Topotecan - Uses, Dosage, Side Effects, Interactions

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

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

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

Mechanism of Action

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

Topoisomerase I relieves torsional strain in DNA by inducing reversible single-strand breaks. Topotecan binds to the topoisomerase I-DNA complex and prevents the religation of these single-strand breaks. The cytotoxicity of topotecan is thought to be due to double-strand DNA damage produced during DNA synthesis when replication enzymes interact with the ternary complex formed by topotecan, topoisomerase I, and DNA. Mammalian cells cannot efficiently repair these double-strand breaks.

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

Indications

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

Use in Cancer

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

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

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

Contraindications

Topotecan Injection is contraindicated in patients who have a history of severe hypersensitivity reactions to topotecan. Reactions have included anaphylactoid reactions.
significantly decreased activity of the bone marrow
anemia
significant anemia
decreased blood platelets
a significant decrease in certain blood clotting cells called platelets
low levels of a type of white blood cell called neutrophils
a type of inflammation of the lung called interstitial pneumonitis
a condition where there is a formation of fibrous tissue in the lung called pulmonary fibrosis
pregnancy
a patient who is producing milk and breastfeeding
moderate to severe kidney impairment
a significant drop in a certain type of white blood cell called a neutrophil
radiation therapy involving the lungs
neutropenic colitis

Dosage

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

Ovarian Cancer

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

Cervical Cancer

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

Small Cell Lung Cancer

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

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

Renal Dose Adjustments

Small cell lung cancer or Ovarian cancer, IV formulation:

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

Small cell lung cancer, oral capsules:

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

Cervical cancer:

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

Dose Adjustments

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

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

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

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

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

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

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

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

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

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

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

Permanently reduce dose to 0.45 mg/m(2)

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

Permanently reduce dose to 0.60 mg/m(2)

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

Permanently discontinue topotecan

Administration advice:

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

Reconstitution/preparation techniques:

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

Side Effects

The Most Common

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

More common

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

Rare

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

Drug Interactions

DRUG	INTERACTION
Abacavir	Topotecan may decrease the excretion rate of Abacavir which could result in a higher serum level.
Abatacept	The risk or severity of adverse effects can be increased when Topotecan is combined with Abatacept.
Abciximab	The risk or severity of bleeding can be increased when Abciximab is combined with Topotecan.
Abemaciclib	The excretion of Abemaciclib can be decreased when combined with Topotecan.
Abrocitinib	The serum concentration of Topotecan can be increased when it is combined with Abrocitinib.
Aceclofenac	Aceclofenac may decrease the excretion rate of Topotecan which could result in a higher serum level.
Acemetacin	Acemetacin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Acenocoumarol	The serum concentration of Acenocoumarol can be increased when it is combined with Topotecan.
Acetaminophen	Acetaminophen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Acetazolamide	Acetazolamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Acetylsalicylic acid	The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Topotecan.
Aclidinium	Topotecan may decrease the excretion rate of Aclidinium which could result in a higher serum level.
Acrivastine	Topotecan may decrease the excretion rate of Acrivastine which could result in a higher serum level.
Acyclovir	The excretion of Topotecan can be decreased when combined with Acyclovir.
Adalimumab	The risk or severity of adverse effects can be increased when Adalimumab is combined with Topotecan.
Adefovir dipivoxil	Adefovir dipivoxil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Adenovirus type	The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Topotecan.
Afatinib	The serum concentration of Topotecan can be increased when it is combined with Afatinib.
Albutrepenonacog	Topotecan may decrease the excretion rate of Albutrepenonacog alfa which could result in a higher serum level.
Alclofenac	Alclofenac may decrease the excretion rate of Topotecan which could result in a higher serum level.
Aldesleukin	The risk or severity of adverse effects can be increased when Aldesleukin is combined with Topotecan.
Alectinib	Alectinib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Alefacept	The risk or severity of adverse effects can be increased when Alefacept is combined with Topotecan.
Alemtuzumab	The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Topotecan.
Alfuzosin	The metabolism of Alfuzosin can be decreased when combined with Topotecan.
Allogeneic	The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Topotecan.
Allopurinol	The risk or severity of adverse effects can be increased when Allopurinol is combined with Topotecan.
Almasilate	Topotecan may decrease the excretion rate of Almasilate which could result in a higher serum level.
Almotriptan	Almotriptan may decrease the excretion rate of Topotecan which could result in a higher serum level.
Alogliptin	Topotecan may decrease the excretion rate of Alogliptin which could result in a higher serum level.
Alprazolam	The metabolism of Alprazolam can be decreased when combined with Topotecan.
Alteplase	The risk or severity of bleeding can be increased when Alteplase is combined with Topotecan.
Altretamine	The risk or severity of adverse effects can be increased when Altretamine is combined with Topotecan.
Amantadine	Amantadine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ambrisentan	The serum concentration of Topotecan can be increased when it is combined with Ambrisentan.
Amikacin	Topotecan may decrease the excretion rate of Amikacin which could result in a higher serum level.
Amiloride	Amiloride may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Aminophenazone	Aminophenazone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Amiodarone	The serum concentration of Topotecan can be increased when it is combined with Amiodarone.
Amitriptyline	Amitriptyline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ammonium	Topotecan may decrease the excretion rate of Ammonium chloride which could result in a higher serum level.
Amobarbital	Amobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Amoxicillin	Topotecan may decrease the excretion rate of Amoxicillin which could result in a higher serum level.
Amphetamine	Amphetamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Amphotericin B	Amphotericin B may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ampicillin	Ampicillin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Amrinone	Topotecan may decrease the excretion rate of Amrinone which could result in a higher serum level.
Amsacrine	The risk or severity of adverse effects can be increased when Amsacrine is combined with Topotecan.
Anagrelide	The risk or severity of bleeding can be increased when Anagrelide is combined with Topotecan.
Anakinra	The risk or severity of adverse effects can be increased when Anakinra is combined with Topotecan.
Ancestim	Topotecan may decrease the excretion rate of Ancestim which could result in a higher serum level.
Ancrod	The risk or severity of bleeding can be increased when Ancrod is combined with Topotecan.
Anifrolumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Anifrolumab.
Anistreplase	The risk or severity of bleeding can be increased when Anistreplase is combined with Topotecan.
Anthrax immune	The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Topotecan.
Anthrax vaccine	The risk or severity of infection can be increased when Anthrax vaccine is combined with Topotecan.
Antihemophilic	Topotecan may decrease the excretion rate of Antihemophilic factor (recombinant), PEGylated which could result in a higher serum level.
Antilymphocyte	The risk or severity of adverse effects can be increased when Topotecan is combined with Antilymphocyte immunoglobulin (horse).
Antipyrine	Antipyrine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Antithrombin Alfa	The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Topotecan.
Antithrombin III	Topotecan may decrease the excretion rate of Antithrombin III human which could result in a higher serum level.
Antithymocyte	The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Topotecan.
Antrafenine	Antrafenine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Apalutamide	The serum concentration of Topotecan can be decreased when it is combined with Apalutamide.
Apixaban	The serum concentration of Topotecan can be increased when it is combined with Apixaban.
Apremilast	The risk or severity of adverse effects can be increased when Topotecan is combined with Apremilast.
Ardeparin	The risk or severity of bleeding can be increased when Ardeparin is combined with Topotecan.
Arformoterol	Topotecan may decrease the excretion rate of Arformoterol which could result in a higher serum level.
Argatroban	The risk or severity of bleeding can be increased when Argatroban is combined with Topotecan.
Aripiprazole	The metabolism of Aripiprazole can be decreased when combined with Topotecan.
Aripiprazole	The metabolism of Aripiprazole lauroxil can be decreased when combined with Topotecan.
Arsenic trioxide	The serum concentration of Topotecan can be increased when it is combined with Arsenic trioxide.
Articaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Articaine.
Asciminib	The serum concentration of Topotecan can be increased when it is combined with Asciminib.
ACOVID-19	The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Topotecan.
Asunaprevir	The serum concentration of Topotecan can be increased when it is combined with Asunaprevir.
Atazanavir	Atazanavir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Atomoxetine	Atomoxetine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Atorvastatin	The metabolism of Atorvastatin can be decreased when combined with Topotecan.
Auranofin	Auranofin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Aurothioglucose	Topotecan may decrease the excretion rate of Aurothioglucose which could result in a higher serum level.
Avanafil	Avanafil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Avatrombopag	Avatrombopag may decrease the excretion rate of Topotecan which could result in a higher serum level.
Azacitidine	The risk or severity of adverse effects can be increased when Azacitidine is combined with Topotecan.
Azathioprine	The risk or severity of adverse effects can be increased when Azathioprine is combined with Topotecan.
Azelaic acid	Azelaic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Aztreonam	Aztreonam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Bacillus	The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Topotecan.
Bacillus antigen	The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Topotecan.
Bacillus calmette	The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Topotecan.
Bacitracin	Bacitracin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Baclofen	Baclofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Balsalazide	Balsalazide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Baricitinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Baricitinib.
Basiliximab	The risk or severity of adverse effects can be increased when Basiliximab is combined with Topotecan.
BCG vaccine	The risk or severity of infection can be increased when BCG vaccine is combined with Topotecan.
Beclomethasone	The risk or severity of adverse effects can be increased when Beclomethasone dipropionate is combined with Topotecan.
Belantamab	The serum concentration of Topotecan can be increased when it is combined with Belantamab mafodotin.
Belatacept	The risk or severity of adverse effects can be increased when Topotecan is combined with Belatacept.
Belimumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Belimumab.

