Irinotecan with 5FU and folinic acid
Irinotecan with fluorouracil (5FU) and folinic acid is a cancer drug treatment. It is used to treat bowel cancer.
What is Irinotecan with fluorouracil (5FU) and folinic acid?
Irinotecan with fluorouracil (5FU) and folinic acid is a combination of cancer drugs. It is sometimes called FOLFIRI or IrMdG. We use the name FOLFIRI in this information.
FOLFIRI is named after the initials of the drugs:
- FOL – folinic acid (also called calcium folinate or leucovorin). This is a drug that makes 5FU work better.
- F – fluorouracil (also called 5FU). This is a type of chemotherapy.
- IRI – irinotecan. This is a type of chemotherapy.
FOLFIRI is used to treat bowel cancer.
It is best to read this information with our general information about chemotherapy and the type of cancer you have.
Your cancer team will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.
DPD testing before treatment
Before starting this treatment, you should have a blood test. This test checks for gene changes that affect how your body produces DPD. DPD is an enzyme that helps the body break down 5FU.
If you have low DPD levels or no DPD (DPD deficiency), you have more risk of serious or life-threatening side effects from 5FU. To reduce your risk, your doctor may give you:
- a lower dose of 5FU to start with
- a different type of chemotherapy.
Having low DPD levels does not usually cause any symptoms. Without a test, you will not know whether your DPD levels are low. Testing finds most people who are affected, but not all. Your doctor, nurse or pharmacist can give you more information about your risk of DPD deficiency, before you start treatment.
How FOLFIRI is given
You usually have FOLFIRI in a chemotherapy day unit or clinic as an outpatient or during a stay in hospital.
During your course of treatment, you will meet someone from your cancer team, such as a:
- cancer doctor
- chemotherapy nurse or a specialist nurse
- specialist pharmacist.
This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of each treatment, you will have a blood test. This is to check that it is safe for you to have treatment.
You will meet with a doctor, nurse or pharmacist before you have treatment. They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacy team will prepare your cancer drugs.
Your nurse will usually give you anti-sickness drugs before the cancer drugs. You will have your cancer treatment through 1 of the following:
- a cannula – a short, thin tube the nurse puts into a vein in the arm or hand
- a central lines – a fine tube that goes under the skin of the chest and into a vein close by
- a PICC line – a fine tube that is put into a vein in the arm and goes up into a vein in the chest
- an implantable port (portacath) – a disc that is put under the skin on the chest or arm and goes into a vein in the chest.
Irinotecan is given as a drip (infusion). Your nurse usually run this through a pump, which gives the drug over a fixed time. This takes between 30 minutes and 90 minutes.
Folinic acid is given in the same way. You may have it at the same time as irinotecan or after. Your nurse will tell you how long the folinic acid will take.
5FU is given in 2 parts. The nurse gives the first part as an injection into your line.
If you have a central line, PICC or port
For the second part of the 5FU dose, the nurse will connect a small portable pump to your line. The pump gives the rest of the 5FU continuously over 46 hours. You can carry the pump on a belt or in a holder.
Your nurse will explain how to look after the pump. They can also tell you what to do if there is a problem with it.
Once the 5FU pump is connected to your line and has been started, you can go home. When it is time to have the pump disconnected, you may go back to hospital. Sometimes a district nurse will do this for you at home.
If you have a cannula
If you have a cannula, you will stay in hospital to have the second part of the 5FU treatment. You have this as a drip over 46 hours.
Your course of chemotherapy
You usually have a course of several cycles of treatment over a few months. When the 5FU infusion is finished, you will have a rest period with no chemotherapy. This completes 1 cycle of treatment. Each cycle takes 14 days.
Your cancer team will discuss your treatment plan with you. They may give you a copy of the plan to take home. They may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to.
About side effects
We explain the most common side effects of this treatment here. We also include some that are less common.
You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here.
Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you:
- drugs to help control some side effects
- advice about managing side effects.
It is important to take any drugs exactly as explained. This means they will be more likely to work for you.
Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.
If your body does not produce enough of an enzyme called DPD, you may have a higher risk of severe or life-threatening side effects.
Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Side effects while treatment is being given
Allergic reaction
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- shivering
- itching
- a skin rash
- feeling dizzy or sick
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, they can treat it quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.
Always call 999 if swelling happens suddenly or you are struggling to breathe.
Irinotecan reaction (acute cholinergic syndrome)
Some people may have side effects within 24 hours of having irinotecan. These include:
- diarrhoea
- tummy cramps
- sweating more than usual
- producing a lot of saliva
- dizziness
- problems with vision
This is called acute cholinergic syndrome. It can usually be prevented or controlled by a drug called atropine. Your nurse gives you atropine as an injection under the skin (subcutaneously). Contact your doctor or nurse if you have any of these symptoms.
Very common side effects
These side effects happen to 10 or more people in every 100 people (10% or more) who have irinotecan or 5FU.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:
- a temperature above 37.5°C
- a temperature below 36°C
- you feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- breathlessness
- diarrhoea
- needing to pass urine (pee) often, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- nosebleeds
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.
If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:
- very low in energy
- breathless
- dizzy and light-headed.
If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Diarrhoea
This treatment may cause severe diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
Your doctor, nurse or pharmacist may give you anti-diarrhoea drugs to take at home.
If you have diarrhoea or a mild increase in stoma activity, follow their advice about:
- taking anti-diarrhoea drugs
- how much and what type of fluids to drink
- any changes to your diet that might help.
