8 Topotecan Side Effects You Should Know About

Chemotherapy. Though often thought of as a uniform type of cancer treatment, chemotherapy treatments are a diverse family of medications that each have their own skill set to offer.

Topotecan (Hycamtin) is one versatile chemotherapy medication. It treats certain types of small cell lung cancer, ovarian cancer, and cervical cancer. What’s more, it’s available as both a capsule taken by mouth and an intravenous (IV) infusion given into a vein. 

Alongside this flexibility in use, topotecan can affect your body in a few different ways. Topotecan works to treat cancer by interfering with the growth of cancer cells. But it can also harm healthy (non-cancerous) cells in your body. This is often what causes side effects.

If you or a loved one are new to topotecan, there are a few side effects that are important to look out for. For some side effects, your healthcare provider can recommend medications or tips to help manage them. For others, additional medical care may be needed. Side effects may also vary depending on your type of cancer and chemotherapy regimen.

Below, we’ll discuss eight side effects to know before starting topotecan.

1. Feeling tired or weak

It's common to feel tired or weak while being treated with chemotherapy, and topotecan is no exception. While receiving topotecan, you may feel like you have less energy than you did before.

To help with fatigue, you may try light exercises — like short walks or yoga — to help with boosting energy. If possible, working your way up to 3 to 5 hours of moderate exercise per week could be beneficial. It's also important to stay well hydrated and nourished to help keep energy levels up. If you feel sleepy, you shouldn’t drive or operate heavy machinery.

2. Nausea and vomiting

Nausea (and sometimes vomiting) is another common topotecan side effect. Your healthcare provider will likely give you anti-nausea medications, like ondansetron (Zofran) or dexamethasone, that you can take before and after receiving topotecan.

It’s usually easier to prevent nausea and vomiting than to treat it after it happens. So it's important to follow your healthcare provider’s directions for taking anti-nausea medications before chemotherapy appointments, and as needed. If nausea and vomiting is still an issue, talk to your healthcare provider about other strategies or medications you can try to help manage it.

If you feel sick after taking topotecan, it’s best to avoid large meals or foods that may upset your stomach, like spicy or greasy foods. You can try eating bland foods, like clear broths, toast, or oatmeal. It’s also important to drink enough fluids, as persistent vomiting can put you at risk for dehydration. If you feel sick or vomit multiple times in a day, you should contact your healthcare provider immediately.

3. Diarrhea

Topotecan may cause diarrhea. Diarrhea may be more severe if you take the oral capsule form of topotecan or are an older adult. In some cases, diarrhea can become life-threatening.

If you develop diarrhea after taking topotecan, make sure to let your healthcare provider know at your next appointment. They can recommend antidiarrheal medications, like loperamide (Imodium A-D), to help control it. Make sure to also drink enough fluids — diarrhea may also cause dehydration. 

However, if your diarrhea remains uncontrolled or gets worse, contact your healthcare provider immediately. They may recommend lowering your dose of topotecan or stopping it altogether.

4. Hair loss

Your hair may become thinner after starting topotecan. This is because topotecan and other chemotherapies can damage hair follicles. It's also possible to lose all the hair on your head and hair on other areas of your body. This usually happens after your first few treatments with topotecan. Hair loss with topotecan is typically temporary and grows back after treatment ends.

What’s more, your scalp may become sensitive after hair loss. You should keep your scalp protected or covered when out in the sun or around cold air. 

Understandably, hair loss can be a tough thing to experience. Make sure to speak with your healthcare provider about resources for coping with hair loss.

5. Stomach pain

While taking topotecan, you may experience pain or discomfort in your stomach. It's also possible to have indigestion, bloating, or feel the need to pass gas. It’s less common than other gut-related side effects, but it’s still possible

If you have stomach pain that does not go away or gets worse, let your healthcare provider know right away. 

6. Blood cell effects

Topotecan may cause myelosuppression. This means your bone marrow may make fewer red blood cells, white blood cells, and platelets than normal. This can make you feel tired and put you at a higher risk for bleeding and infection.

Some signs of lower platelets include:

• Bruising easier

• Bleeding that takes longer to stop

• Bleeding from the gums or nose

• Red spots on the skin

• Blood in the stool (may look black or tarry)

• Blood in the urine

Symptoms of fewer red blood cells (anemia) include:

• Feeling tired or weak

• Feeling out of breath

• Feeling dizzy or lightheaded

• Pale skin

To help check for these blood changes, your healthcare provider should monitor your blood work throughout treatment with topotecan. If blood cell counts become too low, you may need a red blood cell or platelet transfusion to help manage symptoms. And if myelosuppression is severe, your healthcare provider may recommend lowering your dose of topotecan or stopping treatment altogether.

7. Infection

As mentioned, topotecan can lower the number of white blood cells in your blood. Since white blood cells are needed to help fight infections, this can raise your risk of getting sick. 

When your immune system is weaker, you’re at a higher risk of severe infection. So if your white blood cell levels drop too low and are accompanied by a fever, it can be a medical emergency. If you have signs or symptoms of an infection, it's important to get treated as soon as possible. Other possible symptoms include:

• Chills

• Cough

• Sore throat

• Pain or trouble passing urine

Preventative steps are also helpful. Your healthcare provider should monitor your white blood cell counts while receiving topotecan. If your white blood cell count is too low, your healthcare provider may delay your treatment or lower your dose until your white blood cell counts recover. It’s also helpful to limit your contact with people who are sick (or who have been in contact with a sick person). 

8. Shortness of breath

Rarely, topotecan can cause changes to the lungs. It can put you at risk for developing a condition called interstitial lung disease (ILD). You should let your healthcare provider know if you develop a cough, wheezing, or shortness of breath while receiving topotecan. You may be at a higher risk of developing lung problems like these if you have a history of pulmonary fibrosis, lung cancer, or have received radiation to the chest.

If you develop lung problems while receiving topotecan, your healthcare provider may recommend stopping this treatment.

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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