Irino (Irinotecan Hydrochloride Trihydrate)

• Irino is a topoisomerase I inhibitor used in colorectal cancer therapy.
• Metastatic colorectal cancer: improves overall survival when used in combination chemotherapy regimens.
• Advanced colorectal cancer: provides disease control in patients who have progressed on prior therapies.
• Colorectal cancer (FOLFIRI regimen): serves as the irinotecan component of standard combination protocols.

• Irinotecan Hydrochloride Trihydrate is converted intracellularly to SN‑38, a potent inhibitor of topoisomerase I. By stabilizing the topoisomerase‑DNA cleavable complex, it prevents relegation of single‑strand DNA breaks, leading to accumulation of DNA damage, replication arrest, and ultimately tumor cell apoptosis.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Diarrhea: often severe and may require antidiarrheal therapy.
• Neutropenia: reduced white blood cell count increasing infection risk.
• Nausea and vomiting: may be managed with antiemetics.
• Alopecia: temporary hair loss during treatment.
• Fatigue: generalized tiredness affecting daily activities.
• Anemia: decreased red blood cell count causing weakness.

Serious or Rare Side Effects

• Febrile neutropenia: fever with low neutrophil count requiring urgent care.
• Severe colitis: inflammation of the colon that can be life‑threatening.
• Hepatotoxicity: liver enzyme elevations indicating potential liver injury.
• Hypersensitivity reactions: rash, bronchospasm, or anaphylaxis.
• Cardiac toxicity: rare arrhythmias or myocardial ischemia.

• Patients should be monitored closely for known toxicities and appropriate supportive care.
• Baseline blood counts: obtain complete blood count before each cycle.
• Renal and hepatic function: assess liver enzymes and creatinine to adjust dosing if needed.
• Concurrent infections: treat active infections before initiating therapy.
• Pregnancy and lactation: avoid use unless benefits outweigh potential fetal risks.
• Drug‑specific monitoring: watch for signs of severe diarrhea and neutropenia.
• Store at ambient temperature: keep in original container, protect from light and moisture.

Irinotecan may interact with several concomitant medications.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce irinotecan exposure.
• Potent UGT1A1 inhibitors (e.g., atazanavir): can increase SN‑38 levels and toxicity.

Moderate Interactions (Monitor Closely)

• Anticoagulants (warfarin, heparin): heightened bleeding risk due to thrombocytopenia.
• Other myelosuppressive agents: additive bone‑marrow suppression.
• Antiemetics containing metoclopramide: may alter gastric motility affecting drug absorption.