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Folinic acid, fluorouracil and irinotecan (FOLFIRI)

Find out what FOLFIRI is, how you have it and other important information about having FOLFIRI. 

FOLFIRI is a combination of chemotherapy drugs and is also known as irinotecan de Gramont or Irinotecan modified de Gramont. It is a treatment for bowel cancer.

It’s made up of:

  • folinic acid (also called leucovorin, calcium folinate or FA)
  • fluorouracil (also called 5FU)
  • irinotecan

How it works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have it

You have folinic acid, 5FU and irinotecan into your bloodstream (intravenously). 

You have the drugs through a long line - a central line, a PICC line or a portacath. These are long, plastic tubes that give the drugs into a large vein in your chest. The tube stays in place throughout the course of your treatment.

You have the 5FU through a small pump which slowly puts the fluid into your bloodstream (infusion). You can keep the pump in a small bag or attached to a belt. When the 5FU infusion finishes, the nurse blocks the end of the central line with a plastic cap until the start of your next treatment. A district nurse or chemotherapy nurse may be able to do this at home. 

When you have it

You have FOLFIRI chemotherapy as cycles of treatment. Each cycle of treatment lasts 2 weeks (14 days). Depending on your needs, you may have up to 12 cycles, taking up to 6 months in total.

Day 1
  • You have irinotecan through a drip into the bloodstream over 60 to 90 minutes
  • You have folinic acid through a drip into the bloodstream over 2 hours
  • You have an injection of fluorouracil into the bloodstream over 5 minutes
  • You have an infusion of 5FU through a drip or pump into the bloodstream for 46 hours
Day 2
  • You continue to have the 5FU infusion
Day 3 to 14
  • You have no treatment

Then you start the cycle again.

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, food drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might 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.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. 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. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

DPD deficiency

Around 5 out of 100 people (5%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from fluorouracil. It doesn’t cause symptoms so you won’t know if you have a deficiency. Contact your doctor if your side effects are severe.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
29 Jan 2018
  • Electronic Medicines Compendium 
    Accessed January 2018

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination

    Public Health England

    First published: March 2013 and regularly updated on the Gov.UK website

  • Irinotecan/modified de Gramont Chemotherapy (IrMdG): A Guide for Patients

    Western General Hospital Edinburgh Cancer Centre, 2009

  • Irinotecan & modified de Gramont

    South East London NHS Cancer Network, 2009

  • FOLFIRI Followed by FOLFOX6 or the Reverse Sequence in Advanced Colorectal Cancer: A Randomized GERCOR Study

    C Tournigand and others​

    Journal of Clinical Oncology, 2004. Vol 22, number 2, pages 229-237

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