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For patients and those who care for them...

How to manage diarrhea during chemotherapy

Did you know?
Diarrhea caused by chemotherapy (or chemo) can be serious and threaten your life
It might not go away on its own
It might get worse without the right treatment
It can prevent your body from keeping the liquids you drink and from fully digesting your food
It can cause a blood infection
Signs that you may have diarrhea
More bowel movements than you had before you started chemo

(if you are not sure what is normal, keep a daily record; see the chart below)

Softer, looser, or more watery bowel movements

More cramps, gas, or stomach pain
2 kinds of diarrhea
Early diarrhea may happen in the first 24 hours after you receive
CAMPTOSAR (irinotecan HCl injection). In most cases,
it is mild. You may be given medicines before or after
treatment with CAMPTOSAR to help with these problems.

Late diarrhea may happen more than 24 hours after your

treatment with CAMPTOSAR. Late diarrhea can be more
serious. It can threaten your life if it is not managed well.

Do not ignore early or late diarrhea. If left untreated, diarrhea can become serious enough to threaten your life.
Be sure to call your Cancer Care Team if you have diarrhea.

What to drink if you have diarrhea

Drink at least 6 to 8 large glasses of liquids a day
Drink a little at a time, as often as you can. Water,
clear soup, and broth are all good

What not to drink

Dont drink milk
Avoid alcohol and caffeine
(coffee, tea, most colas)

Avoid very hot or

very cold drinks

Avoid prune juice

What to eat

What not to eat

Eat small meals often; think BRAT

B Bananas
RRice (white)
A Applesauce
T Toast (white)
If you do well on these foods, you can start adding others:
Bland, low-fiber foods
Skinless chicken or turkey baked on broiler pan in oven
Crackers, white bread, or spaghetti with unseasoned tomato sauce
Peaches and pears canned in juicenot in syrup

These foods can make diarrhea and cramping worse:

Raw meat and fish
Raw fruits and vegetables
Fatty, fried, spicy, sweet, or rich foods
Whole grains
Dried beans

Check your bowel movements. It is important to know what your normal stool is like. It can help you see how your treatment
affects you. Fill in the chart below, starting 1 week before your treatment. Be sure to make an entry each time you have a bowel movement.
Fill in the time of day and check the box or boxes that best describe your bowel movement. One day is filled in to show you how.

11/24/06 11/24/06 11/24/06


8:15 a.m. 11:25 a.m. 2:30 p.m.




See other side to learn how to treat diarrhea

Taking medicine for diarrhea

Your doctor may suggest that you take a medicine
called Imodium A-D. It is also called loperamide HCl.
You might want to have some on hand before your
treatment starts.
Be sure to take the medicine just as your Cancer Care
Team tells you to. Your Team will tell you the right
dose for bowel problems caused by chemo
During the night, you still have to take 2 caplets
every 4 hours. Dont stop taking it until you have
not had any bowel movement for at least 12 hours
If you get a fever (over 100.4F) or feel sick, call
your Cancer Care Team right away
Keep track of how many bowel movements you
have. If you still have diarrhea 24 hours after taking
Imodium A-D, call your Cancer Care Team right away

Other signs to tell your Cancer Care Team about

Dry mouth
Darker urine, less urine, or both
Weight loss
Feeling tired or weak

Taking Imodium A-D for late diarrhea

Be sure to follow the dosing directions below.
They are for people taking CAMPTOSAR.
Do not follow the directions on the Imodium A-D package.
First Dose:

the Day:
the Night:






Take 2 caplets (4 mg) of Imodium A-D

Take 1 caplet (2 mg) every 2 hours

Take 2 caplets (4 mg) at bedtime and 2 caplets
every 4 hours until morning. You must set your
alarm clock to wake you up during the night so
you can take your Imodium A-D
Stop taking Imodium A-D when you have not had
any bowel movement for 12 hours. Do not take
Imodium A-D for more than 48 hours (2 days)

Be sure to tell your Cancer Care Team right away

if you have any of these signs
Fever (temperature above 100.4F) or shaking chills
Feeling cold
Bad stomach pain or cramps
Feeling woozy, dizzy, or faint
Black or bloody bowel movements

CAMPTOSAR is approved to treat cancer of the colon or rectum that has spread to other parts of the body.
It can be used along with 2 drugs, called 5-FU and LV. 5-FU stands for fluorouracil. LV stands for leucovorin.
CAMPTOSAR can also be used when the cancer has come back or grown worse after treatment with 5-FU.
Important safety information
Taking CAMPTOSAR may cause early and late diarrhea. Both of them can threaten your life. Late diarrhea should be
treated right away with a medicine called Imodium A-D. You may also need to take an antibiotic.
CAMPTOSAR can also decrease your number of white blood cells. This may be treated by a delaying or lowering of the dose.
You can also take a protein that helps produce healthy blood cells.
Some people should be watched closely by their doctors while taking CAMPTOSAR. They include those who:
Are over age 65
Have received radiation in the pelvis or stomach
Have trouble carrying out daily tasks due to their cancer
In rare cases, blocked bowel, colon problems, or liver disease has occurred with CAMPTOSAR.
To help prevent nausea and vomiting, you may be given other drugs before taking CAMPTOSAR. You may also be given
a drug called atropine. It will help you fight side effects such as diarrhea.
In some cases, CAMPTOSAR may cause problems with your heart and blood vessels, including blood clots. Doctors do not
know for sure why this happens.
You should not take CAMPTOSAR if you have severe bone marrow failure.
You should also not take it if you react poorly to fruit sugar. That is because CAMPTOSAR contains a kind of fruit sugar
called sorbitol.

Imodium A-D is a registered trademark of McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil PPC, Inc.
Patient information provided as a service by Pfizer Oncology.

Please see enclosed product information for CAMPTOSAR, including black box warning. You may also visit www.pfizeroncology.com
to view the product information.


2006 Pfizer Inc. All rights reserved.

Printed in USA/November 2006