Belinostat	The risk or severity of adverse effects can be increased when Topotecan is combined with Belinostat.
Belumosudil	The serum concentration of Topotecan can be increased when it is combined with Belumosudil.
Bemiparin	The risk or severity of bleeding can be increased when Bemiparin is combined with Topotecan.
Bendamustine	The risk or severity of adverse effects can be increased when Topotecan is combined with Bendamustine.
Bendroflumethia	Bendroflumethiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Benorilate	Benorilate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Benoxaprofen	Benoxaprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Benserazide	Topotecan may decrease the excretion rate of Benserazide which could result in a higher serum level.
Benzatropine	Benzatropine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Benznidazole	Topotecan may decrease the excretion rate of Benznidazole which could result in a higher serum level.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Benzocaine.
Benzthiazide	Benzthiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Benzydamine	Benzydamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Benzyl alcohol.
Bepotastine	Topotecan may decrease the excretion rate of Bepotastine which could result in a higher serum level.
Berotralstat	The serum concentration of Topotecan can be increased when it is combined with Berotralstat.
Betamethasone	The risk or severity of adverse effects can be increased when Betamethasone is combined with Topotecan.
Betrixaban	The serum concentration of Topotecan can be increased when it is combined with Betrixaban.
Bexarotene	The risk or severity of adverse effects can be increased when Bexarotene is combined with Topotecan.
Bicisate	Topotecan may decrease the excretion rate of Bicisate which could result in a higher serum level.
Bictegravir	The excretion of Topotecan can be decreased when combined with Bictegravir.
Bimekizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Bimekizumab.
Bismuth subgallate	Topotecan may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.
Bisoprolol	The serum concentration of Topotecan can be increased when it is combined with Bisoprolol.
Bisoxatin	Topotecan may decrease the excretion rate of Bisoxatin which could result in a higher serum level.
Bivalirudin	The risk or severity of bleeding can be increased when Bivalirudin is combined with Topotecan.
Bleomycin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Topotecan.
Blinatumomab	The risk or severity of adverse effects can be increased when Topotecan is combined with Blinatumomab.
Bordetella	The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Topotecan.
Bortezomib	The risk or severity of adverse effects can be increased when Bortezomib is combined with Topotecan.
Bosutinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Bosutinib.
Brentuximab	The risk or severity of adverse effects can be increased when Topotecan is combined with Brentuximab vedotin.
Brexanolone	Brexanolone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Brigatinib	The excretion of Topotecan can be decreased when combined with Brigatinib.
Brivaracetam	Brivaracetam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Brodalumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Brodalumab.
Bromazepam	Topotecan may decrease the excretion rate of Bromazepam which could result in a higher serum level.
Bromotheophylline	Bromotheophylline may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Budesonide	The risk or severity of adverse effects can be increased when Topotecan is combined with Budesonide.
Bumadizone	Bumadizone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Bumetanide	Bumetanide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Bupivacaine.
Buprenorphine	Buprenorphine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Bupropion	Topotecan may decrease the excretion rate of Bupropion which could result in a higher serum level.
Buspirone	Buspirone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Busulfan	The risk or severity of adverse effects can be increased when Busulfan is combined with Topotecan.
Butabarbital	Butabarbital may decrease the excretion rate of Topotecan which could result in a higher serum level.
Butacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Butacaine.
Butalbital	Butalbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Butamben	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Butamben.
Cabazitaxel	The risk or severity of adverse effects can be increased when Topotecan is combined with Cabazitaxel.
Caffeine	Caffeine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Canagliflozin	The serum concentration of Topotecan can be increased when it is combined with Canagliflozin.
Canakinumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Canakinumab.
Cangrelor	The risk or severity of bleeding can be increased when Cangrelor is combined with Topotecan.
Cannabidiol	Cannabidiol may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Canrenoic acid	Canrenoic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Capecitabine	The risk or severity of adverse effects can be increased when Topotecan is combined with Capecitabine.
Caplacizumab	The risk or severity of bleeding can be increased when Caplacizumab is combined with Topotecan.
Capmatinib	The serum concentration of Topotecan can be increased when it is combined with Capmatinib.
Capreomycin	Topotecan may decrease the excretion rate of Capreomycin which could result in a higher serum level.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Capsaicin.
Carbamazepine	Carbamazepine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Carbidopa	Carbidopa may decrease the excretion rate of Topotecan which could result in a higher serum level.
Carboplatin	The risk or severity of adverse effects can be increased when Carboplatin is combined with Topotecan.
Carfilzomib	The serum concentration of Topotecan can be increased when it is combined with Carfilzomib.
Carmustine	The risk or severity of adverse effects can be increased when Carmustine is combined with Topotecan.
Carprofen	Carprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Carvedilol	The serum concentration of Topotecan can be increased when it is combined with Carvedilol.
Cefaclor	Cefaclor may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefadroxil	Cefadroxil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefalotin	Cefalotin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefamandole	Cefamandole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefapirin	Cefapirin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefazolin	Cefazolin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefdinir	Cefdinir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefditoren	Cefditoren may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefepime	Cefepime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefmenoxime	Cefmenoxime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefmetazole	Cefmetazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefonicid	Cefonicid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefoperazone	Cefoperazone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceforanide	Ceforanide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefotaxime	Cefotaxime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefotetan	Cefotetan may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefotiam	Cefotiam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefoxitin	Cefoxitin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefpiramide	Cefpiramide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefpirome	Cefpirome may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefpodoxime	Cefpodoxime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefprozil	Cefprozil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefradine	The excretion of Topotecan can be decreased when combined with Cefradine.
Ceftaroline	Ceftaroline fosamil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceftazidime	Ceftazidime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceftibuten	Ceftibuten may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceftizoxime	Ceftizoxime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceftobiprole	Ceftobiprole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceftolozane	Topotecan may decrease the excretion rate of Ceftolozane which could result in a higher serum level.
Ceftriaxone	Ceftriaxone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cefuroxime	Cefuroxime may decrease the excretion rate of Topotecan which could result in a higher serum level.

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Celecoxib	Celecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cenobamate	Cenobamate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Cephalexin	The excretion of Topotecan can be decreased when combined with Cephalexin.
Cephaloglycin	Cephaloglycin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ceritinib	The serum concentration of Topotecan can be increased when it is combined with Ceritinib.
Certolizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Certolizumab pegol.
Cetirizine	Cetirizine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cevimeline	Cevimeline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Chloral hydrate	Topotecan may decrease the excretion rate of Chloral hydrate which could result in a higher serum level.
Chlorambucil	The risk or severity of adverse effects can be increased when Chlorambucil is combined with Topotecan.
Chloramphenicol	The risk or severity of adverse effects can be increased when Chloramphenicol is combined with Topotecan.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Chloroprocaine.
Chloroquine	Chloroquine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Chlorothiazide	Chlorothiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Chloroxylenol	Topotecan may decrease the excretion rate of Chloroxylenol which could result in a higher serum level.
Chlorpromazine	Chlorpromazine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Chlorpropamide	Chlorpropamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Chlorthalidone	Chlorthalidone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Chlorzoxazone	Chlorzoxazone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cholesterol	Cholesterol may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Choline C 11	Topotecan may decrease the excretion rate of Choline C 11 which could result in a higher serum level.
Choline magnesium	Choline magnesium trisalicylate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Choline salicylate	Topotecan may decrease the excretion rate of Choline salicylate which could result in a higher serum level.
Chondroitin sulfate	Topotecan may decrease the excretion rate of Chondroitin sulfate which could result in a higher serum level.
Chromic chloride	Topotecan may decrease the excretion rate of Chromic chloride which could result in a higher serum level.
Chromic nitrate	Topotecan may decrease the excretion rate of Chromic nitrate which could result in a higher serum level.
Chromium	Topotecan may decrease the excretion rate of Chromium which could result in a higher serum level.
Chromium	Topotecan may decrease the excretion rate of Chromium gluconate which could result in a higher serum level.
Chromium nic	Topotecan may decrease the excretion rate of Chromium nicotinate which could result in a higher serum level.
Chromous sulfate	Topotecan may decrease the excretion rate of Chromous sulfate which could result in a higher serum level.
Ciclesonide	The risk or severity of adverse effects can be increased when Topotecan is combined with Ciclesonide.
Cidofovir	Cidofovir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Cilostazol	The metabolism of Cilostazol can be decreased when combined with Topotecan.
Cimetidine	The excretion of Topotecan can be decreased when combined with Cimetidine.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Cinchocaine.
Ciprofloxacin	The excretion of Topotecan can be decreased when combined with Ciprofloxacin.
Cisplatin	The risk or severity of adverse effects can be increased when Cisplatin is combined with Topotecan.
Cladribine	The risk or severity of adverse effects can be increased when Cladribine is combined with Topotecan.
Clarithromycin	The serum concentration of Topotecan can be increased when it is combined with Clarithromycin.
Clevidipine	Topotecan may decrease the excretion rate of Clevidipine which could result in a higher serum level.
Clobazam	Clobazam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Clobetasol pr	The risk or severity of adverse effects can be increased when Clobetasol propionate is combined with Topotecan.
Clofarabine	The risk or severity of adverse effects can be increased when Clofarabine is combined with Topotecan.
Clofazimine	The serum concentration of Topotecan can be increased when it is combined with Clofazimine.
Clomifene	The serum concentration of Topotecan can be increased when it is combined with Clomifene.
Clomipramine	Topotecan may decrease the excretion rate of Clomipramine which could result in a higher serum level.
Clonazepam	Clonazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Clopidogrel	The risk or severity of bleeding can be increased when Clopidogrel is combined with Topotecan.
Clorazepic acid	Clorazepic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Clostridium	The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Clove oil	Topotecan may decrease the excretion rate of Clove oil which could result in a higher serum level.
Clozapine	The risk or severity of neutropenia can be increased when Topotecan is combined with Clozapine.
Cobicistat	The serum concentration of Topotecan can be increased when it is combined with Cobicistat.
Cobimetinib	The serum concentration of Topotecan can be increased when it is combined with Cobimetinib.
Cocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Cocaine.
Colchicine	The metabolism of Colchicine can be decreased when combined with Topotecan.
Colistimethate	Colistimethate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Colistin	Topotecan may decrease the excretion rate of Colistin which could result in a higher serum level.
Conivaptan	The serum concentration of Topotecan can be increased when it is combined with Conivaptan.
Conjugated estr	Conjugated estrogens may decrease the excretion rate of Topotecan which could result in a higher serum level.
Copanlisib	The excretion of Topotecan can be decreased when combined with Copanlisib.
Corifollitropin alfa	Topotecan may decrease the excretion rate of Corifollitropin alfa which could result in a higher serum level.
Corticotropin	The risk or severity of adverse effects can be increased when Topotecan is combined with Corticotropin.
Cortisone acetate	The risk or severity of adverse effects can be increased when Topotecan is combined with Cortisone acetate.
Corynebacterium	The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Crizotinib	The serum concentration of Topotecan can be increased when it is combined with Crizotinib.
Curcumin	The serum concentration of Topotecan can be increased when it is combined with Curcumin.
Cyanocobalamin	The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Topotecan.
Cyclopenthiazide	Cyclopenthiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Cyclophosphamide	The risk or severity of adverse effects can be increased when Cyclophosphamide is combined with Topotecan.
Cyclosporine	Topotecan may increase the immunosuppressive activities of Cyclosporine.
Cyclothiazide	Cyclothiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Cytarabine	The risk or severity of adverse effects can be increased when Cytarabine is combined with Topotecan.
Dabigatran	The risk or severity of bleeding can be increased when Dabigatran is combined with Topotecan.
Dabigatran	The serum concentration of Topotecan can be increased when it is combined with Dabigatran etexilate.
Dabrafenib	Dabrafenib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dacarbazine	The risk or severity of adverse effects can be increased when Dacarbazine is combined with Topotecan.
Daclatasvir	The serum concentration of Topotecan can be increased when it is combined with Daclatasvir.
Dacomitinib	The serum concentration of Topotecan can be increased when it is combined with Dacomitinib.
Dactinomycin	The risk or severity of adverse effects can be increased when Dactinomycin is combined with Topotecan.
Dalfampridine	Topotecan may decrease the excretion rate of Dalfampridine which could result in a higher serum level.
Dalteparin	The risk or severity of bleeding can be increased when Dalteparin is combined with Topotecan.
Danaparoid	The risk or severity of bleeding can be increased when Danaparoid is combined with Topotecan.
Dapagliflozin	Dapagliflozin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Daptomycin	The serum concentration of Topotecan can be increased when it is combined with Daptomycin.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Topotecan.
Darolutamide	The serum concentration of Topotecan can be increased when it is combined with Darolutamide.
Darunavir	The serum concentration of Topotecan can be increased when it is combined with Darunavir.
Dasabuvir	Dasabuvir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dasatinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Dasatinib.
Daunorubicin	The risk or severity of adverse effects can be increased when Daunorubicin is combined with Topotecan.
Decitabine	The risk or severity of adverse effects can be increased when Topotecan is combined with Decitabine.
Deferiprone	Topotecan may decrease the excretion rate of Deferiprone which could result in a higher serum level.
Defibrotide	The risk or severity of bleeding can be increased when Defibrotide is combined with Topotecan.
Deflazacort	The risk or severity of adverse effects can be increased when Topotecan is combined with Deflazacort.
Delafloxacin	Topotecan may decrease the excretion rate of Delafloxacin which could result in a higher serum level.
Denosumab	The risk or severity of adverse effects can be increased when Denosumab is combined with Topotecan.
Desipramine	Topotecan may decrease the excretion rate of Desipramine which could result in a higher serum level.
Desirudin	The risk or severity of bleeding can be increased when Desirudin is combined with Topotecan.
Desmopressin	Desmopressin may decrease the excretion rate of Topotecan which could result in a higher serum level.

