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Irenotecan and Diarrhea Help

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: I am on both Irenotecan and Oxaliplatin. Right now the irenotecan has kicked in with constant liquid diarrhea. I am taking as directed Imodium every 2 hrs during day and 2 pills every 4 hrs at night. I am eating "white" food like white bread, white bagels, bland fruit, Ensure. Any other hints? I seem to be getting quite weak with this. Thanks!
Cheryl

smokeyjoe
Posts: 1428
Joined: Feb 2011

Ask your doctor, but I've had to take much more than two every couple of hours. Leena

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

sorry to hear about the diarrhea.

I had a bag and was on folfox, and managing diarrhea while on chemo was a fulltime job.

I went to 6 naturopaths and ended up finding a naturpath who survived colon cancer.

I was put on a good probiotic, digestive enzymes and gut relief powder and a special anti diarreal mix.

just get the best care and advice you have access to. I decided to look outside the medical system when I got desperate and I realised the harm the side effect drugs were having.

I just added the gut relief product details, its got so many good things in it. ask your onc. the curcumin may enhance folfox effectiness, the l-glutamine may enhance minimising neuropathy. the rest definitely helped with my diarrhea, the goal being to repair your gut each fortnight. These maybe are based on limited studies and clinical practice but they serve as a basis for discussion with your onc.

goodluck and if you end up trying this I would like to know the results as well as your onc opinion.

hugs,

Pete

http://www.purehealthdirect.com/products/products_details.php?products_id=2376
Active Ingredients in Gut Relief by Nutrition Care
Ingredient Qty
Aloe barbadensis .5 mg/g
Curcumin .6074 mg/g
Glucosamine hydrochloride 100 mg/g
Glutamine 500 mg/g
Guar Gum 20 mg/g
Pectin 20 mg/g
Peppermint Oil 600 microgram/g
Quercetin 40 mg/g
Sodium phosphate - dibasic 52 mg/g
Ulmus rubra 100 mg/g

Specific Indications for Gut Relief by Nutrition Care
Aids in maintenance and repair of mucous membranes

Natural relief of symptoms of medically diagnosed irritable bowel syndrome and natural relief for the bloating, abdominal pain, cramping and discomfort associated with irritable bowel syndrome

Relief of muscular aches and pains in the gut
Soothe and protect the gastro intestinal tract
Suitable for assisting upper and lower gastro intestinal health
Supports gastro intestinal health
Warnings (TGA) for Gut Relief by Nutrition Care

Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

Are they giving you ATROPINE as part of your pre-meds package? This really helps.

And you can ask your onc about LOMOTIL by Rx. It works better than Immodium, cuts down the spasms, the peristalis I believe it's called.

-Craig

thxmiker's picture
thxmiker
Posts: 1282
Joined: Oct 2010

Speak with your Doc about the correct use of imodium with Cancer Diarhea. I was taking significantly more imodium then you are describing. I liked lomotil better. It did not dry out my eyes and mouth as bad. (Drying of the mouth will also have a much higher risk of cavities.)

The two other things I did to makes things less bad. Nothing is going to make this go away just less severe. Try a Low residue diet. Very easy to find on the internet and easy to follow. Try liquid probiotics. They can be from $11 a liter to $100 a liter. The more expensive ones were no better then the less expensive ones, if you read the labels. Not all are the same. Probiotics help restore the good flora. It made me less gassy and have less cramps.

Baby wipes and good TP are a must.

My thoughts and prayers are with you!
Best Always, mike

idlehunters's picture
idlehunters
Posts: 1792
Joined: Apr 2009

Your Onc can give you a shot of this med and it will help A LOT in drying you up. Don't get dehydrated!!! This happens faster than you think. Take care.

Jennie

plh4gail's picture
plh4gail
Posts: 1238
Joined: Oct 2010

Sorry for your discomforts. I used white toast, white rice, bananas, and Benefiber ( hoping to bulk things up) when I had the diarrhea from chemo. Good luck and I hope it gets better soon. Oh....I also used Northern ultra and the disposible toilet wipes. No cutting corners on cost in this department!! lol

Love, Gail

doura
Posts: 5
Joined: May 2011

hi
my mom went through this so atropine was a magic just ask your doc about it & u have to have complete tests so as to keep hydrated u might need iv fluids
hope u get better
doura

thingy45's picture
thingy45
Posts: 633
Joined: Apr 2011

I had a bout with that and Imodium did not help, but LOMOTIL did, however I live in Canada do not know if it is available in USA.
Hugs Marjan

