabolism of Irinotecan can be increased when combined with Tamoxifen. Tasimelteon The metabolism of Irinotecan can be decreased when combined with Tasimelteon. Taurocholic acid Taurocholic acid may decrease the excretion rate of Irinotecan which could result in a higher serum level. Tazemetostat The metabolism of Irinotecan can be decreased when combined with Tazemetostat. Technetium The excretion of Technetium Tc-99m mebrofenin can be decreased when combined with Irinotecan. Tecovirimat The metabolism of Irinotecan can be increased when combined with Tecovirimat. Tedizolid phosphate The risk or severity of myelosuppression can be increased when Irinotecan is combined with Tedizolid phosphate. Tegafur The metabolism of Tegafur can be decreased when combined with Irinotecan. Telaprevir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Telaprevir. Telithromycin The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Telithromycin. Telmisartan Telmisartan may decrease the excretion rate of Irinotecan which could result in a higher serum level. Telotristat ethyl The serum concentration of Irinotecan can be decreased when it is combined with Telotristat ethyl. Temozolomide The risk or severity of adverse effects can be increased when Irinotecan is combined with Temozolomide. Temsirolimus The metabolism of Temsirolimus can be decreased when combined with Irinotecan. Tenecteplase The risk or severity of bleeding can be increased when Tenecteplase is combined with Irinotecan. Teniposide The metabolism of Irinotecan can be decreased when combined with Teniposide. Tenofovir alafenamide The metabolism of Irinotecan can be decreased when combined with Tenofovir alafenamide. Tepotinib Tepotinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Teprotumumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Teprotumumab. Terbinafine The metabolism of Irinotecan can be increased when combined with Terbinafine. Terbutaline Terbutaline may increase the neuromuscular blocking activities of Irinotecan. Terfenadine The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Terfenadine. Teriflunomide The risk or severity of adverse effects can be increased when Irinotecan is combined with Teriflunomide. Testosterone The metabolism of Irinotecan can be increased when combined with Testosterone. Testosterone cypionate The metabolism of Testosterone cypionate can be decreased when combined with Irinotecan. Testosterone enanthate The metabolism of Testosterone enanthate can be decreased when combined with Irinotecan. Testosterone propionate The metabolism of Irinotecan can be increased when combined with Testosterone propionate. Tetracaine The risk or severity of methemoglobinemia can be increased when Irinotecan is combined with Tetracaine. Tetracycline The metabolism of Irinotecan can be decreased when combined with Tetracycline. Tezacaftor The metabolism of Tezacaftor can be decreased when combined with Irinotecan. Thalidomide The risk or severity of adverse effects can be increased when Irinotecan is combined with Thalidomide. Thiamylal The metabolism of Irinotecan can be increased when combined with Thiamylal. Thiosulfuric acid The metabolism of Irinotecan can be increased when combined with Thiosulfuric acid. Thiotepa The risk or severity of adverse effects can be increased when Irinotecan is combined with Thiotepa. Ticagrelor The metabolism of Irinotecan can be decreased when combined with Ticagrelor. Tick-borne encephalitis The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Irinotecan. Ticlopidine The metabolism of Irinotecan can be decreased when combined with Ticlopidine. Tinzaparin The risk or severity of bleeding can be increased when Tinzaparin is combined with Irinotecan. Tioguanine The risk or severity of adverse effects can be increased when Tioguanine is combined with Irinotecan. Tipranavir The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Tipranavir. Tirofiban The risk or severity of bleeding can be increased when Tirofiban is combined with Irinotecan. Tivozanib Tivozanib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Tixocortol