Desoximetasone	The risk or severity of adverse effects can be increased when Desoximetasone is combined with Topotecan.
Desvenlafaxine	Topotecan may decrease the excretion rate of Desvenlafaxine which could result in a higher serum level.
Deucravacitinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Deucravacitinib.
Deutetrabenazine	Topotecan may decrease the excretion rate of Deutetrabenazine which could result in a higher serum level.
Dexamethasone	The risk or severity of adverse effects can be increased when Topotecan is combined with Dexamethasone.
Dexamethasone	The serum concentration of Topotecan can be decreased when it is combined with Dexamethasone acetate.
Dexibuprofen	Dexibuprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dexketoprofen	Dexketoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dexmedetomidine	Dexmedetomidine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dexpanthenol	Topotecan may decrease the excretion rate of Dexpanthenol which could result in a higher serum level.
Dexrazoxane	The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Topotecan.
Dextran	Topotecan may decrease the excretion rate of Dextran which could result in a higher serum level.
Diatrizoate	Diatrizoate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Diazepam	Diazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Dichlorobenzyl	Topotecan may decrease the excretion rate of Dichlorobenzyl alcohol which could result in a higher serum level.
Diclofenac	Diclofenac may decrease the excretion rate of Topotecan which could result in a higher serum level.
Diclofenamide	Diclofenamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Dicoumarol	The risk or severity of bleeding can be increased when Dicoumarol is combined with Topotecan.
Dicyclomine	Dicyclomine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Didanosine	Didanosine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dienogest	Topotecan may decrease the excretion rate of Dienogest which could result in a higher serum level.
Diethylstilbestrol	Diethylstilbestrol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Diflunisal	Diflunisal may decrease the excretion rate of Topotecan which could result in a higher serum level.
Difluocortolone	The risk or severity of adverse effects can be increased when Topotecan is combined with Difluocortolone.
Digitoxin	The serum concentration of Topotecan can be increased when it is combined with Digitoxin.
Digoxin	Topotecan may decrease the excretion rate of Digoxin which could result in a higher serum level.
Dihydrostrepto	Dihydrostreptomycin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dimercaprol	Topotecan may decrease the excretion rate of Dimercaprol which could result in a higher serum level.
Dimethyl fu	The risk or severity of adverse effects can be increased when Topotecan is combined with Dimethyl fumarate.
Dimethyl sulfo	Topotecan may decrease the excretion rate of Dimethyl sulfoxide which could result in a higher serum level.
Dinutuximab	The risk or severity of adverse effects can be increased when Topotecan is combined with Dinutuximab.
Diosmin	The serum concentration of Topotecan can be increased when it is combined with Diosmin.
Diphenhydra	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Diphenhydramine.
Dipyridamole	The risk or severity of bleeding can be increased when Dipyridamole is combined with Topotecan.
Diroximel fum	The risk or severity of adverse effects can be increased when Topotecan is combined with Diroximel fumarate.
Disopyramide	Disopyramide may decrease the excretion rate of Topotecan which could result in a higher serum level.
DMethylephedrine	Topotecan may decrease the excretion rate of DL-Methylephedrine which could result in a higher serum level.
Dobutamine	Dobutamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Docetaxel	The risk or severity of adverse effects can be increased when Topotecan is combined with Docetaxel.
Dolutegravir	The serum concentration of Topotecan can be increased when it is combined with Dolutegravir.
Dopamine	Dopamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Doripenem	Topotecan may decrease the excretion rate of Doripenem which could result in a higher serum level.
Doxacurium	Topotecan may decrease the excretion rate of Doxacurium which could result in a higher serum level.
Doxepin	Topotecan may decrease the excretion rate of Doxepin which could result in a higher serum level.
Doxorubicin	The risk or severity of adverse effects can be increased when Doxorubicin is combined with Topotecan.
Doxycycline	Doxycycline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Dronabinol	The serum concentration of Dronabinol can be increased when it is combined with Topotecan.
Dronedarone	The serum concentration of Topotecan can be increased when it is combined with Dronedarone.
Drospirenone	Drospirenone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Drotrecogin alfa	The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Topotecan.
Droxidopa	Topotecan may decrease the excretion rate of Droxidopa which could result in a higher serum level.
Duloxetine	Duloxetine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Duvelisib	The serum concentration of Topotecan can be increased when it is combined with Duvelisib.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Dyclonine.
Dyphylline	Dyphylline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ebola Zaire	The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Topotecan.
Eculizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Eculizumab.
Edetic acid	The risk or severity of bleeding can be increased when Edetic acid is combined with Topotecan.
Edoxaban	The serum concentration of Topotecan can be increased when it is combined with Edoxaban.
Edrophonium	Edrophonium may decrease the excretion rate of Topotecan which could result in a higher serum level.
Efalizumab	The risk or severity of adverse effects can be increased when Efalizumab is combined with Topotecan.
Eflapegrastim	The risk or severity of neutropenia can be increased when Eflapegrastim is combined with Topotecan.
Elagolix	The serum concentration of Topotecan can be increased when it is combined with Elagolix.
Elbasvir	Elbasvir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Eliglustat	The metabolism of Eliglustat can be decreased when combined with Topotecan.
Eltrombopag	Eltrombopag may decrease the excretion rate of Topotecan which could result in a higher serum level.
Emapalumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Emapalumab.
Emtricitabine	The excretion of Topotecan can be decreased when combined with Emtricitabine.
Enalaprilat	Topotecan may decrease the excretion rate of Enalaprilat which could result in a higher serum level.
Enasidenib	The serum concentration of Topotecan can be increased when it is combined with Enasidenib.
Enfortumab	The serum concentration of Topotecan can be increased when it is combined with Enfortumab vedotin.
Enoxaparin	The risk or severity of bleeding can be increased when Enoxaparin is combined with Topotecan.
Entrectinib	The serum concentration of Topotecan can be increased when it is combined with Entrectinib.
Enzalutamide	The serum concentration of Enzalutamide can be increased when it is combined with Topotecan.
Epirubicin	The risk or severity of adverse effects can be increased when Epirubicin is combined with Topotecan.
Eplerenone	Eplerenone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Epoprostenol	The risk or severity of bleeding can be increased when Epoprostenol is combined with Topotecan.
Eptifibatide	The risk or severity of bleeding can be increased when Eptifibatide is combined with Topotecan.
Erdafitinib	The serum concentration of Topotecan can be increased when it is combined with Erdafitinib.
Eribulin	The risk or severity of adverse effects can be increased when Topotecan is combined with Eribulin.
Erlotinib	Erlotinib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ertapenem	Ertapenem may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ertugliflozin	Ertugliflozin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Erythromycin	The serum concentration of Topotecan can be increased when it is combined with Erythromycin.
Erythropoietin	The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Topotecan.
Eslicarbazepine	Eslicarbazepine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Eslicarbazepine	Eslicarbazepine acetate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Estazolam	Estazolam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Estradiol	Estradiol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Estradiol acetate	Estradiol acetate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Estradiol benzoate	Estradiol benzoate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Estradiol cypie	Estradiol cypionate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Estradiol diena	Estradiol dienanthate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Estradiol valerate	Estradiol valerate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Estramustine	The risk or severity of adverse effects can be increased when Topotecan is combined with Estramustine.
Estrone sulfate	The excretion of Topotecan can be decreased when combined with Estrone sulfate.
Eszopiclone	The metabolism of Eszopiclone can be decreased when combined with Topotecan.
Etacrynic acid	Etacrynic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Etafedrine	Topotecan may decrease the excretion rate of Etafedrine which could result in a higher serum level.
Etanercept	The risk or severity of adverse effects can be increased when Etanercept is combined with Topotecan.

