Irinotecan Hydrochloride and Metoclopramide Hydrochloride

• Generic Name: irinotecan
• Dosage Forms: n.a.
• Other Brand Names: Camptosar

Conventional irinotecan: Used as a component of first-line therapy in combination with fluorouracil and leucovorin for the treatment of metastatic carcinoma of the colon or rectum.

Conventional irinotecan: Used as a single agent for treatment of metastatic carcinoma of the colon or rectum in patients whose disease has recurred or progressed following initial therapy with fluorouracil-based antineoplastic regimens.

Liposomal irinotecan: Used in combination with fluorouracil and leucovorin for the treatment of metastatic adenocarcinoma of the pancreas in patients whose disease has progressed following gemcitabine-based chemotherapy (designated an orphan drug by FDA for treatment of this cancer ).

Conventional irinotecan: Used in combination with cisplatin for the initial treatment of extensive small cell lung cancer.

Conventional irinotecan: Under investigation for the treatment of metastatic or recurrent cervical cancer.

• Generic Name: metoclopramide
• Dosage Forms: n.a.
• Other Brand Names: Metozolv ODT, Reglan

Symptomatic treatment of acute and recurrent diabetic gastric stasis (gastroparesis). Successful therapy often requires long-term, intermittent use, since diabetic gastric stasis is a chronic, recurrent disease.

Has been used for the symptomatic treatment of acute and chronic postsurgical gastric stasis following vagotomy and gastric resection or vagotomy and pyloroplasty.

Prevention of postoperative nausea and vomiting when nasogastric suction is considered undesirable.

Used parenterally in high doses for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy including cisplatin alone or in combination with other antineoplastic agents.

Prevention of nausea and vomiting associated with other antineoplastic agents (e.g., cyclophosphamide, dacarbazine, doxorubicin, methotrexate) and with cancer chemotherapy regimens that do not include cisplatin.

ASCO does not consider metoclopramide an appropriate first-line antiemetic for any group of patients receiving chemotherapy of high emetic risk and states that this drug should be reserved for patients unable to tolerate or refractory to first-line agents (i.e., a type 3 serotonin [5-HT3] receptor antagonist [e.g., dolasetron, granisetron, ondansetron, palonosetron] with dexamethasone and aprepitant).

ASCO states that the combination of a 5-HT3 receptor antagonist, dexamethasone, and aprepitant is preferred in patients receiving combination chemotherapy with an anthracycline and cyclophosphamide; ASCO recommends combined therapy with a 5-HT3 receptor antagonist and dexamethasone for other chemotherapy regimens of moderate emetic risk (i.e., 31–90% incidence of emesis without antiemetics) and dexamethasone alone for chemotherapy regimens of low emetic risk (i.e., 11–30% incidence).

In patients experiencing nausea and vomiting despite recommended prophylaxis regimens, ASCO recommends that clinicians consider adding a benzodiazepine (e.g., alprazolam, lorazepam), butyrophenone, or phenothiazine to the regimen or substituting high-dose IV metoclopramide for the 5-HT3 receptor antagonist in the regimen.

Antiemetics can be prescribed on an as-needed basis for chemotherapy regimens with minimal emetic risk (<10% incidence of emesis without antiemetics).

Metoclopramide has been used orally for the prevention of chemotherapy-induced nausea and vomiting. Some experts state that patients receiving oral chemotherapy requiring only as-needed (“prn”) antiemetic therapy or receiving an IV chemotherapy regimen with low emetic risk may receive oral metoclopramide.

Oral metoclopramide has been effective when given in combination with dexamethasone for the prevention of delayed emesis in patients receiving chemotherapy. For prevention of delayed emesis in patients receiving cisplatin or other chemotherapy of high emetic risk, ASCO recommends the combination of dexamethasone and aprepitant.

Used parenterally to facilitate small intestine intubation when the tube (e.g., endoscope, biopsy tube) does not pass through the pylorus during 10 minutes of conventional maneuvers.

Used parenterally to stimulate gastric emptying and intestinal transit of barium when delayed emptying interferes with radiographic examination of the stomach and/or small intestine.

Short-term (≤12 weeks) relief of symptomatic, documented gastroesophageal reflux in adults who are unresponsive to conventional therapy (e.g., changes in lifestyle, habits, diet, weight reduction) alone.

Regular use for this purpose has declined; proton-pump inhibitors provide greater control of acid reflux. Some experts recommend against use of metoclopramide for this purpose based on the drug’s adverse effect profile and lack of high-quality supporting data.