The risk or severity of adverse effects can be increased when Irinotecan is combined with Tixocortol. Tocilizumab The metabolism of Irinotecan can be increased when combined with Tocilizumab. Tofacitinib Irinotecan may increase the immunosuppressive activities of Tofacitinib. Topiramate The metabolism of Irinotecan can be increased when combined with Topiramate. Topotecan The risk or severity of adverse effects can be increased when Irinotecan is combined with Topotecan. Torasemide The excretion of Torasemide can be decreased when combined with Irinotecan. Tositumomab The risk or severity of adverse effects can be increased when Tositumomab is combined with Irinotecan. Trabectedin The risk or severity of adverse effects can be increased when Irinotecan is combined with Trabectedin. Tramadol The metabolism of Irinotecan can be decreased when combined with Tramadol. Trastuzumab Trastuzumab may increase the neutropenic activities of Irinotecan. Trastuzumab emtansine The metabolism of Trastuzumab emtansine can be decreased when combined with Irinotecan. Trazodone The metabolism of Irinotecan can be decreased when combined with Trazodone. Tretinoin The risk or severity of adverse effects can be increased when Tretinoin is combined with Irinotecan. Triamcinolone The metabolism of Irinotecan can be increased when combined with Triamcinolone. Triazolam The metabolism of Triazolam can be decreased when combined with Irinotecan. Trichlormethiazide The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Irinotecan. Triclabendazole The metabolism of Irinotecan can be decreased when combined with Triclabendazole. Triflupromazine Triflupromazine may increase the neuromuscular blocking activities of Irinotecan. Trifluridine The risk or severity of adverse effects can be increased when Trifluridine is combined with Irinotecan. Triflusal The risk or severity of bleeding can be increased when Triflusal is combined with Irinotecan. Trilostane The risk or severity of adverse effects can be increased when Irinotecan is combined with Trilostane. Trimethaphan The serum concentration of Trimethaphan can be increased when it is combined with Irinotecan. Troglitazone The metabolism of Irinotecan can be increased when combined with Troglitazone. Troleandomycin The serum concentration of SN-38, an active metabolite of Irinotecan, can be increased when used in combination with Troleandomycin. Tubocurarine Tubocurarine may increase the neuromuscular blocking activities of Irinotecan. Tucatinib The metabolism of Tucatinib can be decreased when combined with Irinotecan. Typhoid vaccine The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Irinotecan. Typhoid Vaccine Live The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Irinotecan. Typhoid The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Irinotecan. Tyrothricin Tyrothricin may increase the neuromuscular blocking activities of Irinotecan. Udenafil The metabolism of Udenafil can be decreased when combined with Irinotecan. Upadacitinib The risk or severity of adverse effects can be increased when Irinotecan is combined with Upadacitinib. Urokinase The risk or severity of bleeding can be increased when Urokinase is combined with Irinotecan. Valbenazine The metabolism of Valbenazine can be decreased when combined with Irinotecan. Valproic acid The risk or severity of neutropenia can be increased when Valproic acid is combined with Irinotecan. Valsartan The excretion of Valsartan can be decreased when combined with Irinotecan. Vandetanib Vandetanib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Vardenafil The metabolism of Vardenafil can be decreased when combined with Irinotecan. Varicella zoster vaccine The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Irinotecan. Varicella zoster vaccine The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Irinotecan. Vedolizumab The risk or severity of adverse effects can be increased when Irinotecan is combined with Vedolizumab. Velpatasvir Velpatasvir may decrease the excretion rate of Irinotecan which could result in a higher serum level. Vemurafenib