20 to 50     : Dose as in normal renal function and monitor closely
10 to 20     : Dose as in normal renal function and monitor closely
<10           : Reduce dose (50–80 mg/m2) and monitor closely. Increase as tolerated
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
HD                     :Unlikely to be dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unlikely to be dialysed. Dose as in GFR <10 mL/min
CAV/VVHD      :Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Antipsychotics: avoid concomitant use with clozapine (increased risk of agranulocytosis)
Antivirals: metabolism possibly inhibited by atazanavir (increased risk of toxicity)
ADMINISTRATION
Reconstition
–
Route
IV infusion
Rate of Administration
Over 30–90 minutes
Comments
Dilute in 250 mL sodium chloride 0.9% or glucose 5%
OTHER INFORMATION
Manufacturer advises avoiding use in renal impairment due to lack of dataMetabolism is primarily hepatic: where irinotecan is rapidly converted to active metabolite SN-38 by hepatic carboxylesterase enzymesExcretion is predominantly biliary: 64% excreted in faeces. The mean 24 hr urinary excretion of irinotecan and SN-38 (its active metabolite) was 19.9% and 0.25% respectivelyInfrequent reports of renal insufficiency due to inadequate hydrationTransient, mild to moderate increase in serum creatinine reported in 7.3% patients