Drug Name

Classification
Dosage/ Route/ Frequency

Mechanism of Action

Oxaliplatin
Antineoplastic
100mg/50ml per vial diluted in
10ccsterile water in 250 cc D5W IV
Infusion to run for 2 hours every 28
days
Oxaliplatin undergoes
nonenzymatic conversion in
physiologic solutions to active
derivatives via displacement of the
labile oxalate ligand. Several
transient reactive species are
formed, including monoaquo and
diaquo DACH platinum, which
covalently bind with
macromolecules. Both inter- and
intrastrand Pt-DNA crosslinks are
formed. Crosslinks are formed
between the N7 positions of two
adjacent guanines (GG), adjacent
adenine-guanines (AG), and
guanines separated by an
intervening nucleotide (GNG).
These crosslinks inhibit DNA
replication and transcription.
Cytotoxicity is cell-cycle
nonspecific. In vivo studies have
shown antitumor activity of
Oxaliplatin against colon
carcinoma. In combination with 5fluorouracil, Oxaliplatin exhibits in
vitro and in vivo antiproliferative
activity greater than either
compound alone in several tumor
models [HT29 (colon), GR
(mammary), and L1210
(leukemia)].

Uses/ Indication

adjuvant treatment of stage III

colon cancer in patients who have
undergone complete resection of the
primary tumor.

treatment of advanced colorectal

cancer.

Contraindication

Allergy to oxaliplatin, carboplatin

(Paraplatin), cisplatin (Platinol
- History of kidney disease

- Pregnancy and Lactating

mothers
Side Effects
Adverse Effects

Constipation, headache, cough,

nausea and vomiting, diarrhea,
mouth sores, low blood counts
Feeling of dysphagia, shortness of
breath, jaw spasms, abnormal
tongue sensation and feeling of
chest pressure, pain or tingling of
arms, Unable to eat or drink for 24
hours or have signs of dehydration:
tiredness, thirst, dry mouth, dark
and decreased amount of urine, or
dizziness.

Drug Interaction

No specific cytochrome P-450based drug interaction studies have

been conducted.
Because platinum-containing
species are eliminated primarily
through the kidney, clearance of
these products may be decreased by
coadministration of potentially
nephrotoxic compounds; although,
this has not been specifically
studied

Special Concerns

While receiving treatment with

Oxaliplatin: avoid cold
temperatures and cold objects
Avoid sun exposure. Wear
SPF 15 (or higher) sun
block and protective
clothing.
In general, drinking
alcoholic beverages should
be avoided. You should
discuss this with your
doctor.
Get plenty of rest.
Maintain good nutrition.
If you experience symptoms
or side effects, be sure to
discuss them with your
health care team. They can
prescribe medications
and/or offer other
suggestions that are
effective in managing such

problems.

Drug Name
Classification
Dosage/ Route/ Frequency
Mechanism of Action

Capecitabine
Antineoplastic
500mg/tab, 2 tabs BID x 14 days
Capecitabine belongs to the
category of chemotherapy called
antimetabolites. Antimetabolites are
very similar to normal substances
within the cell. When the cells
incorporate these substances into
the cellular metabolism, they are
unable to divide. Antimetabolites
are cell-cycle specific. They attack
cells at very specific phases in the
cycle. Antimetabolites are classified
according to the substances with
which they interfere.

Uses/ Indication

Colon or rectal cancer

Metastatic breast cancer
Esophageal, gastric, hepatobiliady,
neuroendocrine, pancreatic,
ovarian, Fallopian tube, peritoneal
or unknown primary cancers
-allergy to capecitabine or to 5fluoruracil
-pregnancy and lactating mothers
Low WBC count, low RBc count,
hand-foot syndrome (Palmarplantar erythrodysesthesia or PPE) skin rash, swelling, redness, pain
and/or peeling of the skin on the
palms of hands and soles of feet.
Usually mild, has started as early as
2 weeks after start of treatment.
May require reductions in the dose
of the medication), diarrhea,
elevated liver enzymes, fatigue,
nausea and vomiting, rash and
itching, abdominal pain

Contraindication
Side Effects

Adverse Effects

Fever, unusual bleeding or

bruising, black or tarry
stools, constipation, mouth
sores, Swelling, redness
and/or pain in one leg or
arm and not the other

Yellowing of the skin or

eyes
Tingling or burning,
redness, swelling of the
palms of the hands or soles
of the feet.
Confusion, loss of balance,
excessive sleepiness

Drug Interaction

Patients receiving concomitant

capecitabine and oral coumarinderivative anticoagulant therapy
should have their anticoagulant
response (INR or prothrombin time)
monitored frequently in order to
adjust the anticoagulant dose
accordingly.

Special Concerns

Do not have
immunizations/vaccinations without
the consent of your doctor, and
avoid contact with people who have
recently received oral polio vaccine.
This medication may make you
more sensitive to the sun. Avoid
prolonged sun exposure, tanning
booths, and sunlamps. Use an
effective sunscreen and wear
protective clothing when outdoors.
This will also help protect you from
problems related to heat (hand/foot
syndrome). See Side Effects section
for more information.
To lower the chance of getting cut,
bruised or injured, use caution with
sharp objects like safety razors and
nail cutters, and avoid activities
such as contact sports. Use a softbristle toothbrush to lower the risk
of bleeding gums.
Caution is advised when this drug is
used in the elderly because they
may be more sensitive to the side
effects of this medication,
especially nausea, vomiting, and
diarrhea.

