Campto

How does it work?

Campto infusion contains the active ingredient irinotecan hydrochloride trihydrate, which is a chemotherapy medicine used to treat cancer.

Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells spread, destroying nearby tissues. Irinotecan works by stopping the cancer cells from multiplying.

Like normal healthy cells, cancer cells go through a continuous process of change. Each cell divides into two daughter cells. These cells grow, rest and then divide again. Chemotherapy medicines are powerful chemicals designed to interrupt this cycle and stop cells from growing and multiplying.

Before a cell divides to make two identical cells, it has to make a copy of its genetic material (DNA). An enzyme called topoisomerase I helps this process. Irinotecan is a type of chemotherapy medicine known as a topoisomerase I inhibitor. It works by blocking the action of topoisomerase I. This prevents the cells from making copies of their DNA and so stops them divinding and increasing in numbers. This in turn stops the growth of abnormal tissue.

Unfortunately, irinotecan can also affect normal, healthy cells, particularly those that multiply quickly, such as blood cells. The most important side effect is on the bone marrow where blood cells are made. Irinotecan can decrease the production of blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor the levels of blood cells.

In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the chemotherapy between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer has regrown to its previous size. The aim is to decrease the amount of cancer with each successive course.

Irinotecan is given by a drip into a vein (intravenous infusion) to treat cancer of the large intestine and rectum (colorectal cancer). As well as this use, irinotecan is also being investigated in other types of cancer.

What is it used for?

Advanced cancer of the large bowel and rectum

Irinotecan is used in combination with 5-fluorouracil (5-FU) and folinic acid for people who have not already had chemotherapy for their disease. It is also used on its own for people whose cancer has not responded fully to treatment with a 5-fluorouracil regimen.

Cancer of the large bowel and rectum that has spread to other parts of the body and expresses epidermal growth factor receptor (EGFR) on its cells

In this case irinotecan is used in combination with cetuximab for people whose cancer has not responded fully to treatment with other chemotherapy regimens containing irinotecan.

Warning!

You may feel dizzy or get disturbances in your vision within 24 hours of having your irinotecan drip. If affected, you should not drive or operate machinary until the symptoms pass.

Irinotecan can cause two types of diarrhoea. One type may start within 24 hours of treatment and is part of a syndrome called Acute Cholingeric Syndrome. As well as diarrhoea there may be other symptoms such as sweating, abdominal cramps, watering eyes, visual disturbances, excessive mouth watering and dizziness. If you get these symptoms after you have gone home from hospital, you must contact your doctor immediately so that they can be suitably treated, usually with an injection of atropine. Do not use any antidiarrhoeal treatment that you have been given for delayed diarrhoea - see below.

The other type of diarrhoea is called delayed diarrhoea. This can happen 24 hours or more after the dose of irinotecan has been given. If this occurs you should IMMEDIATELY take the antidiarrhoeal treatment (usually loperamide) that has been given to you for this purpose. Follow the instructions given to you by the hospital for taking it exactly. These may be different from the instructions in the information leaflet provided by the manufacturer. It is also important to start drinking large amounts of fluids to prevent dehydration IMMEDIATELY. You should let your doctor or the hospital department that is administering your treatment know that you are having diarrhoea. You should contact your doctor again if you have very severe diarrhoea, if you have nausea and vomiting or fever with the diarrhoea, or if you still have diarrhoea 48 hours after starting your antidiarrhoeal treatment.

Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.

You should have regular blood tests to monitor your liver function while taking this medicine.

As this medicine may be harmful to an unborn baby, women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least three months after treatment is finished.

Your ability to become pregnant or father a child may be affected by treatment with this medicine. It is important to discuss fertility with your doctor before starting treatment.

Use with caution in

Elderly people

Raised levels of a bile pigment produced by the liver called bilirubin (hyperbilirubinaemia).

Campto infusion contains sorbitol and may be unsuitable for people with hereditary fructose intolerance.

Not to be used in

Children

Blockage of the bowel (bowel obstruction)

Chronic inflammatory bowel disease such as ulcerative colitis or Crohn's disease

Raised levels (over three times more than normal) of the bile pigment bilirubin that is produced by the liver

Severe reduction in blood cell production in the bone marrow

Pregnancy

Breastfeeding.

The manufacturer has not studied the effect of this medicine in people with kidney problems, hence it is not recommended for people with decreased kidney function.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine should not be used during pregnancy, as it may be harmful to the developing baby. Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least three months after treatment is finished. Seek medical advice from your doctor. Consult your doctor immediately if you get pregnant during treatment with this medicine.

It is not known if this medicine passes into breast milk. However, because of the possible adverse effects it could have on a nursing infant, mothers who are having treatment with this medicine should not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Diarrhoea (see warnings above)

Nausea and vomiting

Dehydration

Abdominal pain

Constipation

Loss of appetite

Inflammation of the lining of the mouth (stomatitis)

Reversible hair loss

Decrease in the number of a type of white blood cell (neutrophil) in the blood (neutropenia)

Decrease in the number of red blood cells in the blood (anaemia)

Decrease in the number of platelets in the blood (thrombocytopenia)

Increased susceptibility to infections

Fever

Weakness or loss of strength (asthenia)

Fatigue

Acute cholinergic syndrome (see warning above)

Muscle cramps

Skin reactions such as rash and itch

Reactions at the infusion site

Alteration in results of liver function tests

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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