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Thanks for all the fabulous advice. It is also so good to know one is not alone in this as the oncologist certainly doesn't talk about it (although the dietician does). I did get the injection just before the irenotecan and nausea pills but didn't get nausea thankfully. I live in Canada and will ask about Lomatil as Imodium didn't do much at all at least at the dosage I was given. I got the softest tissue possible and those wipe things - boy did that help! I have reverted to just plain jello (lots) and clear broth and that has slackened it but now to get the energy back without getting it all again. Luckily I got my dog to a safe place with friends for awhile. But I've leaned on my friends too much right at the beginning - I'm going to be better prepared next time (less than a week!). Lots to look forward to - neuropathy with the one (I'm giving L-glutamine a go) and diarrhea with the other (lots of options there).
It was our long weekend here in Canada (Victoria day) - yours (many of you anyways) is next weekend right? Lots of firecrackers!
Cheryl

plh4gail's picture
plh4gail
Posts: 1238
Joined: Oct 2010

For me with the Irinotecan, Immodium doesn't touch the problem. It takes Lomotil. I take 2 the first diarrhea then one each next time and stops after about 4. Good luck :) And bananas, white rice, and white toast while having the issue.

Love and hugs, Gail

luvmum
Posts: 457
Joined: Dec 2010

I know the frustration of diarrhea... saw my mum going to toilet 14 times a day! She also takes lomotil to stop it.

I hope your diarrhea will be under control soon!
Dora

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

That's for sure. I'm going to ask the oncologist for lomotil next time. I'll start the BRAT (bananas, white rice, etc.) tomorrow. I just noticed the jello has asparatame in it. I'm missing my pup. Thanks all.
Cheryl

geotina's picture
geotina
Posts: 2123
Joined: Oct 2009

I tried to send you a pm regarding this but your settings are set so you don't receive pm's. George was just in the hospital for the diarrhea, it was quite bad so be careful, it can get critical pretty fast. He did end up with 3 days of fluids, potassium and 2 units of blood. Things have really turned around and he is doing so much better.

Anyway, make sure you incorporate the BRAT diet (bananas, rice, applesauce and toast) with your meals. It really binds things.

Make sure the Immodium you take is Immodium AD. Generic is fine as long as it has the same ingridients as the name brand and the cost is significantly less, I get it at Costco or Walmart. I checked this with the onc and nurse and they both said generic is fine.

Take care and hope things improve for you -

Tina

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Now here is a dumb message - what is a "pm" - personal message? Maybe I can undo the setting.
See my message at the end of this thread.
Thanks!
Cheryl

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi Tina: I do have my email entered to receive personal messages. Not sure why it wouldn't let you. Technology!
Cheryl

menright's picture
menright
Posts: 258
Joined: Oct 2008

I once had serious diarrhea and Opium extract was prescribed and fix it. It is a closely controlled dtug and tastes nasty but it worked.

Good luck,

Mike

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi and thanks : My nurse came over this morning and checked to make sure I'm not getting dehydrated (ended up in the hospital last year with same thing but with cisplatin - they reduced dosage and I was fine after that). So far, so good. I'm drinking gallons of gatorade and apple juice. I have now had all of the items on the BRAT (oh the rice was so so so delicious!) and so far not worse, but not better. The oncologist has prescribed lomotil (here in Canada it is viewed as a "special" prescription, kind of narcotic like so may not get it delivered until tomorrow) to see if that works better. HOpe so as treatment is coming up on Tuesday and I'd like one shot at a delicious meal before I do this all again! I get the Imodium (loparomi....) as a prescription to save money from the cancer centre.
Did any one you have to have a dosage reduction with irenotecan because of the diarrhea or did they just manage it?
Cheryl

plh4gail's picture
plh4gail
Posts: 1238
Joined: Oct 2010

Do they give you Atropine IV as a pre med when you get your chemo? That helps a lot I think.

Gail

Livingbyfaith's picture
Livingbyfaith
Posts: 56
Joined: Sep 2007

My husband ended up in the hospital twice from this drug, very bad diarreah and vomitting. They are switching him back to folfox which he tolerated better. Rough stuff, ask them if they can reduce dose or change chemo. Nothing helped my husband meds wise.

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi Gail and Living by Faith: Luckily I didn't get the vomiting. I am on both Irenotecan and Oxaliplatin so folfoxfiri????. Anyways, many people on this discussion board recommended Lomotil rather than Imodium and halleluia that worked! The nurse was here yesterday, ordered it, pills came, took one, and that worked. Not that I want to take a pill this strong for very long but it worked. I complemented it with the BRAT diet and hopefully I'll know what to do next time - manage it before it happens, not after like I tried to do. I'll talk to the oncologist about changing the dose. I had to do that last year when I too ended up in the hospital for 10 days (with cisplatin).

Gail - yes, they give you an injection just before they IV in the irenotecan. Obviously didn't work well with me! But if I start preparing the day before foodwise ...

