Prevention of irinotecan-induced diarrhoea by oral carbonaceous adsorbent (Kremezin) in cancer patients.
Irinotecan (CPT-11) treatments induce severe diarrhoea at a rate of >40%. In clinical trials, we evaluated the preventing effects of oral alkalization, which has been reported previously, and oral carbonaceous adsorbent (Kremezin trade mark ) on diarrhoea possibly induced by CPT-11. Evaluation was made by counting the maximum number of bowel motions in each patient. Five patients out of 7 treated with CPT-11 had bowel motions of >5 times daily, and maximum number of bowel motions reached 20 times in 1 patient. Oral alkalization (2 g sodium bicarbonate, 2 g magnesium oxide and 300 mg ursodeoxycholic acid daily for 4 days) decreased bowel motions from 20 to 8 thereafter in the patient. Maximum number of bowel motions in other 3 patients treated in a combination of CPT-11 and oral alkalization was <3. Oral adsorbent (2 g Kremezin x 3 times, during and after CPT-11 treatment) also decreased maximum number of bowel motions from 7 (without oral adsorbent) to 3 in 1 patient. Also, the maximum number of bowel motions in other 3 patients treated with oral adsorbent was <3 (p<0.05, vs CPT-11 alone). Effect of oral Kremezin on plasma concentrations of CPT-11 and its related compounds after a 1-h CPT-11 infusion, evaluated in a patient, was small. These results suggested that the oral Kremezin is effective in ameliorating CPT-11-induced diarrhoea without decreasing much the plasma clearance of CPT-11.
Department of Pharmacy, Chugoku-Rousai General Hospital, 1-5-1 Hiro-Tagaya, Kure City, Hiroshima 737-0193, Japan. mae@db3.so-net.ne.jp
Yorinobu
Y
Maeda
Terumasa
T
Ohune
Mamoru
M
Nakamura
Miho
M
Yamasaki
Yoshie
Y
Kiribayashi
Teruo
T
Murakami
D000327:Adsorption; D000328:Adult; D000368:Aged; D000930:Antidiarrheals / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects* / Q000493:pharmacokinetics; D002166:Camptothecin / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D002244:Carbon / Q000494:pharmacology*; D003672:Defecation / Q000187:drug effects; D003967:Diarrhea / Q000139:chemically induced* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010087:Oxides / Q000494:pharmacology*; D013997:Time Factors; D016896:Treatment Outcome
D000930:Antidiarrheals; D000972:Antineoplastic Agents, Phytogenic; D010087:Oxides; D002244:Carbon; D000077146:Irinotecan; C040896:AST 120; D002166:Camptothecin