Ethambutol	Ethambutol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ethosuximide	Ethosuximide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Ethotoin	Ethotoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Ethyl chloride	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Ethyl chloride.
Etidocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Etidocaine.
Etodolac	Etodolac may decrease the excretion rate of Topotecan which could result in a higher serum level.
Etomidate	Etomidate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Etonogestrel	Etonogestrel may decrease the excretion rate of Topotecan which could result in a higher serum level.
Etoposide	The risk or severity of adverse effects can be increased when Etoposide is combined with Topotecan.
Etoricoxib	Etoricoxib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Eucalyptus oil	Topotecan may decrease the excretion rate of Eucalyptus oil which could result in a higher serum level.
Everolimus	The serum concentration of Topotecan can be increased when it is combined with Everolimus.
Ezogabine	Ezogabine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Famotidine	The excretion of Topotecan can be decreased when combined with Famotidine.
Famtozinameran	The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Topotecan.
Favipiravir	The serum concentration of Topotecan can be increased when it is combined with Favipiravir.
Febuxostat	The excretion of Topotecan can be decreased when combined with Febuxostat.
Fedratinib	The serum concentration of Topotecan can be increased when it is combined with Fedratinib.
Felbamate	Felbamate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Fenbufen	Fenbufen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fenfluramine	Fenfluramine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Fenofibrate	Topotecan may decrease the excretion rate of Fenofibrate which could result in a higher serum level.
Fenofibric acid	Topotecan may decrease the excretion rate of Fenofibric acid which could result in a higher serum level.
Fenoldopam	Fenoldopam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fenoprofen	Fenoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fentanyl	The metabolism of Fentanyl can be decreased when combined with Topotecan.
Fesoterodine	Topotecan may decrease the excretion rate of Fesoterodine which could result in a higher serum level.
Fexinidazole	The excretion of Topotecan can be decreased when combined with Fexinidazole.
Fexofenadine	The serum concentration of Topotecan can be increased when it is combined with Fexofenadine.
Filgotinib	The serum concentration of Topotecan can be increased when it is combined with Filgotinib.
Filgrastim	The risk or severity of neutropenia can be increased when Filgrastim is combined with Topotecan.
Finerenone	The serum concentration of Finerenone can be increased when it is combined with Topotecan.
Fingolimod	Topotecan may increase the immunosuppressive activities of Fingolimod.
Flavoxate	Topotecan may decrease the excretion rate of Flavoxate which could result in a higher serum level.
Flecainide	The excretion of Topotecan can be decreased when combined with Flecainide.
Flibanserin	The serum concentration of Topotecan can be increased when it is combined with Flibanserin.
Floctafenine	Floctafenine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Florbetaben	Topotecan may decrease the excretion rate of Florbetaben (18F) which could result in a higher serum level.
Florbetapir	Topotecan may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
Floxuridine	The risk or severity of adverse effects can be increased when Floxuridine is combined with Topotecan.
Fluconazole	The serum concentration of Topotecan can be increased when it is combined with Fluconazole.
Flucytosine	The risk or severity of adverse effects can be increased when Topotecan is combined with Flucytosine.
Fludarabine	The risk or severity of adverse effects can be increased when Topotecan is combined with Fludarabine.
Fludeoxyglucos	Topotecan may decrease the excretion rate of Fludeoxyglucose (18F) which could result in a higher serum level.
Fludrocortisone	The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Topotecan.
Fluindione	The risk or severity of bleeding can be increased when Fluindione is combined with Topotecan.
Flumazenil	Topotecan may decrease the excretion rate of Flumazenil which could result in a higher serum level.
Flunarizine	Flunarizine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Flunisolide	The risk or severity of adverse effects can be increased when Flunisolide is combined with Topotecan.
Fluocinolone	The risk or severity of adverse effects can be increased when Fluocinolone acetonide is combined with Topotecan.
Fluocinonide	The risk or severity of adverse effects can be increased when Topotecan is combined with Fluocinonide.
Fluocortolone	The risk or severity of adverse effects can be increased when Topotecan is combined with Fluocortolone.
Fluoromethol	The risk or severity of adverse effects can be increased when Fluorometholone is combined with Topotecan.
Fluorouracil	The risk or severity of adverse effects can be increased when Fluorouracil is combined with Topotecan.
Flupentixol	The risk or severity of myelosuppression can be increased when Flupentixol is combined with Topotecan.
Fluprednisolone	The risk or severity of adverse effects can be increased when Topotecan is combined with Fluprednisolone.
Flurazepam	Flurazepam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Flurbiprofen	Flurbiprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Flutamide	Flutamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fluticasone	The risk or severity of adverse effects can be increased when Topotecan is combined with Fluticasone.
Fluticasone fur	The risk or severity of adverse effects can be increased when Topotecan is combined with Fluticasone furoate.
Fluticasone	The risk or severity of adverse effects can be increased when Fluticasone propionate is combined with Topotecan.
Fluvoxamine	Fluvoxamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Folic acid	Folic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fomepizole	Topotecan may decrease the excretion rate of Fomepizole which could result in a higher serum level.
Fondaparinux	Fondaparinux may decrease the excretion rate of Topotecan which could result in a higher serum level.
Formestane	Topotecan may decrease the excretion rate of Formestane which could result in a higher serum level.
Foscarnet	Foscarnet may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fosfomycin	Fosfomycin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fosinopril	Fosinopril may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fosphenytoin	Fosphenytoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Fostamatinib	Fostamatinib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Fostemsavir	Fostemsavir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Framycetin	Framycetin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Furosemide	Furosemide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Fusidic acid	Fusidic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Futibatinib	The serum concentration of Topotecan can be increased when it is combined with Futibatinib.
Gabapentin	Gabapentin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Gabapentin	Topotecan may decrease the excretion rate of Gabapentin enacarbil which could result in a higher serum level.
Gadobenic acid	Gadobenic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Gadodiamide	Gadodiamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Gadofosveset	Topotecan may decrease the excretion rate of Gadofosveset trisodium which could result in a higher serum level.
Gadopentetic	Gadopentetic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Gadoteric acid	Topotecan may decrease the excretion rate of Gadoteric acid which could result in a higher serum level.
Gadoteridol	Gadoteridol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Gallium nitrate	The risk or severity of adverse effects can be increased when Topotecan is combined with Gallium nitrate.
Ganciclovir	The excretion of Topotecan can be decreased when combined with Ganciclovir.
Gefitinib	Gefitinib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Gemcitabine	The risk or severity of adverse effects can be increased when Gemcitabine is combined with Topotecan.
Gemfibrozil	Topotecan may decrease the excretion rate of Gemfibrozil which could result in a higher serum level.
Gemtuzumab	The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Topotecan.
Gentamicin	Topotecan may decrease the excretion rate of Gentamicin which could result in a higher serum level.
Gilteritinib	The excretion of Topotecan can be decreased when combined with Gilteritinib.
Gimeracil	Topotecan may decrease the excretion rate of Gimeracil which could result in a higher serum level.
Givosiran	Givosiran may decrease the excretion rate of Topotecan which could result in a higher serum level.
Glasdegib	The serum concentration of Topotecan can be increased when it is combined with Glasdegib.
Glatiramer	The risk or severity of adverse effects can be increased when Topotecan is combined with Glatiramer.
Glecaprevir	The serum concentration of Topotecan can be increased when it is combined with Glecaprevir.
Glipizide	Topotecan may decrease the excretion rate of Glipizide which could result in a higher serum level.
Glycerol	Topotecan may decrease the excretion rate of Glycerol phenylbutyrate which could result in a higher serum level.

Golimumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Golimumab.
Golodirsen	Topotecan may decrease the excretion rate of Golodirsen which could result in a higher serum level.
Goserelin	Goserelin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Grazoprevir	Grazoprevir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Guanethidine	Topotecan may decrease the excretion rate of Guanethidine which could result in a higher serum level.
Guanfacine	Guanfacine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Guanidine	The excretion of Topotecan can be decreased when combined with Guanidine.
Guselkumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Guselkumab.
Haemophilus	The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Topotecan.
Haloperidol	The serum concentration of Haloperidol can be increased when it is combined with Topotecan.
Heparin	The risk or severity of bleeding can be increased when Heparin is combined with Topotecan.
Hepatitis A Vaccine	The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Topotecan.
Hepatitis B Vacci	The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Topotecan.
Human adenovirus	The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Topotecan.
Hydralazine	Topotecan may decrease the excretion rate of Hydralazine which could result in a higher serum level.
Hydrochlorothiazide	Hydrochlorothiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Hydrocortisone	The risk or severity of adverse effects can be increased when Topotecan is combined with Hydrocortisone acetate.
Hydrocortisone but	The risk or severity of adverse effects can be increased when Topotecan is combined with Hydrocortisone butyrate.
Hydrocortisone suc	The risk or severity of adverse effects can be increased when Topotecan is combined with Hydrocortisone succinate.
Hydroflumethiazide	Hydroflumethiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Hydromorphone	Hydromorphone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Hydroxocobalamin	Hydroxocobalamin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Hydroxychloroquine	The risk or severity of adverse effects can be increased when Topotecan is combined with Hydroxychloroquine.
Hydroxyethyl Starch	Topotecan may decrease the excretion rate of Hydroxyethyl Starch which could result in a higher serum level.
Hydroxyurea	The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Topotecan.
Ibritumomab	The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Topotecan.
Ibrutinib	The metabolism of Ibrutinib can be decreased when combined with Topotecan.
Ibuprofen	Ibuprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ibutilide	Ibutilide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Icatibant	Topotecan may decrease the excretion rate of Icatibant which could result in a higher serum level.
Icosapent	Icosapent may decrease the excretion rate of Topotecan which could result in a higher serum level.
Icosapent ethyl	The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Topotecan.
Idarubicin	The risk or severity of adverse effects can be increased when Topotecan is combined with Idarubicin.
Idarucizumab	Topotecan may decrease the excretion rate of Idarucizumab which could result in a higher serum level.
Idebenone	Topotecan may decrease the excretion rate of Idebenone which could result in a higher serum level.
Idelalisib	The risk or severity of adverse effects can be increased when Topotecan is combined with Idelalisib.
Ifosfamide	The risk or severity of adverse effects can be increased when Topotecan is combined with Ifosfamide.
Iloperidone	The metabolism of Iloperidone can be decreased when combined with Topotecan.
Iloprost	The risk or severity of bleeding can be increased when Iloprost is combined with Topotecan.
Imatinib	The risk or severity of adverse effects can be increased when Imatinib is combined with Topotecan.
Imipramine	Imipramine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Indacaterol	The serum concentration of Topotecan can be increased when it is combined with Indacaterol.
Indapamide	Indapamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Indigotindisulfo	Topotecan may decrease the excretion rate of Indigotindisulfonic acid which could result in a higher serum level.
Indomethacin	The risk or severity of adverse effects can be increased when Indomethacin is combined with Topotecan.
Inebilizumab	The risk or severity of infection can be increased when Topotecan is combined with Inebilizumab.
Infliximab	The risk or severity of adverse effects can be increased when Infliximab is combined with Topotecan.
Influenza A	The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Influenza A virus	The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Influenza A virus	The therapeutic efficacy of Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen can be decreased when used in combination with Topotecan.
Influenza	The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Influenza A vir	The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Influenza A	The therapeutic efficacy of Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen can be decreased when used in combination with Topotecan.
Influenza A virus	The therapeutic efficacy of Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Influenza A	The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Influenza A	The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Influenza B	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Influenza B	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Influenza B	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Influenza	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Topotecan.
Inosine	Topotecan may decrease the excretion rate of Inosine pranobex which could result in a higher serum level.
Inositol	Topotecan may decrease the excretion rate of Inositol which could result in a higher serum level.
Inotersen	Inotersen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Inotuzumab	The serum concentration of Topotecan can be increased when it is combined with Inotuzumab ozogamicin.
Interferon a	The risk or severity of adverse effects can be increased when Interferon alfa-2a is combined with Topotecan.
Interferon	The risk or severity of adverse effects can be increased when Interferon alfa-2b is combined with Topotecan.
Interferon	The risk or severity of adverse effects can be increased when Interferon alfa-n1 is combined with Topotecan.
Interferon alfa	The risk or severity of adverse effects can be increased when Interferon alfa-n3 is combined with Topotecan.
Interferon	The risk or severity of adverse effects can be increased when Interferon alfacon-1 is combined with Topotecan.
Interferon	The risk or severity of adverse effects can be increased when Interferon beta-1b is combined with Topotecan.
Interferon gamma	The risk or severity of adverse effects can be increased when Interferon gamma-1b is combined with Topotecan.
Iobenguane	Topotecan may decrease the excretion rate of Iobenguane sulfate I-123 which could result in a higher serum level.
Iodixanol	Topotecan may decrease the excretion rate of Iodixanol which could result in a higher serum level.
Ioflupane	Topotecan may decrease the excretion rate of Ioflupane I-123 which could result in a higher serum level.
Iopromide	Topotecan may decrease the excretion rate of Iopromide which could result in a higher serum level.
Iothalamic acid	Topotecan may decrease the excretion rate of Iothalamic acid which could result in a higher serum level.
Ioversol	Topotecan may decrease the excretion rate of Ioversol which could result in a higher serum level.
Ioxilan	Topotecan may decrease the excretion rate of Ioxilan which could result in a higher serum level.
Ipecac	Topotecan may decrease the excretion rate of Ipecac which could result in a higher serum level.
Ipilimumab	Topotecan may decrease the excretion rate of Ipilimumab which could result in a higher serum level.
Irinotecan	The risk or severity of adverse effects can be increased when Irinotecan is combined with Topotecan.
Isavuconazole	The serum concentration of Topotecan can be increased when it is combined with Isavuconazole.
Isavuconazonium	The serum concentration of Topotecan can be increased when it is combined with Isavuconazonium.
Isoniazid	Isoniazid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Isosorbide	Isosorbide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Isosorbide mon	Isosorbide mononitrate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Isosulfan blue	Topotecan may decrease the excretion rate of Isosulfan blue which could result in a higher serum level.
Isotretinoin	Isotretinoin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Isoxicam	Isoxicam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Isradipine	Isradipine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Istradefylline	The serum concentration of Topotecan can be increased when it is combined with Istradefylline.
Itraconazole	The serum concentration of Topotecan can be increased when it is combined with Itraconazole.
Ivacaftor	The serum concentration of Topotecan can be increased when it is combined with Ivacaftor.
Ixabepilone	The serum concentration of Topotecan can be increased when it is combined with Ixabepilone.
Ixazomib	Topotecan may decrease the excretion rate of Ixazomib which could result in a higher serum level.
Ixekizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Ixekizumab.
JCOVID-19 Vaccine	The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Topotecan.
Japa encephalitis	The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Topotecan.
Kanamycin	Topotecan may decrease the excretion rate of Kanamycin which could result in a higher serum level.
Ketamine	Topotecan may decrease the excretion rate of Ketamine which could result in a higher serum level.

