3.7.3 Parent Handout: Prevention and Management of Irinotean induced diarrhea

Dear Parent/Patient:

Your child is receiving Irinotecan as part of their chemotherapy.  This drug can cause severe diarrhea. The following tips can help your child cope with diarrhea:

1) BUY LOPERAMIDE (also known as Imodium®). You should have this medication at home before your child’s first chemotherapy treatment.  You can get this at any local pharmacy.  Loperamide comes in a variety of forms (liquid, caplets, dissolving tablets).  Please read the label CAREFULLY and BRING your MEDICATION to your FIRST chemotherapy appointment.

2) Please document your child’s bowel habits BEFORE treatment starts. This is so you can compare your child’s bowel habits before and after treatment, and help you recognize diarrhea promptly.  Please record the following:

________ bowel movements per day OR ____________ bowel movements per week

Stool usually appears:

______HARD    _____ LOOSE   _____FORMED   _____SOFT   _____WATERY 

3) AFTER your child’s chemotherapy has started, please record the following:

Number of bowel movements per day______Is this an increase in number of stools?_____

When did it start? ____________

Stool appears: HARD____   LOOSE____  FORMED____ SOFT_____ WATERY______

4) AFTER your child’s chemotherapy has started, at the FIRST SIGN of diarrhea be sure to           START taking LOPERAMIDE. Please give as follows and ensure your MD/NP has completed     this section:

Child’s weight ______kg

First dose (please give after the FIRST loose stool): __________

Then give:    _________ EVERY __________ hours while awake

AND _________ EVERY _________ while sleeping

DO NOT EXCEED ______________ PER DAY

*ONCE DIARRHEA has stopped for 12 hours, you can STOP giving loperamide

*if using liquid form of medication please confirm dosing with your MD/NP as concentration of medication may differ depending on what brand

5) Call your doctor or oncology team if your child is still having diarrhea after taking loperamide for 24 hours, or if there is fever, nausea/vomiting, or any questions.

OTHER HELPFUL TIPS:

• Drink plenty of Gatoraide, broth, clear soups or water
• Eat small meals that are gentle on your stomach. Ex: bananas, rice, applesauce, toast, white meat chicken (no skin), canned fruits
• Avoid fatty, greasy foods, spicy foods, high fiber foods, beans, or foods containing dairy
• Avoid milk, coffee, alcohol, or drinks containing caffeine
• Ensure perianal area is kept clean and dry to prevent irritation
• Clean perianal area with mild soap and warm water after each bowel movement
• Allow skin to dry completely, may use a barrier cream for comfort/protection
• Avoid use of laxatives (peg flakes, lactulose, senekot, docusate)

Printable document: 3.7.3 Parent Handout Prevention and Management of Irinotean induced diarrhea.