Topotecan | Side Effects, Dosage, Uses & More
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Generic Name:

topotecan, Oral capsule

All Brands

  • Hycamtin
SECTION 1 of 5

Highlights for topotecan

Oral capsule
1

Topotecan comes in the form of a capsule you take by mouth. It’s also available as a solution that a healthcare provider injects into your body.

2

Topotecan capsules are used to treat small cell lung cancer that has relapsed (come back).

3

Topotecan capsules are available as the brand-name drug Hycamtin. They’re not available as a generic drug.

4

The more common side effects of this drug include nausea, diarrhea, vomiting, hair loss, or tiredness.

5

In some cases, topotecan capsules can cause serious side effects. These can include a decreased blood cell count, severe diarrhea, lung problems, or infertility.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Decreased blood cell count warning. Your bone marrow makes blood cells. Topotecan can damage your bone marrow and cause bone marrow suppression. This is a severe decrease in the number of your blood cells, including white blood cells, red blood cells, and platelets. This raises your risk of infection and abnormal bleeding or bruising. Your doctor will need to check the number of cells in your blood before you take this medication. If it’s too low, your doctor may not prescribe this medication for you. Your doctor may also check the number of your blood cells often during treatment with this drug.

Diarrhea

Topotecan can cause severe and life-threatening diarrhea that may need to be treated in the hospital. Call your doctor right away if you have:

  • diarrhea with fever
  • diarrhea three or more times per day
  • diarrhea with stomach pain or cramps

Lung problems that can cause death

Topotecan can cause a condition called interstitial lung disease. This disease makes your lung tissue thicker and stiffer. Over time, these changes can make it impossible to breath. Call your doctor right away if you have new or worsening symptoms of coughing, fever, shortness of breath, or trouble breathing.

Infertility

Topotecan can cause short-term and long-term problems with fertility (ability to have children). It may lower sperm counts in men or make it hard for a women to get pregnant. Before you take topotecan, tell your doctor if you’re planning to become pregnant.

Drug features

Topotecan is a prescription drug. It comes as a capsule you take by mouth. It’s also available as an injection.

Topotecan capsules are available as the brand-name drug Hycamtin. They’re not available as a generic drug.

Topotecan capsules may be used as part of a combination therapy. This means you may need to take them with other medications.

Why it's used

Topotecan capsules are used to treat small cell lung cancer that has come back.

See Details

How it works

Topotecan belongs to a class of drugs called topoisomerase I inhibitors.

See Details

Why it's used

Topotecan capsules are used to treat small cell lung cancer that has come back. Your doctor may prescribe this medication for you if your cancer responded to your first treatment with chemotherapy. You must wait at least 45 days since your last dose of chemotherapy to start treatment with this drug.

How it works

Topotecan belongs to a class of drugs called topoisomerase I inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Topotecan capsules work by damaging cancer cells. They also limit the cells’ ability to grow.

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topotecan Side Effects

Oral capsule

More common side effects

The more common side effects of topotecan can include:

  • nausea

  • diarrhea

  • vomiting

  • hair loss

  • tiredness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Decreased blood cell count. Symptoms can include:

    • fever
    • chills
    • cough
    • burning or pain during urination
    • increased bleeding
  • Severe diarrhea. Symptoms can include:

    • diarrhea with fever
    • diarrhea three or more times a day
    • diarrhea with pain or cramps in the abdomen (stomach area)
  • Interstitial lung disease, which can cause death. Symptoms can include:

    • coughing
    • fever
    • shortness of breath
    • trouble breathing
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Topotecan can cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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topotecan May Interact with Other Medications

Oral capsule

Topotecan can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Medications that might interact with this drug

Drugs you should not use with topotecan

Do not take these drugs with topotecan. When used with topotecan, these drugs can cause dangerous effects in your body. Examples of these drugs include:

  • Antibiotics, such as azithromycin, clarithromycin, or erythromycin
    • Using any of these drugs with topotecan can increase the amount of topotecan in your body to dangerous levels.
  • Antifungal drugs, such as itraconazole or ketoconazole
    • Using any of these drugs with topotecan can increase the amount of topotecan in your body to dangerous levels.
  • Heart drugs, such as diltiazem, verapamil, carvedilol, captopril, felodipine, ranolazine, dronedarone, amiodarone, ticagrelor, or quinidine
    • Using any of these drugs with topotecan can increase the amount of topotecan in your body to dangerous levels.
  • Conivaptan
    • Using this drug with topotecan can increase the amount of topotecan in your body to dangerous levels.
  • HIV drugs, such as lopinavir or ritonavir
    • Using any of these drugs with topotecan can increase the amount of topotecan in your body to dangerous levels.
  • Eltrombopag or cyclosporine
    • Using either of these drugs with topotecan can increase the amount of topotecan in your body to dangerous levels.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Topotecan warnings
pregnancy warning
Pregnant women

Topotecan is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should be only used if the potential risk to the fetus is acceptable given the drug’s potential benefit.