The metabolism of Irinotecan can be increased when combined with Vemurafenib. Venetoclax The metabolism of Irinotecan can be decreased when combined with Venetoclax. Venlafaxine Venlafaxine may increase the excretion rate of Irinotecan which could result in a lower serum level and potentially a reduction in efficacy. Verapamil The metabolism of Irinotecan can be decreased when combined with Verapamil. strain live antigen The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Irinotecan. Vilanterol The risk or severity of adverse effects can be increased when Irinotecan is combined with Vilanterol. Viloxazine The metabolism of Irinotecan can be decreased when combined with Viloxazine. Vinblastine The metabolism of Irinotecan can be increased when combined with Vinblastine. Vincristine The metabolism of Vincristine can be decreased when combined with Irinotecan. Vindesine The risk or severity of adverse effects can be increased when Vindesine is combined with Irinotecan. Vinorelbine The risk or severity of adverse effects can be increased when Vinorelbine is combined with Irinotecan. Vismodegib Vismodegib may decrease the excretion rate of Irinotecan which could result in a higher serum level. Pregnancy and Lactation AU TGA pregnancy category: D US FDA pregnancy category: D Pregnancy Available postmarketing and published data reporting the use in pregnant women, are insufficient and confounded by concomitant use of other cytotoxic drugs, to evaluate for any drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes. Verify the pregnancy status in female patients of reproductive potential before initiating therapy Lactation Irinotecan and its metabolites are present in human milk; there is no information regarding the effects of the drug on the breastfed infant, or milk production; because of the potential for serious adverse reactions from the drug in a breastfed child, advise lactating women not to breastfeed during treatment and for 7 days after the final dose How should this medicine be used? Irinotecan comes as a liquid to be given over 90 minutes intravenously (into a vein) by a doctor or nurse. It is usually given not more often than once a week, according to a schedule that alternates one or more weeks when you receive irinotecan with one or more weeks when you do not receive the medication. Your doctor will choose the schedule that will work best for you. Your doctor may need to delay your treatment and adjust your dose if you experience certain side effects. Be sure to tell your doctor how you are feeling during your treatment with irinotecan. Your doctor may give you medication to prevent nausea, and vomiting before you receive each dose of irinotecan. Your doctor may also give you other medication(s) to prevent or treat other side effects. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient. What special precautions should I follow? Before receiving irinotecan, tell your doctor and pharmacist if you are allergic to irinotecan, sorbitol, or any other medications. tell your doctor if you are taking ketoconazole (Nizoral). Your doctor will probably tell you not to take ketoconazole for one week before you begin your treatment with irinotecan or during your treatment. tell your doctor if you are taking St. John’s wort. You should not take St. John’s wort for 2 weeks before you begin your treatment with irinotecan or during your treatment. tell your doctor and pharmacist what other 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: atazanavir (Reyataz); gemfibrozil (Lopid); medications for seizures such as carbamazepine (Carbatrol, Epitol, Tegretol), phenobarbital (Luminal), phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane, in Rifamate and Rifater). 