Topotecan (Hycamtin, Potactasol)
This page tells you about a chemotherapy drug called topotecan and its possible side effects. There is information about
Topotecan was originally developed from the wood of a Chinese tree. It is also known by its brand names, Hycamtin and Potactasol. It is a treatment for
- Ovarian cancer that has spread to other parts of the body
- Small cell lung cancer that has come back or spread
- Cervical cancer that has come back after radiotherapy or has spread
Topotecan is a type of chemotherapy drug called a topoisomerase 1 inhibitor. It works by blocking a chemical called topoisomerase 1. This chemical helps to separate and repair the DNA in cells when they divide. Cancer cells need to make and repair DNA in order to grow and multiply. Blocking the action of this enzyme damages the DNA and so the cells die.
Topotecan is available as Hycamtin capsules or as a liquid given into a vein.
You swallow the capsules. They are a treatment for small cell lung cancer. You take them for 5 days every 3 weeks.You should swallow the capsules whole and don't crush, chew or cut them. You can take them with or without food. It is very important that you take capsules according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. If you forget to take a dose don't take a double dose to make up for it. Just take the usual dose at the next scheduled time.
Topotecan into a vein
Topotecan is also available as a clear liquid that you have into your bloodstream. You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
You usually have the treatment every 3 weeks.
For ovarian cancer and small cell lung cancer you have treatment once a day for 5 days.
For cervical cancer you have treatment once a day for 3 days. You usually have it with another chemotherapy drug called cisplatin.
The treatment takes about half an hour each time. Your doctor will discuss with you when to stop the treatment.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with topotecan below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having topotecan with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment ends
- Feeling or being sick can be quite severe and happens in up to up to 7 out of 10 people (70%). It can usually be kept under control with anti sickness medicines. Tell your doctor or nurse if you are still being sick as you can try other anti sickness drugs
- Hair loss or thinning happens in about 6 out of 10 people (60%). 4 out of 10 people (40%) have complete hair loss. It usually begins about 3 to 4 weeks after your treatment starts but is temporary and your hair will grow back
- Diarrhoea happens to about 4 out of every 10 people (40%) and can be severe. Drink plenty of fluids and tell your doctor or nurse if it lasts more than a couple of days or if you have more than 3 episodes of diarrhoea in 1 day
- Constipation occurs in 2 to 4 out of every 10 people (20 to 40%) treated – if you are constipated for more than 3 days, tell your doctor or nurse
- About 3 out of 10 people (30%) treated have a fever (high temperature) – you may have other flu like symptoms, such as a headache, weakness, joint pain and muscle aches
- A sore mouth or mouth ulcers happens in up to 3 in every 10 people (30%) – tell your doctor or nurse as they can give you medicines to help prevent infection and relieve pain and soreness
- Loss of appetite and weight loss occurs in about 2 out of every 10 people (20%)
Between 1 and 10 in every 100 people have one or more of these effects.
- An allergic reaction during the treatment – let your nurse know if you feel hot or have any skin rashes, itching, dizziness, or headaches. Also tell them if you have shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
- Muscle pain
- Severe tummy (abdominal) pain, a high temperature and diarrhoea due to bowel inflammation – let your doctor or nurse know straight away if you have this
Fewer than 1 in 100 people have these effects.
- Lung inflammation causing difficulty breathing, a cough and a high temperature – tell your doctor or nurse if you have this effect.
- A skin rash
- Yellow skin
- Women may stop having periods (amenorrhoea) but this may only be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
Drinking alcohol during topotecan treatment may make you feel very unwell. Check with your doctor before drinking alcohol.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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