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Ketazolam	Topotecan may decrease the excretion rate of Ketazolam which could result in a higher serum level.
Ketoconazole	The serum concentration of Topotecan can be increased when it is combined with Ketoconazole.
Ketoprofen	Ketoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ketorolac	Ketorolac may decrease the excretion rate of Topotecan which could result in a higher serum level.
Labetalol	Labetalol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lacosamide	Lacosamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Lamivudine	Lamivudine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lamotrigine	Lamotrigine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Lansoprazole	Lansoprazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lapatinib	The serum concentration of Topotecan can be increased when it is combined with Lapatinib.
Larotrectinib	The serum concentration of Topotecan can be increased when it is combined with Larotrectinib.
Lasmiditan	The serum concentration of Topotecan can be increased when it is combined with Lasmiditan.
Latamoxef	Latamoxef may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ledipasvir	The serum concentration of Topotecan can be increased when it is combined with Ledipasvir.
Lefamulin	The serum concentration of Topotecan can be increased when it is combined with Lefamulin.
Leflunomide	The risk or severity of adverse effects can be increased when Topotecan is combined with Leflunomide.
Lemborexant	The serum concentration of Topotecan can be increased when it is combined with Lemborexant.
Lenalidomide	The risk or severity of adverse effects can be increased when Lenalidomide is combined with Topotecan.
Lenograstim	The risk or severity of neutropenia can be increased when Lenograstim is combined with Topotecan.
Lenvatinib	The serum concentration of Topotecan can be increased when it is combined with Lenvatinib.
Lepirudin	The risk or severity of bleeding can be increased when Lepirudin is combined with Topotecan.
Lesinurad	Topotecan may decrease the excretion rate of Lesinurad which could result in a higher serum level.
Letermovir	Letermovir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Leuprolide	Leuprolide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Levamlodipine	The serum concentration of Levamlodipine can be increased when it is combined with Topotecan.
Levetiracetam	Levetiracetam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Levobupivacaine.
Levocarnitine	Levocarnitine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Levocetirizine	Topotecan may decrease the excretion rate of Levocetirizine which could result in a higher serum level.
Levofloxacin	The excretion of Topotecan can be decreased when combined with Levofloxacin.
Levoketoconazole	The serum concentration of Topotecan can be increased when it is combined with Levoketoconazole.
Levomilnacipran	Topotecan may decrease the excretion rate of Levomilnacipran which could result in a higher serum level.
Levosalbutamol	Topotecan may decrease the excretion rate of Levosalbutamol which could result in a higher serum level.
Levothyroxine	The serum concentration of Topotecan can be decreased when it is combined with Levothyroxine.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Lidocaine.
Linagliptin	The serum concentration of Topotecan can be increased when it is combined with Linagliptin.
Linezolid	The risk or severity of adverse effects can be increased when Linezolid is combined with Topotecan.
Liothyronine	Liothyronine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lipegfilgrastim	Topotecan may increase the myelosuppressive activities of Lipegfilgrastim.
Lisinopril	Lisinopril may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lithium carbonate	Topotecan may decrease the excretion rate of Lithium carbonate which could result in a higher serum level.
Lithium citrate	Lithium citrate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lixisenatide	Topotecan may decrease the excretion rate of Lixisenatide which could result in a higher serum level.
Lofexidine	The excretion of Topotecan can be decreased when combined with Lofexidine.
Lomitapide	The serum concentration of Topotecan can be increased when it is combined with Lomitapide.
Lomustine	The risk or severity of adverse effects can be increased when Topotecan is combined with Lomustine.
Lonafarnib	The serum concentration of Topotecan can be increased when it is combined with Lonafarnib.
Loncastuximab	The serum concentration of Topotecan can be increased when it is combined with Loncastuximab tesirine.
Loperamide	The serum concentration of Topotecan can be increased when it is combined with Loperamide.
Lopinavir	The serum concentration of Topotecan can be increased when it is combined with Lopinavir.
Loracarbef	Loracarbef may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lorazepam	Lorazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Lorcaserin	Topotecan may decrease the excretion rate of Lorcaserin which could result in a higher serum level.
Lorlatinib	The serum concentration of Topotecan can be decreased when it is combined with Lorlatinib.
Lornoxicam	Lornoxicam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lorpiprazole	Topotecan may decrease the excretion rate of Lorpiprazole which could result in a higher serum level.
Lovastatin	The metabolism of Lovastatin can be decreased when combined with Topotecan.
Loxapine	The serum concentration of Topotecan can be increased when it is combined with Loxapine.
Loxoprofen	Loxoprofen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lubiprostone	Topotecan may decrease the excretion rate of Lubiprostone which could result in a higher serum level.
Lumacaftor	The serum concentration of Topotecan can be increased when it is combined with Lumacaftor.
Lumiracoxib	Lumiracoxib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Lusutrombopag	The serum concentration of Topotecan can be increased when it is combined with Lusutrombopag.
Macitentan	Topotecan may decrease the excretion rate of Macitentan which could result in a higher serum level.
Magnesium	The serum concentration of Magnesium can be decreased when it is combined with Topotecan.
Magnesium carb	Topotecan may decrease the excretion rate of Magnesium carbonate which could result in a higher serum level.
Magnesium chl	Topotecan may decrease the excretion rate of Magnesium chloride which could result in a higher serum level.
Magnesium hydr	Topotecan may decrease the excretion rate of Magnesium hydroxide which could result in a higher serum level.
Magnesium sulfa	Magnesium sulfate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Magnesium trisi	Topotecan may decrease the excretion rate of Magnesium trisilicate which could result in a higher serum level.
Mangafodipir	Topotecan may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Mannitol	Mannitol may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Maprotiline	Maprotiline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Maribavir	The serum concentration of Topotecan can be increased when it is combined with Maribavir.
Measles vir	The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Topotecan.
Mecamylamine	Mecamylamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Mechlorethamine	The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Topotecan.
Meclofenamic acid	Meclofenamic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Medroxyproges	Medroxyprogesterone acetate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Mefenamic acid	Mefenamic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Mefloquine	The serum concentration of Topotecan can be increased when it is combined with Mefloquine.
Megestrol acetate	Megestrol acetate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Meloxicam	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Meloxicam.
Melphalan	The risk or severity of adverse effects can be increased when Topotecan is combined with Melphalan.
Memantine	Topotecan may decrease the excretion rate of Memantine which could result in a higher serum level.
Meningococcal	The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Topotecan.
Meperidine	Meperidine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Mephenytoin	Mephenytoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Mepivacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Mepivacaine.
Mepolizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Mepolizumab.
Meprednisone	The risk or severity of adverse effects can be increased when Topotecan is combined with Meprednisone.
Mercaptopurine	The risk or severity of adverse effects can be increased when Topotecan is combined with Mercaptopurine.
Meropenem	Meropenem may decrease the excretion rate of Topotecan which could result in a higher serum level.
Mesalazine	Mesalazine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Metamfetamine	Topotecan may decrease the excretion rate of Metamfetamine which could result in a higher serum level.
Metamizole	The risk or severity of myelosuppression can be increased when Metamizole is combined with Topotecan.
Metaxalone	Metaxalone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Metformin	The excretion of Topotecan can be decreased when combined with Metformin.
Methadone	Methadone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Methazolamide	Methazolamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.