Women who can become pregnant should use effective birth control during treatment and for 1 month after treatment ends. Men should also use effective birth control during treatment and for 3 months after treatment ends if they have a sexual partner who can become pregnant.

breast feeding warning
Women who are breast-feeding

It’s not known if topotecan passes into breast milk and causes side effects in a child who is breastfed.

Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

senior warning
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

childrens warning
For children

This medication has not been studied in children. It should not be used in people younger than 18 years of age.

call the doctor
When to call the doctor

Call your doctor right away if:

  • you become pregnant while taking this drug
  • you get the contents of a topotecan capsule in your eyes
allergy warning
Allergies

Topotecan can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take topotecan (Dosage)

Oral capsule

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Relapsed small cell lung cancer

Brand: Hycamtin

Form: oral capsule
Strengths: 0.25 mg, 1 mg
Adult dosage (ages 18–64 years)
  • Typical dosage: 2.3 mg/m2 once per day for 5 days in a row, repeated every 21 days. Your doctor will round your dose to the nearest 0.25 mg.
Child dosage (ages 0–17 years)

This medication has not been studied in children. It should not be used in people younger than 18 years of age.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lower dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with kidney disease:

  • Moderate kidney disease (creatinine clearance rate of 30–49 mL/min): Take 1.5 mg/m2 once per day for 5 days in a row. Repeat every 21 days.
  • Severe kidney disease (creatinine clearance rate less than 30 mL/min): Take 0.6 mg/m2 once per day for 5 days in a row. Repeat every 21 days.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Heathline Pharmacist Editorial Team

Topotecan comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your lung cancer may not go away or may continue to spread.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • decreased blood cell counts, with symptoms such as fever, chills, or increased bleeding
  • inflammation (irritation and swelling) and ulcers (sores) in your stomach and intestines

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

You may not feel any different if the drug is working. Your doctor will do certain tests to monitor your cancer. Your test results will tell your doctor if the drug is working to treat your cancer.

Topotecan is used for long-term treatment.

You’ll take topotecan capsules for 5 days in a row every 21 days

Your doctor will decide how many cycles of treatment you’ll need. They’ll decide based on your cancer’s response to the treatment.

Store this drug carefully

  • Store topotecan capsules in the refrigerator at a temperature between 36°F and 46°F (2°C and 8°C).
  • Keep the topotecan capsules in the bottle and carton they came in to protect them from light.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

If any of your topotecan capsules are broken or leaking: Do not touch them with your bare hands. Put on gloves and carefully throw away the damaged capsules. Then, wash your hands well with soap and water.

If you get any of the contents of the capsule on your skin: Wash the area well with soap and water right away.

If you get any of the contents of the capsule in your eyes: Wash your eyes right away with gently flowing water for at least 15 minutes. Then, call your doctor.

If you vomit after taking topotecan capsules: Don’t take another dose on the same day. Wait to take your next scheduled dose.

Clinical monitoring

Your doctor should monitor certain health issues while you take this drug. This can help make sure you stay safe during your treatment. These issues include:

  • Blood cell counts. Topotecan can reduce your blood cell counts. Blood tests will tell your doctor if your blood cell counts are at a healthy level.
  • Breathing problems. Topotecan can cause lung disease, which can make it hard to breathe. Your doctor will check your breathing for signs of:
    • cough
    • fever
    • trouble breathing
    • a reduced amount of oxygen going to your lungs

Hidden costs

You may need to have blood tests done during your treatment with topotecan. The cost of these tests will depend on your insurance coverage.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor may need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does topotecan Cost?

Oral capsule

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Lowest price for topotecan

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These prices represent the lowest priced national pharmacies for topotecan on GoodRx. They may be lower than your insurance.

Show Sources

  • GlaxoSmithKline. (2014, June). Hycamtin (topotecan) capsules, for oral use [package insert]. Research Triangle Park, NC.

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on February 20, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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