Drug Name

Irinotecan

Classification
Dosage/ Route/ Frequency

Antineoplastic

Mechanism of Action

Irinotecan belongs to a class of

chemotherapy drugs called plant
alkaloids. Plant alkaloids are made
from plants. The vinca alkaloids
are made from the periwinkle plant
(catharanthus rosea). The taxanes
are made from the bark of the
Pacific Yew tree (taxus). The vinca
alkaloids and taxanes are also
known as antimicrotubule agents.
The podophyllotoxins are derived
from the May apple plant.
Camptothecan analogs are derived
from the Asian "Happy Tree"
(Camptotheca acuminata).
Podophyllotoxins and
camptothecan analogs are also
known as topoisomerase inhibitors.
The plant alkaloids are cell-cycle
specific. This means they attack the
cells during various phases of
division.
- interfere with the action of
topoisomerase enzymes
(topoisomerase I and II).
Topoisomerase enzymes control the
manipulation of the structure of
DNA necessary for replication.

Uses/ Indication

Metastatic colon or rectal cancer

Contraindication

-allergy to any ingredient in

irinotecan
- pregnancy and lactating mothers
Diarrhea,runny nose, watery eyes,
sweating, flushing, abdominal
cramping, nausea and vomiting,
weakness, low WBC count, low
RBI count, hair loss, poor appetite,
fever, weight loss
Chills, fainting, dizziness,
lightheadedness, dark colored urine,
extreme fatigue, mouth sores
In general the use of laxatives or
stool stimulants should be avoided

Side Effects

Adverse Effects
Drug Interaction

350

mg/m2l IV over 90
minutes every 28 days

because of the potential for

worsening diarrhea. Discuss any
laxative use with your health care
professional.
Other antineoplastic agents,
atazanavir, clarithromycin, diuretics
(eg, furosemide), gemfibrozil,
indinavir, itraconazole,
ketoconazole, lopinavir,
nefazodone, nelfinavir, ritonavir,
saquinavir, telaprevir, or
voriconazole because they may
increase the risk of irinotecan's side
effects
Carbamazepine, hydantoins
(eg, phenytoin),
phenobarbital, rifabutin,
rifampin, or St. John's wort
because they may decrease
irinotecan's effectiveness
Special Concerns

Irinotecan is an irritant. An irritant

is a chemical that can cause
inflammation of the vein through
which it is given. If the medication
escapes from the vein it can cause
tissue damage. The nurse or doctor
who gives this medication must be
carefully trained.

Irinotecan may lower the

ability of your body to fight
infection. Avoid contact
with people who have colds
or infections. Tell your
doctor if you notice signs of
infection like fever, sore
throat, rash, or chills.
Irinotecan may reduce the
number of clot-forming cells
(platelets) in your blood.
Avoid activities that may
cause bruising or injury. Tell
your doctor if you have
unusual bruising or
bleeding. Tell your doctor if
you have dark, tarry, or

bloody stools.
Administration of irinotecan with
radiation therapy has not been
adequately studied and is not
recommended.

Drug Name
Classification
Dosage/ Route/ Frequency
Mechanism of Action

Uses/ Indication

Tropisetron
Anti-emetic
2mg IV prior and after
administration of Irinotecan
a highly potent and selective
competitive antagonist of the 5HTreceptor, a subclass of serotonin
receptors located on peripheral
neurons and within the CNS.
Surgery and treatment with certain
substances, including some
chemotherapeutic agents, may
trigger the release of serotonin (5HT) from enterochromaffin-like
cells in the visceral mucosa and
initiate the emesis reflex and its
accompanying feeling of nausea.
Tropisetron selectively blocks the
excitation of the presynaptic 5-HT
receptors of the peripheral neurons
in this reflex, and may exert
additional direct actions within the
CNS on 5-HTreceptors mediating
the actions of vagal input to the area
postrema. These effects are
considered to be the underlying
mechanism of action of the antiemetic effect of tropisetron.
-For the prevention of nausea and
vomiting induced by cytotoxic
therapy .
- For the treatment and prevention
of post-operative nausea and
vomiting in adults

Contraindication

-Hypersensitivity to tropisetron,
other 5-HTreceptor antagonists, or
any other components of the

formulation.
Pregnancy and lactation
Side Effects

Commonly headache, constipation

and, less frequently, dizziness,
fatigue, somnolence, and
gastrointestinal disorders, such as
abdominal pain, diarrhea and
anorexia

Adverse Effects

Bradycardia, hypotension,
shivering, hypertension, skin
reactions and bronchospasm
-Concomitant administration of
tropisetron with rifampicin or other
liver enzyme- inducing drugs (e.g.
phenobarbital) results in lower
plasma concentrations of
tropisetron and, therefore requires
an increase in dosage in extensive
metabolisers (but not in poor
metabolisers). The effects on
tropisetron plasma levels of
cytochrome P450 enzyme inhibitors
e.g. cimetidine are negligible and
do not require dose adjustment.

Drug Interaction

-As a prolongation of the QTc

interval has been observed in
patients administered tropisetron,
care should be taken when other
drugs that are likely to prolong the
QT interval are taken concomitantly
with tropisetron.
Special Concerns

-No interaction studies have been

performed with tropisetron and
drugs used in anesthesia, so there
should be caution in such
circumstances.