Methimazole	The risk or severity of adverse effects can be increased when Methimazole is combined with Topotecan.
Methohexital	Methohexital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Methotrexate	The risk or severity of adverse effects can be increased when Methotrexate is combined with Topotecan.
Methoxsalen	Methoxsalen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Methoxy	The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Topotecan.
Methsuximide	Methsuximide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Methyldopa	Methyldopa may decrease the excretion rate of Topotecan which could result in a higher serum level.
Methylene blue	The serum concentration of Topotecan can be increased when it is combined with Methylene blue.
Methylnaltrexone	Topotecan may decrease the excretion rate of Methylnaltrexone which could result in a higher serum level.
Methylphenobarb	Methylphenobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Methylprednisol	The risk or severity of adverse effects can be increased when Methylprednisolone is combined with Topotecan.
Methyltestoster	Topotecan may decrease the excretion rate of Methyltestosterone which could result in a higher serum level.
Meticrane	Meticrane may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Metoclopramide	Topotecan may decrease the excretion rate of Metoclopramide which could result in a higher serum level.
Metolazone	Metolazone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Metoprolol	Metoprolol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Metyrapone	Metyrapone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Midazolam	The serum concentration of Midazolam can be increased when it is combined with Topotecan.
Mifepristone	The serum concentration of Topotecan can be increased when it is combined with Mifepristone.
Migalastat	Topotecan may decrease the excretion rate of Migalastat which could result in a higher serum level.
Milnacipran	Topotecan may decrease the excretion rate of Milnacipran which could result in a higher serum level.
Milrinone	Milrinone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Mirabegron	The serum concentration of Topotecan can be increased when it is combined with Mirabegron.
Mitapivat	The serum concentration of Topotecan can be increased when it is combined with Mitapivat.
Mitomycin	The risk or severity of adverse effects can be increased when Mitomycin is combined with Topotecan.
Mitoxantrone	The risk or severity of adverse effects can be increased when Topotecan is combined with Mitoxantrone.
MCOVID-19 Vacc	The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Topotecan.
Modified vacci	The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Topotecan.
Mometasone	The risk or severity of adverse effects can be increased when Topotecan is combined with Mometasone furoate.
Monomethyl	The risk or severity of adverse effects can be increased when Topotecan is combined with Monomethyl fumarate.
Morphine	The serum concentration of Topotecan can be increased when it is combined with Morphine.
Mosunetuzumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Mosunetuzumab.
Moxisylyte	Topotecan may decrease the excretion rate of Moxisylyte which could result in a higher serum level.
Mumps virus	The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Topotecan.
Muromonab	The risk or severity of adverse effects can be increased when Muromonab is combined with Topotecan.
Muzolimine	Muzolimine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Mycophenolate	The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Topotecan.
Mycophenolic acid	The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Topotecan.
N-acetyltyrosine	Topotecan may decrease the excretion rate of N-acetyltyrosine which could result in a higher serum level.
Nabumetone	Nabumetone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nadolol	The excretion of Topotecan can be decreased when combined with Nadolol.
Nadroparin	The risk or severity of bleeding can be increased when Nadroparin is combined with Topotecan.
Naldemedine	Topotecan may decrease the excretion rate of Naldemedine which could result in a higher serum level.
Nalmefene	Topotecan may decrease the excretion rate of Nalmefene which could result in a higher serum level.
Naloxone	Topotecan may decrease the excretion rate of Naloxone which could result in a higher serum level.
Naproxen	Naproxen may decrease the excretion rate of Topotecan which could result in a higher serum level.
Natalizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Natalizumab.
Nateglinide	Nateglinide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nedaplatin	The risk or severity of adverse effects can be increased when Nedaplatin is combined with Topotecan.
Nedocromil	Nedocromil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nefazodone	Topotecan may decrease the excretion rate of Nefazodone which could result in a higher serum level.
Nelarabine	The risk or severity of adverse effects can be increased when Topotecan is combined with Nelarabine.
Nelfinavir	Nelfinavir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Neomycin	Topotecan may decrease the excretion rate of Neomycin which could result in a higher serum level.
Neratinib	The serum concentration of Topotecan can be increased when it is combined with Neratinib.
Netilmicin	Topotecan may decrease the excretion rate of Netilmicin which could result in a higher serum level.
Netupitant	The serum concentration of Topotecan can be increased when it is combined with Netupitant.
Nicorandil	Topotecan may decrease the excretion rate of Nicorandil which could result in a higher serum level.
Nifedipine	Topotecan may decrease the excretion rate of Nifedipine which could result in a higher serum level.
Nilotinib	The serum concentration of Topotecan can be increased when it is combined with Nilotinib.
Nilutamide	Nilutamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nimesulide	The risk or severity of bleeding can be increased when Nimesulide is combined with Topotecan.
Nintedanib	The serum concentration of Topotecan can be increased when it is combined with Nintedanib.
Nisoldipine	Nisoldipine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nitrazepam	Nitrazepam may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Nitric Oxide	Nitric Oxide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nitrofurantoin	Nitrofurantoin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nitroprusside	Nitroprusside may decrease the excretion rate of Topotecan which could result in a higher serum level.
Norgestimate	The serum concentration of Topotecan can be increased when it is combined with Norgestimate.
Novobiocin	Novobiocin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Nuvaxovid	The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Topotecan.
Obinutuzumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Obinutuzumab.
Ocrelizumab	Ocrelizumab may increase the immunosuppressive activities of Topotecan.
Octinoxate	Topotecan may decrease the excretion rate of Octinoxate which could result in a higher serum level.
Ofatumumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Ofatumumab.
Olaparib	The risk or severity of adverse effects can be increased when Topotecan is combined with Olaparib.
Olsalazine	Olsalazine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Omadacycline	The serum concentration of Topotecan can be increased when it is combined with Omadacycline.
Ombitasvir	The serum concentration of Topotecan can be increased when it is combined with Ombitasvir.
Omeprazole	Omeprazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Opium	Topotecan may decrease the excretion rate of Opium which could result in a higher serum level.
Oseltamivir	Oseltamivir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Osimertinib	Osimertinib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Oteseconazole	The serum concentration of Topotecan can be increased when it is combined with Oteseconazole.
Oxacillin	Oxacillin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Oxaliplatin	The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Topotecan.
Oxaprozin	Oxaprozin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Oxazepam	Oxazepam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Oxcarbazepine	Oxcarbazepine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Oxetacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Oxetacaine.
Oxybenzone	Topotecan may decrease the excretion rate of Oxybenzone which could result in a higher serum level.
Oxybuprocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Oxybuprocaine.
Oxyphenbutazone	Oxyphenbutazone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Oxyquinoline	Topotecan may decrease the excretion rate of Oxyquinoline which could result in a higher serum level.
Ozanimod	The risk or severity of adverse effects can be increased when Topotecan is combined with Ozanimod.
Paclitaxel	The risk or severity of adverse effects can be increased when Topotecan is combined with Paclitaxel.
Pacritinib	The serum concentration of Topotecan can be increased when it is combined with Pacritinib.
Palbociclib	The serum concentration of Topotecan can be increased when it is combined with Palbociclib.
Palifermin	The therapeutic efficacy of Palifermin can be decreased when used in combination with Topotecan.
Paliperidone	The serum concentration of Topotecan can be increased when it is combined with Paliperidone.

Palonosetron	Palonosetron may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pamidronic acid	Pamidronic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Panobinostat	The risk or severity of adverse effects can be increased when Topotecan is combined with Panobinostat.
Pantoprazole	Pantoprazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Paraldehyde	Paraldehyde may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Paramethadione	Paramethadione may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Parecoxib	Parecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Paritaprevir	Paritaprevir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Parnaparin	The risk or severity of bleeding can be increased when Parnaparin is combined with Topotecan.
Paromomycin	Paromomycin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Patent Blue	Topotecan may decrease the excretion rate of Patent Blue which could result in a higher serum level.
Pazopanib	The risk or severity of adverse effects can be increased when Topotecan is combined with Pazopanib.
Pegaptanib	Topotecan may decrease the excretion rate of Pegaptanib which could result in a higher serum level.
Pegaspargase	The risk or severity of adverse effects can be increased when Pegaspargase is combined with Topotecan.
Pegcetacoplan	The risk or severity of adverse effects can be increased when Topotecan is combined with Pegcetacoplan.
Pegfilgrastim	The risk or severity of neutropenia can be increased when Pegfilgrastim is combined with Topotecan.
Peginesatide	The risk or severity of Thrombosis can be increased when Peginesatide is combined with Topotecan.
Peginterferon al	The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Topotecan.
Peginterferon alf	The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Topotecan.
Peginterferon beta	The risk or severity of adverse effects can be increased when Topotecan is combined with Peginterferon beta-1a.
Pemetrexed	The risk or severity of adverse effects can be increased when Pemetrexed is combined with Topotecan.
Penbutolol	Topotecan may decrease the excretion rate of Penbutolol which could result in a higher serum level.
Penicillamine	The risk or severity of adverse effects can be increased when Penicillamine is combined with Topotecan.
Pentaerythritol	Topotecan may decrease the excretion rate of Pentaerythritol tetranitrate which could result in a higher serum level.
Pentamidine	Pentamidine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pentastarch	Topotecan may decrease the excretion rate of Pentastarch which could result in a higher serum level.
Pentetic acid	Topotecan may decrease the excretion rate of Pentetic acid which could result in a higher serum level.
Pentobarbital	Pentobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Pentosan polysul	The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Topotecan.
Pentostatin	The risk or severity of adverse effects can be increased when Pentostatin is combined with Topotecan.
Pentoxifylline	The risk or severity of bleeding can be increased when Pentoxifylline is combined with Topotecan.
Perampanel	Perampanel may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Perindopril	Perindopril may decrease the excretion rate of Topotecan which could result in a higher serum level.
Permethrin	Topotecan may decrease the excretion rate of Permethrin which could result in a higher serum level.
Pertussis vaccine	The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Topotecan.
Pexidartinib	The excretion of Topotecan can be decreased when combined with Pexidartinib.
Phenacemide	Phenacemide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Phenazopyridine	Phenazopyridine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Phenelzine	Phenelzine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Phenindione	The risk or severity of bleeding can be increased when Phenindione is combined with Topotecan.
Phenobarbital	Phenobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Phenol	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Phenol.
Phenprocoumon	The risk or severity of bleeding can be increased when Phenprocoumon is combined with Topotecan.
Phensuximide	Phensuximide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Phentolamine	Phentolamine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Phenylalanine	The risk or severity of adverse effects can be increased when Phenylalanine is combined with Topotecan.
Phenylbutazone	Phenylbutazone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Phenytoin	Phenytoin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Pholcodine	Topotecan may decrease the excretion rate of Pholcodine which could result in a higher serum level.
Phosphoric acid	Topotecan may decrease the excretion rate of Phosphoric acid which could result in a higher serum level.
Phylloquinone	Phylloquinone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pibrentasvir	The serum concentration of Topotecan can be increased when it is combined with Pibrentasvir.
Picosulfuric acid	Topotecan may decrease the excretion rate of Picosulfuric acid which could result in a higher serum level.
Pimecrolimus	The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Topotecan.
Pindolol	Pindolol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Piperacillin	Piperacillin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Piracetam	Topotecan may decrease the excretion rate of Piracetam which could result in a higher serum level.
Piretanide	Piretanide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Pirfenidone	The risk or severity of adverse effects can be increased when Topotecan is combined with Pirfenidone.
Piroxicam	Piroxicam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pitolisant	Topotecan may decrease the excretion rate of Pitolisant which could result in a higher serum level.
Plazomicin	The excretion of Topotecan can be decreased when combined with Plazomicin.
Plerixafor	Topotecan may decrease the excretion rate of Plerixafor which could result in a higher serum level.
Polythiazide	Polythiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Pomalidomide	The risk or severity of adverse effects can be increased when Topotecan is combined with Pomalidomide.
Ponatinib	The serum concentration of Topotecan can be increased when it is combined with Ponatinib.
Ponesimod	The risk or severity of adverse effects can be increased when Topotecan is combined with Ponesimod.
Posaconazole	The serum concentration of Topotecan can be increased when it is combined with Posaconazole.
Potassium	Potassium may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Potassium acetate	Topotecan may decrease the excretion rate of Potassium acetate which could result in a higher serum level.
Potassium bica	Topotecan may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Potassium cation	Potassium cation may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Potassium chloride	Potassium chloride may decrease the excretion rate of Topotecan which could result in a higher serum level.
Potassium citrate	Potassium citrate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Potassium nitrate	Topotecan may decrease the excretion rate of Potassium nitrate which could result in a higher serum level.
Potassium per	Topotecan may decrease the excretion rate of Potassium perchlorate which could result in a higher serum level.
Potassium sulfate	Topotecan may decrease the excretion rate of Potassium sulfate which could result in a higher serum level.
Pralatrexate	The risk or severity of adverse effects can be increased when Topotecan is combined with Pralatrexate.
Pralidoxime	Pralidoxime may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pralsetinib	The serum concentration of Topotecan can be increased when it is combined with Pralsetinib.
Pramipexole	Pramipexole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pramocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Pramocaine.
Prasugrel	The risk or severity of bleeding can be increased when Prasugrel is combined with Topotecan.
Pravastatin	Pravastatin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Prednisolone	The risk or severity of adverse effects can be increased when Prednisolone is combined with Topotecan.
Prednisolone	The serum concentration of Topotecan can be decreased when it is combined with Prednisolone phosphate.
Prednisone	The risk or severity of adverse effects can be increased when Prednisone is combined with Topotecan.
Pregabalin	Pregabalin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Prilocaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Prilocaine.
Primidone	Primidone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Probenecid	Topotecan may decrease the excretion rate of Probenecid which could result in a higher serum level.
Procainamide	The excretion of Procainamide can be decreased when combined with Topotecan.
Procaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Procaine.
Procaine benzylp	Topotecan may decrease the excretion rate of Procaine benzylpenicillin which could result in a higher serum level.
Procarbazine	The risk or severity of adverse effects can be increased when Topotecan is combined with Procarbazine.
Progesterone	Progesterone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Promethazine	Topotecan may decrease the excretion rate of Promethazine which could result in a higher serum level.
Propafenone	The serum concentration of Topotecan can be increased when it is combined with Propafenone.
Propantheline	Propantheline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Proparacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Proparacaine.