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 diabetes; fructose intolerance (inability to digest the natural sugar found in fruit); or liver, lung, or kidney disease. tell your doctor if you are pregnant, plan to become pregnant, or plan to father a child. You or your partner should not become pregnant while you are receiving irinotecan. You will need to have a negative pregnancy test before you begin receiving this medication. If you are female, use effective birth control during your treatment and for 6 months after your final dose. If you are a male and your partner can become pregnant, you should use effective birth control (condoms) during your treatment and for 3 months after your final dose. If you or your partner become pregnant while receiving irinotecan, call your doctor. Irinotecan may harm the fetus. tell your doctor if you are breastfeeding. You should not breastfeed while you are receiving irinotecan injection, and for 7 days after your final dose. you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of receiving an irinotecan injection. if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving irinotecan. you should know that irinotecan may make you dizzy or affect your vision, especially during the first 24 hours after you receive a dose. Do not drive a car or operate machinery until you know how this medication affects you. talk to your doctor before you receive any vaccinations during your treatment with irinotecan. References https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020571s031s032s033s036s037lbl.pdf https://www.cancer.gov/about-cancer/treatment/drugs/acalabrutinib https://medlineplus.gov/druginfo/meds/a608043.htm https://en.wikipedia.org/wiki/Irinotecan https://go.drugbank.com/drugs/DB00762 https://www.drugs.com/mtm/irinotecan.html https://www.ncbi.nlm.nih.gov/books/NBK554441/ https://www.webmd.com/drugs/2/drug-13700/irinotecan-intravenous/details/list-contraindications https://pubchem.ncbi.nlm.nih.gov/compound/Irinotecan https://pubchem.ncbi.nlm.nih.gov/compound/Irinotecan-hydrochloride ChemIDplus LICENSE https://www.nlm.nih.gov/copyright.html Irinotecan [INN:BAN] https://chem.nlm.nih.gov/chemidplus/sid/0097682445 ChemIDplus Chemical Information Classification https://chem.nlm.nih.gov/chemidplus/ DrugBank https://www.drugbank.ca/legal/terms_of_use Irinotecan https://www.drugbank.ca/drugs/DB00762 DTP/NCI https://www.cancer.gov/policies/copyright-reuse irinotecan https://dtp.cancer.gov/dtpstandard/servlet/dwindex?searchtype=NSC&outputformat=html&searchlist=728073 EPA DSSTox LICENSE https://www.epa.gov/privacy/privacy-act-laws-policies-and-resources Irinotecan https://comptox.epa.gov/dashboard/DTXSID1041051 CompTox Chemicals Dashboard Chemical Lists https://comptox.epa.gov/dashboard/chemical-lists/ European Chemicals Agency (ECHA) https://echa.europa.eu/web/guest/legal-notice (+)-7-ethyl-10-hydroxycamptothecine 10-[1,4â��-bipiperidine]-1â��-carboxylate https://echa.europa.eu/information-on-chemicals (+)-7-ethyl-10-hydroxycamptothecine 10-[1,4’-bipiperidine]-1’-carboxylate https://echa.europa.eu/information-on-chemicals/cl-inventory-database/-/discli/details/224824 FDA Global Substance Registration System (GSRS) https://www.fda.gov/about-fda/about-website/website-policies#linking IRINOTECAN https://gsrs.ncats.nih.gov/ginas/app/beta/substances/7673326042 Hazardous Substances Data Bank (HSDB) IRINOTECAN https://pubchem.ncbi.nlm.nih.gov/source/hsdb/7607 Human Metabolome Database (HMDB) http://www.hmdb.ca/citing Irinotecan http://www.hmdb.ca/metabolites/HMDB0014900 HMDB0014900_msms_374470 https://hmdb.ca/metabolites/HMDB0014900#spectra ChEBI Irinotecan http://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:80630 ChEBI Ontology http://www.ebi.ac.uk/chebi/userManualForward.do#ChEBI%20Ontology FDA Pharm Classes https://www.fda.gov/about-fda/about-website/website-policies#linking IRINOTECAN https://dailymed.nlm.nih.gov/dailymed/browse-drug-classes.cfm FDA Pharmacological Classification https://www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162549.htm NCI Thesaurus (NCIt) https://www.cancer.gov/policies/copyright-reuse https://ncithesaurus.