Diuretics increases risk of dehydration secondary to vomiting/diarrhea Prophylactic dexamethasone s anantiemetic may enhance lypmphocytopenia

Prochlorperazine may increase incidence of akaathisia reduce irinotecan exposure

Netropenia, anemia Thrombocytopenia, acute diarrhoea, Sweating, hyersalivation Abdominal cramps Lachrymation Miosis Weakness Nausea, vomiting Alopecia and skin reactions CV toxicity Fatal sepsis due to myelosuppression Severe chronic diarrhoea

Inflammatory bowel disease Bowel obstruction Severe hepatic impairment Pregnancy Lactation

Special precautions Previuos pelvic/abdominal irradiation

Raised plasma -bilirubin concnentration Sevee myelosuppression Avoid extravasation

Refractory colorectal malignancies

Dosage-

125mg/m2 infused i.v. over 90 minutes once weekly for 4 weeks followed by a2 week rest period or, 350mg/m2 infused over 90 min repeated once every 3 week

Metastatic colorectal cancer as 1st line treatment 25mg.m2 infused iv over 90min on days 1.8.25, and 22 of a 6 week cycle alternnately, 180mg/m2 infused iv over 90min on days 1.15, and 29 of 8 week cycle

Use cotraindicated.Observe caution