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Propiverine	Topotecan may decrease the excretion rate of Propiverine which could result in a higher serum level.
Propoxycaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Propoxycaine.
Propranolol	Propranolol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Propylthiouracil	The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Topotecan.
Protein C	The risk or severity of bleeding can be increased when Protein C is combined with Topotecan.
Protein S	The risk or severity of bleeding can be increased when Protein S human is combined with Topotecan.
Prucalopride	The metabolism of Prucalopride can be decreased when combined with Topotecan.
Pyrantel	Topotecan may decrease the excretion rate of Pyrantel which could result in a higher serum level.
Pyrazinamide	Pyrazinamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pyridoxine	Pyridoxine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Pyrimethamine	The excretion of Topotecan can be decreased when combined with Pyrimethamine.
Pyrithione	Topotecan may decrease the excretion rate of Pyrithione which could result in a higher serum level.
Quetiapine	Topotecan may decrease the excretion rate of Quetiapine which could result in a higher serum level.
Quinethazone	Quinethazone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Quinidine	The serum concentration of Topotecan can be increased when it is combined with Quinidine.
Quinine	The serum concentration of Topotecan can be increased when it is combined with Quinine.
Rabeprazole	Rabeprazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Rabies immune	The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Topotecan.
Rabies antigen, A	The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Topotecan.
Rabies antigen, B	The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Topotecan.
Raltitrexed	The risk or severity of adverse effects can be increased when Raltitrexed is combined with Topotecan.
Ramelteon	Ramelteon may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ranitidine	Ranitidine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ranolazine	The serum concentration of Topotecan can be increased when it is combined with Ranolazine.
Rasagiline	Topotecan may decrease the excretion rate of Rasagiline which could result in a higher serum level.
Ravulizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Ravulizumab.
Regorafenib	The serum concentration of Topotecan can be increased when it is combined with Regorafenib.
Relebactam	The excretion of Topotecan can be decreased when combined with Relebactam.
Relugolix	The serum concentration of Topotecan can be increased when it is combined with Relugolix.
Remdesivir	The excretion of Topotecan can be decreased when combined with Remdesivir.
Reserpine	The serum concentration of Topotecan can be increased when it is combined with Reserpine.
Resorcinol	Topotecan may decrease the excretion rate of Resorcinol which could result in a higher serum level.
Retapamulin	The metabolism of Retapamulin can be decreased when combined with Topotecan.
Reteplase	The risk or severity of bleeding can be increased when Reteplase is combined with Topotecan.
Revefenacin	The serum concentration of Topotecan can be increased when it is combined with Revefenacin.
Reviparin	The risk or severity of bleeding can be increased when Reviparin is combined with Topotecan.
Ribavirin	Ribavirin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ribostamycin	Topotecan may decrease the excretion rate of Ribostamycin which could result in a higher serum level.
Rifampicin	The serum concentration of Topotecan can be decreased when it is combined with Rifampicin.
Rifamycin	The serum concentration of Topotecan can be increased when it is combined with Rifamycin.
Rilonacept	The risk or severity of adverse effects can be increased when Topotecan is combined with Rilonacept.
Rilpivirine	Rilpivirine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Riluzole	Riluzole may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Rimegepant	The serum concentration of Topotecan can be increased when it is combined with Rimegepant.
Riociguat	The serum concentration of Topotecan can be increased when it is combined with Riociguat.
Ripretinib	The serum concentration of Topotecan can be increased when it is combined with Ripretinib.
Risankizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Risankizumab.
Risdiplam	The serum concentration of Topotecan can be increased when it is combined with Risdiplam.
Ritonavir	The serum concentration of Topotecan can be increased when it is combined with Ritonavir.
Rituximab	The risk or severity of adverse effects can be increased when Rituximab is combined with Topotecan.
Rivaroxaban	The serum concentration of Topotecan can be increased when it is combined with Rivaroxaban.
Rizatriptan	Rizatriptan may decrease the excretion rate of Topotecan which could result in a higher serum level.
Rofecoxib	Rofecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Roflumilast	The serum concentration of Roflumilast can be increased when it is combined with Topotecan.
Rolapitant	The serum concentration of Topotecan can be increased when it is combined with Rolapitant.
Romidepsin	The serum concentration of Topotecan can be increased when it is combined with Romidepsin.
Ropeginterferon	The risk or severity of adverse effects can be increased when Topotecan is combined with Ropeginterferon alfa-2b.
Ropivacaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Ropivacaine.
Rosiglitazone	Rosiglitazone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Rotavirus vaccine	The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Topotecan.
Roxadustat	The serum concentration of Topotecan can be increased when it is combined with Roxadustat.
Rubella virus	The risk or severity of infection can be increased when Rubella virus vaccine is combined with Topotecan.
Rucaparib	Rucaparib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Rufinamide	Rufinamide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Ruxolitinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Ruxolitinib.
Sacubitril	Topotecan may decrease the excretion rate of Sacubitril which could result in a higher serum level.
Safinamide	Safinamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Salbutamol	Salbutamol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Salicylamide	Salicylamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Salicylic acid	Salicylic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Salmon calcitonin	Salmon calcitonin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Salsalate	Salsalate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Sapropterin	The serum concentration of Topotecan can be increased when it is combined with Sapropterin.
Saquinavir	The serum concentration of Topotecan can be increased when it is combined with Saquinavir.
Sarecycline	The serum concentration of Topotecan can be increased when it is combined with Sarecycline.
Sarilumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Sarilumab.
Satralizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Satralizumab.
Saxagliptin	Topotecan may decrease the excretion rate of Saxagliptin which could result in a higher serum level.
Secobarbital	Secobarbital may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Secukinumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Secukinumab.
Selenious acid	Topotecan may decrease the excretion rate of Selenious acid which could result in a higher serum level.
Selenium	Topotecan may decrease the excretion rate of Selenium which could result in a higher serum level.
Selexipag	The serum concentration of Topotecan can be increased when it is combined with Selexipag.
Selpercatinib	The excretion of Topotecan can be decreased when combined with Selpercatinib.
Selumetinib	The serum concentration of Topotecan can be increased when it is combined with Selumetinib.
Sibutramine	Topotecan may decrease the excretion rate of Sibutramine which could result in a higher serum level.
Sildenafil	The serum concentration of Topotecan can be increased when it is combined with Sildenafil.
Silodosin	The serum concentration of Topotecan can be increased when it is combined with Silodosin.
Siltuximab	The risk or severity of adverse effects can be increased when Topotecan is combined with Siltuximab.
Simeprevir	The serum concentration of Topotecan can be increased when it is combined with Simeprevir.
Simvastatin	The serum concentration of Topotecan can be increased when it is combined with Simvastatin.
Siponimod	The risk or severity of adverse effects can be increased when Topotecan is combined with Siponimod.
Sipuleucel-T	The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Topotecan.
Sirolimus	The risk or severity of adverse effects can be increased when Sirolimus is combined with Topotecan.
Sitagliptin	The serum concentration of Topotecan can be increased when it is combined with Sitagliptin.
Smallpox	The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Topotecan.
Sodium acetate	Topotecan may decrease the excretion rate of Sodium acetate which could result in a higher serum level.
Sodium aurothio	Topotecan may decrease the excretion rate of Sodium aurothiomalate which could result in a higher serum level.
Sodium citrate	The risk or severity of bleeding can be increased when Sodium citrate is combined with Topotecan.
Sodium fluoride	Topotecan may decrease the excretion rate of Sodium fluoride which could result in a higher serum level.

Sodium sulfate	Topotecan may decrease the excretion rate of Sodium sulfate which could result in a higher serum level.
Sofosbuvir	The serum concentration of Topotecan can be increased when it is combined with Sofosbuvir.
Solriamfetol	The excretion of Topotecan can be decreased when combined with Solriamfetol.
Sorafenib	The serum concentration of Topotecan can be increased when it is combined with Sorafenib.
Sorbitol	Topotecan may decrease the excretion rate of Sorbitol which could result in a higher serum level.
Sotagliflozin	The serum concentration of Topotecan can be increased when it is combined with Sotagliflozin.
Sotorasib	The serum concentration of Topotecan can be increased when it is combined with Sotorasib.
Spesolimab	The risk or severity of adverse effects can be increased when Topotecan is combined with Spesolimab.
Spironolactone	Spironolactone may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
St. John’s Wort	The serum concentration of Topotecan can be decreased when it is combined with St. John’s Wort.
Stiripentol	The excretion of Topotecan can be decreased when combined with Stiripentol.
Streptokinase	The risk or severity of bleeding can be increased when Streptokinase is combined with Topotecan.
Streptomycin	Topotecan may decrease the excretion rate of Streptomycin which could result in a higher serum level.
Streptozocin	The risk or severity of adverse effects can be increased when Streptozocin is combined with Topotecan.
Strontium chloride	Topotecan may decrease the excretion rate of Strontium chloride which could result in a higher serum level.
Sucralfate	Sucralfate may decrease the excretion rate of Topotecan which could result in a higher serum level.
Sulbactam	Topotecan may decrease the excretion rate of Sulbactam which could result in a higher serum level.
Sulfadiazine	Sulfadiazine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Sulfamethoxazole	The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Topotecan.
Sulfasalazine	The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Topotecan.
Sulfinpyrazone	The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Topotecan.
Sulindac	Sulindac may decrease the excretion rate of Topotecan which could result in a higher serum level.
Sulodexide	The risk or severity of bleeding can be increased when Sulodexide is combined with Topotecan.
Sulthiame	Sulthiame may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Sumatriptan	Sumatriptan may decrease the excretion rate of Topotecan which could result in a higher serum level.
Sunitinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Sunitinib.
Suvorexant	The serum concentration of Topotecan can be increased when it is combined with Suvorexant.
SynEstrogens, A	Topotecan may decrease the excretion rate of Synthetic Conjugated Estrogens, A which could result in a higher serum level.
SyntEstrogens, B	Topotecan may decrease the excretion rate of Synthetic Conjugated Estrogens, B which could result in a higher serum level.
Tacrolimus	The serum concentration of Tacrolimus can be increased when it is combined with Topotecan.
Tadalafil	Tadalafil may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tafamidis	The serum concentration of Topotecan can be increased when it is combined with Tafamidis.
Tafenoquine	The excretion of Topotecan can be decreased when combined with Tafenoquine.
Talazoparib	The serum concentration of Topotecan can be increased when it is combined with Talazoparib.
Tamoxifen	The serum concentration of Topotecan can be increased when it is combined with Tamoxifen.
Tamsulosin	Tamsulosin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tasimelteon	Topotecan may decrease the excretion rate of Tasimelteon which could result in a higher serum level.
Taurocholic acid	Taurocholic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tazemetostat	The excretion of Topotecan can be decreased when combined with Tazemetostat.
Technetium	Topotecan may decrease the excretion rate of Technetium Tc-99m exametazime which could result in a higher serum level.
Technetium T	Topotecan may decrease the excretion rate of Technetium Tc-99m mebrofenin which could result in a higher serum level.
Technetium Tc	Topotecan may decrease the excretion rate of Technetium Tc-99m oxidronate which could result in a higher serum level.
Technetium Tc	Topotecan may decrease the excretion rate of Technetium Tc-99m pyrophosphate which could result in a higher serum level.
Technetium	The serum concentration of Topotecan can be increased when it is combined with Technetium Tc-99m sestamibi.
Tedizolid	The risk or severity of myelosuppression can be increased when Topotecan is combined with Tedizolid phosphate.
Teduglutide	Topotecan may decrease the excretion rate of Teduglutide which could result in a higher serum level.
Tegafur	Topotecan may decrease the excretion rate of Tegafur which could result in a higher serum level.
Tegaserod	The serum concentration of Topotecan can be increased when it is combined with Tegaserod.
Telaprevir	The serum concentration of Topotecan can be increased when it is combined with Telaprevir.
Telavancin	Topotecan may decrease the excretion rate of Telavancin which could result in a higher serum level.
Telmisartan	Telmisartan may decrease the excretion rate of Topotecan which could result in a higher serum level.
Temazepam	Temazepam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Temozolomide	The risk or severity of adverse effects can be increased when Temozolomide is combined with Topotecan.
Temsirolimus	The serum concentration of Topotecan can be increased when it is combined with Temsirolimus.
Tenecteplase	The risk or severity of bleeding can be increased when Tenecteplase is combined with Topotecan.
Teniposide	The risk or severity of adverse effects can be increased when Teniposide is combined with Topotecan.
Tenofovir	The serum concentration of Tenofovir alafenamide can be increased when it is combined with Topotecan.
Tenofovir	The serum concentration of Topotecan can be increased when it is combined with Tenofovir disoproxil.
Tenoxicam	Tenoxicam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tepotinib	The serum concentration of Topotecan can be increased when it is combined with Tepotinib.
Teprotumumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Teprotumumab.
Terbutaline	Terbutaline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Teriflunomide	The risk or severity of adverse effects can be increased when Topotecan is combined with Teriflunomide.
Testolactone	Testolactone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Testosterone	Testosterone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Testosterone cyp	Topotecan may decrease the excretion rate of Testosterone cypionate which could result in a higher serum level.
Testosterone en	Topotecan may decrease the excretion rate of Testosterone enanthate which could result in a higher serum level.
Testosterone pro	Topotecan may decrease the excretion rate of Testosterone propionate which could result in a higher serum level.
Testosterone unde	Topotecan may decrease the excretion rate of Testosterone undecanoate which could result in a higher serum level.
Tetracaine	The risk or severity of methemoglobinemia can be increased when Topotecan is combined with Tetracaine.
Tetracycline	Tetracycline may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tetradecyl	Topotecan may decrease the excretion rate of Tetradecyl hydrogen sulfate (ester) which could result in a higher serum level.
Tezacaftor	The serum concentration of Topotecan can be increased when it is combined with Tezacaftor.
Thalidomide	The risk or severity of adverse effects can be increased when Topotecan is combined with Thalidomide.
Thiabendazole	Thiabendazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Thiamylal	Thiamylal may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Thiethylperazine	Thiethylperazine may decrease the excretion rate of Topotecan which could result in a higher serum level.
Thiopental	Thiopental may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Thiotepa	The risk or severity of adverse effects can be increased when Topotecan is combined with Thiotepa.
Tiagabine	Tiagabine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Tiaprofenic acid	Tiaprofenic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Ticagrelor	The serum concentration of Topotecan can be increased when it is combined with Ticagrelor.
Tick-borne	The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Topotecan.
Ticlopidine	The risk or severity of bleeding can be increased when Ticlopidine is combined with Topotecan.
Tiludronic acid	Topotecan may decrease the excretion rate of Tiludronic acid which could result in a higher serum level.
Timolol	Timolol may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tinidazole	Tinidazole may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tinzaparin	The risk or severity of bleeding can be increased when Tinzaparin is combined with Topotecan.
Tioguanine	The risk or severity of adverse effects can be increased when Tioguanine is combined with Topotecan.
Tiopronin	Topotecan may decrease the excretion rate of Tiopronin which could result in a higher serum level.
Tiotropium	Topotecan may decrease the excretion rate of Tiotropium which could result in a higher serum level.
Tipranavir	The serum concentration of Topotecan can be increased when it is combined with Tipranavir.
Tirofiban	The risk or severity of bleeding can be increased when Tirofiban is combined with Topotecan.
Tivozanib	Tivozanib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tixocortol	The risk or severity of adverse effects can be increased when Topotecan is combined with Tixocortol.
Tizanidine	Tizanidine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Tobramycin	Topotecan may decrease the excretion rate of Tobramycin which could result in a higher serum level.
Tocilizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Tocilizumab.
Tocopherol	Topotecan may decrease the excretion rate of Tocopherol which could result in a higher serum level.
Tofacitinib	The metabolism of Tofacitinib can be decreased when combined with Topotecan.