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=ncit&code=C62040 ChEMBL http://www.ebi.ac.uk/Information/termsofuse.html ChEMBL Protein Target Tree https://www.ebi.ac.uk/chembl/g/#browse/targets ClinicalTrials.gov https://clinicaltrials.gov/ct2/about-site/terms-conditions#Use https://clinicaltrials.gov/ Comparative Toxicogenomics Database (CTD) http://ctdbase.org/about/legal.jsp https://ctdbase.org/detail.go?type=chem&acc=D000077146 Drug Gene Interaction database (DGIdb) LICENSE The data used in DGIdb is all open access and where possible made available as raw data dumps in the downloads section. http://www.dgidb.org/downloads https://www.dgidb.org/drugs/IRINOTECAN Therapeutic Target Database (TTD) Irinotecan http://idrblab.net/ttd/data/drug/details/D07HOB Drug Induced Liver Injury Rank (DILIrank) Dataset https://www.fda.gov/about-fda/about-website/website-policies#linking irinotecan https://www.fda.gov/science-research/liver-toxicity-knowledge-base-ltkb/drug-induced-liver-injury-rank-dilirank-dataset NORMAN Suspect List Exchange LICENSE Data: CC-BY 4.0; Code (hosted by ECI, LCSB): Artistic-2.0 https://creativecommons.org/licenses/by/4.0/ irinotecan NORMAN Suspect List Exchange Classification https://www.norman-network.com/nds/SLE/ EU Clinical Trials Register https://www.clinicaltrialsregister.eu/ 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 MassBank of North America (MoNA) LICENSE The content of the MoNA database is licensed under CC BY 4.0. https://mona.fiehnlab.ucdavis.edu/documentation/license Irinotecan https://mona.fiehnlab.ucdavis.edu/spectra/browse?query NCI Cancer Drugs LICENSE https://www.cancer.gov/policies/copyright-reuse Camptosar (Irinotecan Hydrochloride) https://www.cancer.gov/about-cancer/treatment/drugs/irinotecanhydrochloride NIPH Clinical Trials Search of Japan https://rctportal.niph.go.jp/en/ NLM RxNorm Terminology https://www.nlm.nih.gov/research/umls/rxnorm/docs/termsofservice.html irinotecan https://rxnav.nlm.nih.gov/id/rxnorm/51499 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/ Protein Data Bank in Europe (PDBe) http://www.ebi.ac.uk/pdbe-srv/pdbechem/chemicalCompound/show/CP0 PubChem https://pubchem.ncbi.nlm.nih.gov RCSB Protein Data Bank (RCSB PDB) https://www.rcsb.org/pages/policies https://www.rcsb.org/ Springer Nature https://pubchem.ncbi.nlm.nih.gov/substance/?source=15745&sourceid=43054018-511979638 Thieme Chemistry LICENSE The Thieme Chemistry contribution within PubChem is provided under a CC-BY-NC-ND 4.0 license, unless otherwise stated. https://creativecommons.org/licenses/by-nc-nd/4.0/ https://pubchem.ncbi.nlm.nih.gov/substance/?source=22163&sourceid=43054018-511969977 https://pubchem.ncbi.nlm.nih.gov/substance/?source=22163&sourceid=43054018-511983888 WHO Model Lists of Essential Medicines LICENSE WHO supports open access to the published output of its activities as a fundamental part of its mission and a public benefit to be . https://www.who.int/about/who-we-are/publishing-policies/copyright Irinotecan https://list.essentialmeds.org/medicines/96 Wikidata LICENSE CCZero https://creativecommons.org/publicdomain/zero/1.0/ Irinotecan https://www.wikidata.org/wiki/Q412197 Wiley https://pubchem.ncbi.nlm.nih.gov/substance/?source=wiley&sourceid=142984 Medical Subject Headings (MeSH) https://www.nlm.nih.gov/copyright.html Irinotecan https://www.ncbi.nlm.nih.gov/mesh/2027907 MeSH Tree http://www.nlm.nih.gov/mesh/meshhome.html Topoisomerase I Inhibitors https://www.ncbi.nlm.nih.gov/mesh/68059004 KEGG LICENSE Academic users may freely use the KEGG website. Non-academic use of KEGG generally requires a commercial license https://www.kegg.jp/kegg/legal.html Phytochemical compounds http://www.genome.jp/kegg-bin/get_htext?br08003.keg 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 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 IUPHAR/BPS Guide to PHARMACOLOGY https://www.guidetopharmacology.org/about.jsp#license Guide to Pharmacology Target Classification https://www.guidetopharmacology.org/targets.jsp National Drug Code (NDC) Directory https://www.fda.gov/about-fda/about-website/website-policies#linking FDA Drug Type and Pharmacologic Classification https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory PATENTSCOPE (WIPO) SID 389051816 https://pubchem.ncbi.nlm.nih.gov/substance/389051816 SID 389987652 https://pubchem.ncbi.nlm.nih.gov/substance/389987652 Show More