Contact the hospital straight away on the 24-hour number if:
- you have diarrhoea at night
- you have uncomfortable stomach cramps
- you have diarrhoea 4 or more times in a day
- you have a moderate increase in stoma activity
- the anti-diarrhoea drugs do not work within 24 hours.
You may need to give a stool sample, or go to hospital to have fluids through a drip or antibiotics.
Constipation
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help.
If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away.
Feeling sick
Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
Contact the hospital straight away on the 24-hour number, if:
- a sore mouth or throat affects how much you can drink or eat
- your mouth, tongue, throat or lips have any blisters, ulcers or white patches.
They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:
- drink plenty of fluids
- avoid alcohol and tobacco
- avoid food or drinks that irritate your mouth and throat.
Tummy pain
Feeling tired
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired.
If you feel sleepy, do not drive or use machinery.
Hair loss
Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.
If you want to cover up hair loss, there are different ways you can do this. Your nurse will give you information about coping with hair loss.
Remember to protect your skin from the sun. Use suncream with a sun protection factor (SPF) of at least 30 on your scalp. Or cover up with a hat or scarf.
Hair loss is almost always temporary. Your hair will usually grow back after treatment ends.
Hand-foot (palmar-plantar) syndrome
This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome.
If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker.
The skin on the palms of your hands and the soles of your feet may:
- be sore
- be painful, tingle, or swell
- peel, crack or blister.
If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.
You can care for your hands and feet by:
- keeping your hands and feet cool by washing in cool water
- gently moisturising your hands and feet regularly
- wearing gloves to protect your hands and nails when working in the house or garden
- wearing loose cotton socks and avoiding tight-fitting shoes and gloves.
Loss of appetite
This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.
Difficulty breathing
5FU can cause sudden tightness (spasm) in the muscles in your chest for a short time. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during treatment:
- breathlessness
- a cough that does not go away
- wheezing.
Always call 999 if you have difficulty breathing.
Other side effects
These side effects happen to less than 10 in 100 people (less than 10%) who have irinotecan or 5FU. Some of them are much rarer than this but they are still important to know about. Rare means a side effect that happens to less than 1 in 1,000 people (less than 0.1%).
Constipation
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help.
If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away.
Effects on the liver
This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.
Effects on the eyes
Your eyes may become watery and feel sore. Your doctor, nurse or pharmacist can give you advice and eye drops to help with this.
Contact the hospital on the 24-hour number if:
- your eyes get red and inflamed (conjunctivitis)
- you have pain in your eyes
- you notice any change in your vision.
Effects on the heart
5FU can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.
You may develop heart problems even if these test results are normal. Very rarely, 5FU causes heart failure or a heart attack. The risk of this happening is very low. It happens to less than 1 in 100 (1%) of people who have 5FU. But it is important that you know about it.
Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- breathlessness
- dizziness
- changes to your heartbeat (palpitations)
- swollen feet and ankles.
Always call 999 if you have:
- chest pain, pressure, heaviness, tightness or squeezing across the chest
- difficulty breathing.
Skin changes
Chemotherapy can affect your skin. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.
This treatment can also:
- cause a rash, which may be itchy
- make your skin darker or lighter in some areas
- make any area treated with radiotherapy become red or sore. If you have white skin the area will become red and if you have black or brown skin the area might become darker
- make you more sensitive to the sun.
Your skin may burn more easily during treatment and for several months after. Use a sun cream of at least SPF 30. SPF stands for sun protection factor. Cover up with clothing and wear a hat.
Always tell your doctor, nurse or pharmacist about any skin changes . They can give you advice or prescribe creams or medicines to help. Changes to your skin are usually temporary and improve when treatment ends.
Nail changes
This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. These changes usually disappear as the nails grow out after treatment. Sometimes nails can become loose or fall out.
If the skin around your nails becomes sore and swollen, contact the hospital straight away on the 24-hour number. These might be signs of an infection.
Tips to look after your nails:
- Keep your nails clipped short and clean.
- Avoid using very hot water when washing your hands or bathing.
- Moisturise your nails and cuticles regularly.
- It is okay to use water-based nail polish - but ask your cancer team if you want to use false nails, gels or other acrylics during treatment.
- Wear gloves to protect your nails when working in the house or garden.
- If your toenails are affected, wear well-fitting shoes, or shoes with open toes to cushion them.
Tell your doctor or nurse about any changes to your nails. They can give you advice or arrange for you to see a podiatrist. They are a foot care specialist.
Effects on nervous system
This treatment can affect the nervous system. This is rare but may need urgent treatment. Contact the hospital straight away on the 24-hour number or go to the hospital if you have:
- mood changes (such as feeling excitable or agitated)
- difficulty with speech, balance, movement or coordination
- a headache that does not get better
- drowsiness or confusion
- changes in eyesight
- seizures (fits).
Other information
Driving and using machines
If you feel sick, have blurred vision or notice any effects on your nervous system, do not drive or use machines. Your doctor can tell you more about this.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- throbbing pain or swelling in a leg or arm
- reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
- suddenly feeling breathless or coughing.
Always call 999 if you have:
- chest pain
- difficulty breathing.
A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.
Other medicines
Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop, pharmacy or online
- vitamins or supplements
- herbal drugs and complementary or homeopathic therapies
- recreational drugs – for example, cannabis.
Vaccinations
Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.
If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.
It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.
Contraception
Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:
- what types of contraception to use
- how long after treatment you should continue to use contraception.
Breastfeeding
You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk.
Your doctor, nurse or pharmacist can give you more information.
Fertility
Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
Sex
It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or semen. If you have sex in the first few days after treatment, your cancer team will usually advise using condoms or a dental dam to protect your partner.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.
If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
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