Tolazamide	Tolazamide may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tolbutamide	Topotecan may decrease the excretion rate of Tolbutamide which could result in a higher serum level.
Tolcapone	Tolcapone may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tolfenamic acid	Tolfenamic acid may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tolmetin	Tolmetin may decrease the excretion rate of Topotecan which could result in a higher serum level.
Tolterodine	Topotecan may decrease the excretion rate of Tolterodine which could result in a higher serum level.
Tolvaptan	Tolvaptan may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Topiramate	Topiramate may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Torasemide	Torasemide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Toremifene	The serum concentration of Topotecan can be increased when it is combined with Toremifene.
Tositumomab	The risk or severity of adverse effects can be increased when Tositumomab is combined with Topotecan.
Trabectedin	The risk or severity of adverse effects can be increased when Topotecan is combined with Trabectedin.
Tramadol	The metabolism of Tramadol can be decreased when combined with Topotecan.
Trametinib	Topotecan may decrease the excretion rate of Trametinib which could result in a higher serum level.
Trastuzumab	Trastuzumab may increase the neutropenic activities of Topotecan.
Trastuzumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Trastuzumab emtansine.
Trazodone	The serum concentration of Topotecan can be decreased when it is combined with Trazodone.
Tretinoin	The risk or severity of adverse effects can be increased when Tretinoin is combined with Topotecan.
Triamcinolone	The risk or severity of adverse effects can be increased when Triamcinolone is combined with Topotecan.
Triamterene	Triamterene may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Triazolam	Triazolam may decrease the excretion rate of Topotecan which could result in a higher serum level.
Trichlormethia	Trichlormethiazide may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Triethylenetetr	Topotecan may decrease the excretion rate of Triethylenetetramine which could result in a higher serum level.
Trifluridine	The risk or severity of adverse effects can be increased when Trifluridine is combined with Topotecan.
Triflusal	The risk or severity of bleeding can be increased when Triflusal is combined with Topotecan.
Trilaciclib	The excretion of Topotecan can be decreased when combined with Trilaciclib.
Trilostane	The risk or severity of adverse effects can be increased when Topotecan is combined with Trilostane.
Trimebutine	Topotecan may decrease the excretion rate of Trimebutine which could result in a higher serum level.
Trimethadione	Trimethadione may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Trimethoprim	The excretion of Topotecan can be decreased when combined with Trimethoprim.
Trimetrexate	Topotecan may decrease the excretion rate of Trimetrexate which could result in a higher serum level.
Tropisetron	Topotecan may decrease the excretion rate of Tropisetron which could result in a higher serum level.
Tucatinib	The serum concentration of Topotecan can be increased when it is combined with Tucatinib.
Typhoid vaccine	The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Topotecan.
Typhoid Vaccine	The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Topotecan.
Typhoid Vi	The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Topotecan.
Ubrogepant	The serum concentration of Topotecan can be increased when it is combined with Ubrogepant.
Umbralisib	The serum concentration of Topotecan can be increased when it is combined with Umbralisib.
Umeclidinium	The serum concentration of Topotecan can be increased when it is combined with Umeclidinium.
Upadacitinib	The risk or severity of adverse effects can be increased when Topotecan is combined with Upadacitinib.
Urokinase	The risk or severity of bleeding can be increased when Urokinase is combined with Topotecan.
Vaborbactam	Topotecan may decrease the excretion rate of Vaborbactam which could result in a higher serum level.
Valaciclovir	Valaciclovir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Valbenazine	Topotecan may decrease the excretion rate of Valbenazine which could result in a higher serum level.
Valdecoxib	Valdecoxib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Valganciclovir	Topotecan may decrease the excretion rate of Valganciclovir which could result in a higher serum level.
Valproic acid	Valproic acid may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Vancomycin	Topotecan may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Vandetanib	The serum concentration of Topotecan can be increased when it is combined with Vandetanib.
Vardenafil	The metabolism of Vardenafil can be decreased when combined with Topotecan.
Varenicline	Topotecan may decrease the excretion rate of Varenicline which could result in a higher serum level.
Varicella zoster	The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Topotecan.
Varicella	The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Topotecan.
Vedolizumab	The risk or severity of adverse effects can be increased when Topotecan is combined with Vedolizumab.
Velpatasvir	The serum concentration of Topotecan can be increased when it is combined with Velpatasvir.
Vemurafenib	The serum concentration of Topotecan can be increased when it is combined with Vemurafenib.
Venetoclax	The serum concentration of Topotecan can be increased when it is combined with Venetoclax.
Venlafaxine	Venlafaxine may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Verapamil	The serum concentration of Topotecan can be increased when it is combined with Verapamil.
Vibrio antigen	The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Topotecan.
Vigabatrin	Vigabatrin may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Vilanterol	The risk or severity of adverse effects can be increased when Topotecan is combined with Vilanterol.
Viloxazine	Topotecan may decrease the excretion rate of Viloxazine which could result in a higher serum level.
Vinblastine	The risk or severity of adverse effects can be increased when Vinblastine is combined with Topotecan.
Vincristine	The risk or severity of adverse effects can be increased when Vincristine is combined with Topotecan.
Vindesine	The risk or severity of adverse effects can be increased when Vindesine is combined with Topotecan.
Vinflunine	The serum concentration of Topotecan can be increased when it is combined with Vinflunine.
Vinorelbine	The risk or severity of adverse effects can be increased when Vinorelbine is combined with Topotecan.
Vismodegib	Vismodegib may decrease the excretion rate of Topotecan which could result in a higher serum level.
Voclosporin	The serum concentration of Topotecan can be increased when it is combined with Voclosporin.
Vorapaxar	The serum concentration of Topotecan can be increased when it is combined with Vorapaxar.
Vorinostat	The risk or severity of adverse effects can be increased when Topotecan is combined with Vorinostat.
Vortioxetine	Topotecan may decrease the excretion rate of Vortioxetine which could result in a higher serum level.
Voxelotor	The serum concentration of Voxelotor can be increased when it is combined with Topotecan.
Voxilaprevir	The serum concentration of Topotecan can be increased when it is combined with Voxilaprevir.
Warfarin	The serum concentration of Warfarin can be increased when it is combined with Topotecan.
Ximelagatran	The risk or severity of bleeding can be increased when Ximelagatran is combined with Topotecan.
Yellow fever vaccine	The risk or severity of infection can be increased when Yellow fever vaccine is combined with Topotecan.
Zaleplon	Zaleplon may increase the excretion rate of Topotecan which could result in a lower serum level and potentially a reduction in efficacy.
Zanamivir	Zanamivir may decrease the excretion rate of Topotecan which could result in a higher serum level.
Zidovudine	The risk or severity of adverse effects can be increased when Zidovudine is combined with Topotecan.
Zonisamide	The serum concentration of Topotecan can be increased when it is combined with Zonisamide.
Zopiclone	The metabolism of Zopiclone can be decreased when combined with Topotecan

Pregnancy and Lactation

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

Pregnancy

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

Lactation

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

How should this medicine be used?

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

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

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

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

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

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

What special precautions should I follow?

Before taking topotecan,

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

Topotecan – Uses, Dosage, Side Effects, Interactions

Mechanism of Action