Irinotecán Glenmark (Irinotecan Hydrochloride Trihydrate)

• Irinotecán Glenmark is a topoisomerase I inhibitor used in colorectal cancer therapy.
• Metastatic colorectal cancer: improves overall survival when combined with fluoropyrimidine‑based chemotherapy.
• Colorectal cancer (advanced): provides disease control in patients who have progressed on prior regimens.

• Irinotecan is a pro‑drug that is converted intracellularly to SN‑38, a potent inhibitor of topoisomerase I. By stabilising the enzyme‑DNA cleavable complex, it prevents relegation of single‑strand DNA breaks, leading to accumulation of DNA damage and ultimately cell death in rapidly dividing tumor cells.

Irinotecán Glenmark may cause a range of adverse reactions.

Common Side Effects

• Nausea and vomiting: frequent gastrointestinal upset.
• Diarrhea: can be severe and may require antidiarrheal therapy.
• Neutropenia: reduced white blood cell count increasing infection risk.
• Fatigue: persistent tiredness affecting daily activities.
• Alopecia: hair loss in some patients.
• Abdominal pain: discomfort in the stomach area.

Serious or Rare Side Effects

• Febrile neutropenia: fever with low neutrophil count requiring urgent care.
• Severe colitis: intense inflammation of the colon that may be life‑threatening.
• Hepatotoxicity: liver enzyme elevations indicating possible liver injury.
• Pulmonary toxicity: rare lung inflammation or fibrosis.
• Anaphylactic reactions: immediate hypersensitivity requiring emergency treatment.
• Hemorrhagic cystitis: bladder inflammation with bleeding, though uncommon.

Before initiating therapy, clinicians should assess patient‑specific risk factors and monitor closely.

• Monitor blood counts: perform regular complete blood count tests to detect neutropenia.
• Assess liver function: evaluate hepatic enzymes and bilirubin prior to each cycle.
• Evaluate bowel status: avoid use in patients with recent bowel obstruction or perforation.
• Use prophylactic antiemetics: administer anti‑nausea medication to reduce vomiting.
• Adjust dose in hepatic impairment: consider reduced dosing for patients with significant liver dysfunction.
• Store at controlled room temperature: keep in original packaging, protect from moisture and light.

Irinotecán Glenmark can interact with several medicines; awareness helps prevent adverse outcomes.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): increase SN‑38 exposure.
• UGT1A1 inhibitors (e.g., atazanavir, indinavir): raise risk of severe neutropenia and diarrhea.
• Concurrent myelosuppressive agents: amplify bone‑marrow toxicity.
• High‑dose radiation therapy to the abdomen: may exacerbate gastrointestinal toxicity.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin): may modestly raise drug levels.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): could reduce efficacy.
• Anticoagulants (e.g., warfarin): monitor coagulation parameters due to potential bleeding risk.
• Antidiarrheal agents (e.g., loperamide): use cautiously as they may mask severe diarrhea.