Indications
Tipiracil is always used together with Trifluridine in a single combination tablet. This combination is a prescription cancer medicine used for adults with colorectal (bowel) cancer or stomach cancer that has spread to other parts of the body (metastatic) and has already been treated with, or cannot be treated with, other standard chemotherapy. For bowel cancer it may be given together with Bevacizumab. It is prescribed and supervised by a cancer specialist (oncologist).
How It Works
Trifluridine is the active anticancer part. It is built into the DNA of cancer cells in place of a normal building block, which damages the DNA and stops the cells from dividing. On its own, Trifluridine is broken down very quickly in the body by an enzyme called thymidine phosphorylase. Tipiracil blocks this enzyme, so Trifluridine stays in the blood at useful levels for longer. Tipiracil itself has no direct anticancer effect.
Dosage and Administration
The dose is worked out by the oncologist from your height and weight (body surface area) and must be taken exactly as prescribed. Treatment is given in cycles, with days of tablets followed by rest days, and the doctor may delay, lower or stop doses depending on blood test results.
- Take the tablets twice a day, within 1 hour after finishing the morning and evening meals.
- Swallow the tablets whole with water.
- If you miss a dose or vomit after a dose, do not take an extra dose; take the next dose at the usual time.
- Wash your hands after handling the tablets. Carers should wear gloves if possible.
Interactions
Tell your doctor about all medicines you take. Medicines that interact with thymidine pathways, such as Zidovudine and other similar antiviral nucleosides, may interfere with how this combination works. Live vaccines should be avoided because the medicine weakens the immune system. Other medicines that lower blood counts can add to the risk of infection and bleeding.
Contraindications
Do not take this medicine if you are allergic to Trifluridine, Tipiracil or any ingredient in the tablet. Your doctor will not start treatment if your blood counts are too low.
Side Effects
The most important side effect is a drop in blood counts: low white blood cells (neutropenia), which raises the risk of infection, low red blood cells (anaemia), causing tiredness and pale skin, and low platelets, which can cause bruising or bleeding. Other common effects include nausea, vomiting, diarrhoea, loss of appetite, tiredness, weakness, stomach pain, fever and hair thinning.
Get urgent medical help if you have a fever of 38°C or higher, chills or other signs of infection, unusual bleeding or bruising, severe or continuing diarrhoea or vomiting, or feel very weak or short of breath.
Pregnancy and Lactation
This medicine can harm an unborn baby. Women who could become pregnant must use effective contraception during treatment and for at least 6 months after the last dose. Men with a female partner who could become pregnant should use condoms during treatment and for at least 3 months after the last dose. Do not breastfeed during treatment and for at least 1 day after the last dose, or as your doctor advises.
Precautions and Warnings
- Blood counts are checked before each cycle and often during treatment.
- People with kidney or liver problems need extra care and may need dose changes.
- Report any sign of infection straight away.
- Avoid contact with people who have infections where possible, and keep good hand hygiene.
- Older patients may have more blood count problems.
Overdose
Taking too much can cause severe lowering of blood counts. Contact a doctor or go to hospital straight away. There is no specific antidote; treatment is supportive, with close monitoring of blood counts.
Therapeutic Class
Antineoplastic agent (antimetabolite, thymidine phosphorylase inhibitor used in combination with Trifluridine).
Storage
Store below 30°C in a dry place, in the original pack, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.