Keeping Current  |  Nurse-to-Nurse Forum  |  Resources  |  Side Effect and Symptom Management  |  Breaking News  |  Events

[ Ask a Nurse Expert ] [ View Previous Questions/Comments ]
[ FAQs: Diarrhea | Community Care | HSR | Panitumumab | New Endpoints | Rash | Stage II Colon Cancer | Virtual Colonoscopy ]
[ FAQs: Stage of Disease/Treatment | Stool-Based DNA Test ]

FAQs - Fast Facts (Diarrhea)

Rule

Question: What is standard management of diarrhea in patients receiving irinotecan?

Answer: Irinotecan is associated with 2 types of diarrhea: an acute and a late form. The acute form occurs during or immediately following irinotecan infusion (ie, within 24 hours). Patients also may experience cholinergic symptoms (eg, diaphoresis, abdominal cramping). Delayed-onset diarrhea is more common and occurs 2 to 10 days posttreatment at varying levels of severity. Awareness of the potential for diarrhea severe enough to require hospitalization and interventions designed to recognize and intervene early are key to preventing life-threatening effects. Current standard management includes:

  1. Assess and document baseline bowel history. At each follow-up visit and/or telephone contact, carefully conduct and document posttreatment assessments that include changes in bowel movements over baseline, onset and duration, aggravating and alleviating factors (eg, relationship to food intake), stool character (any blood, pus or mucous), accompanying symptoms (eg, fever, abdominal pain, and cramping). Note triggers for further evaluation and intervention (eg, fever, blood or pus in stool, significant increase in diarrheal episodes, interference with activities of daily living.1,2
  2. Acute-onset diarrhea is managed with intravenous (IV) atropine 0.25 to 1.0 mg, unless clinically contraindicated.2 Delayed-onset diarrhea is managed with a high-dose loperamide (Imodium) regimen: 4 mg with the first episode of diarrhea, followed by 2 mg every 2 hours until the patient is diarrhea free for at least 12 hours. As an alternative, diphenoxylate/atropine (Lomotil) can be used at a dose of 2 tablets 4 times a day, although published data on its efficacy are limited. Octreotide (Sandostatin) 100 to 150 mcg subcutaneously 3 times per day (TID) with dosage escalation up to 500 mcg TID is recommended for patients with diarrhea that does not respond to loperamide and diphenoxylate/atropine. Patients with severe unresponsive diarrhea are usually hospitalized to receive more aggressive supportive care with IV hydration, octreotide (25-50 mcg/h), and antibiotics.1
  3. Patients should be instructed to increase their fluid intake to 3 L per day and to modify their diets to avoid foods and beverages that are irritating to the gastrointestinal tract (eg, spicy, greasy, or fried foods, milk products, gas-forming cruciferous vegetables, caffeine, and alcohol). They can follow the BRAT (bananas, rice, applesauce, toast) diet until diarrhea resolves and then gradually reintroduce foods, progressing to their normal diet over a period of days, beginning with bland foods such as plain pasta, potatoes, and bread. Liquids should include clear broth and other salt and sugar-containing products (eg, Gatorade).2 Click here for more about Diarrhea.

References

  1. Benson AB, Ajani JA, Catalano RB, Engelking C, et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol. 2004;22:2918-2926. [ Pub Med ]
  2. Engelking C. Diarrhea. In: Yarbro CH, Frogge MH, Goodman M, eds. Cancer Symptom Management. Boston: Jones & Bartlett; 2004:528-557.

Rule

Read More

Rule

[ Previous Page ] [ Home ]

This page was last modified on 7/31/2006, at 3:15:28 pm ET.