One question I have is about taking cal/mag for the neuropathy (I'm taking L-glutamine). They do give it with the chemo IV if you ask for it here. But doesn't that contribute to diarrhea? I was taking large doses before chemo started but have stopped for that reason. I have low bone density so should have the calcium as I don't drink milk.

Thanks!

Cheryl

plh4gail's picture
plh4gail
Posts: 1238
Joined: Oct 2010

Yes Cheryl....you are probably just going to have to go easy on the foods you eat and at the first sign of diarrhea take the Lomotil. Thats what I had to do. When I got the radiation/chemo pump last summer ....my diarrhea got so bad I ate the brat diet ( mostly only) for about 3 weeks. I was soooo sick. lost so much weight managed to not get dehydrated. Good luck to you!

Love and hugs, Gail

geotina's picture
geotina
Posts: 2123
Joined: Oct 2009

I tested it and it says "westie66 does not allow private messages". I think you have to go to preferences and click the box that says "allow private messages".

Tina

traci43's picture
traci43
Posts: 775
Joined: Jul 2007

4th round of XELIRI, I had diarreha for 10 days! and the woste blister imaginable. The Doctor started Atropine before infusion. I also went from full dose irinotecan every three weeks to half-dose every other week and 3/4 dose of the Xeloda. I ususally have soft stool and bad cramping on days 5 and 11 (odd but that's the way it works!) but no more diarreha. My CEA has been steadily dropping 0.1 ever two weeks and my tumors were about 3/4 the size they were at the start of treatment (12 rounds completed). It's slow going but appears to be working. I suggest asking your doctor about Atropine and/or reduced dose. Good luck, Traci

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westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi Tina and Gracie: OK, will try again but I'm sure I had clicked on the receive emails but maybe forgot to "save" it. Thanks!
Cheryl

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Well, I don't know why it isn't working. I just looked at my page and I put in my email address but I don't see a place where it says Accept Emails like it does for Accept Personal Messages. I did a "submit" but not sure what else to do.
Cheryl

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: I checked CSN Email and I did have some emails there. So something is working but not sure what! Can someone send me an email message so I can check again?
Thanks!
Cheryl

Lifeisajourney
Posts: 217
Joined: Apr 2010

I know that sounds sick, but firm bowels panic me and since I have diviticulis, soft is better or I aggravate that. I should not say I like diaherra, I like loose bowels....I try to compensate with lots of water...lomotil is alway there if real watery bowels starts I don't hesitate to take them, if I having cramping with loose watery bowels. It was explained that the part of bowel I had removed helped with the watery portion of things and I might always have issues. Also, I will forever have to watch my diet, fiber is not good for me and I watch that. The BRat diet is good. During chemo it is a lot harder to control things and I counted on Lomotil, vaseoline and cream cheese on ritz crackers and noodles with butter. Just my experience, Chemo bowels, are a real problem and mine are not much better now, but I do agree on hydrating, I do drink a lot of water which doesn't help loose bowels.....Good luck. I find it interesting the different drugs that can be used, I hope you find one....Pat

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi all: I can relate - almost liking diarrhea! I have an incisional hernia from the surgery a year ago and constipation is not something I want or need. I met with my oncology team this morning and we've worked out a management plan for the irenotecan. (1) reduced dose by 20% (because I lost so much weight so fast); (2) go back and forth with the lomotil and the BRAT diet. What this means is that try adding a "white low fibre" food from this list I have (e.g. slice of skinless chicken, piece of cheese, tapioca pudding). If diarrhea comes back, take the lomotil (the dietician suggested one in am and one in pm). Then try adding something else. Absolutely no fibre foods. I can live with this (but avoid dinner parties!). I worried about lack of protein so I need to get some but L-Glutamine is full of protein and I'm doing that for any neuropathy that may happen (I bought the tin whereby you mix one scoop with water or juice and that gives you 5 grams).
I did end up dehydrated - they couldn't even find a vein to draw my blood this morning and I have a huge huge bruise.
And a tip to the bum weary! My oncologist nurse says baby diaper rash cream - two brands Penatax and Zincolax or something like that. And I'm off to try this right now!

menright's picture
menright
Posts: 258
Joined: Oct 2008

I had a similar issue and eventually I was prescribed an optium extract, while tightly controlled, did the trick.

Best of Luck

Mike

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Thanks, Mike. I'll have to ask about that but it may not be available here in Ontario. The lomotil appears to work. I had chemo cycle 2 today and now the neuropathy is rearing it's ugly head (see new discussion thread). They give you a whole bunch of pills and an injection of atropine for the nausea (which hasn't bothered me yet) but not too much for the diarrhea except for lomotil and diet which taken together seem to work. Now on to the neuropathy...
Cheryl

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