Irinotecan with fluorouracil (5FU) and folinic acid (FOLFIRI)
Irinotecan with fluorouracil (5FU) and folinic acid is a chemotherapy treatment used to treat bowel cancer. It is sometimes called FOLFIRI, which is the name we use in this information.
This information is best when read with our general information about chemotherapy and bowel cancer.
The drugs used in FOLFIRIBack to top
FOLFIRI is named after the initials of the drugs used in treatment. The drugs are:
Fluorouracil is often called 5FU, which is the name we use in this information. You might hear folinic acid being called calcium folinate or leucovorin. Folinic acid is not a chemotherapy drug, but it is often given with 5FU, as it has been shown to make it work better.
You will have FOLFIRI in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will also give you anti-sickness (anti-emetic) drugs as an injection into a vein, or as tablets.
Your treatment will be given through one of the following:
- a short, thin tube (cannula) that the nurse puts into a vein in your arm or hand
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
FOLFIRI can be given in different ways. Ask your doctor or nurse to explain how you will be given FOLFIRI. The following is information about two different ways of having FOLFIRI:
On the first day, your nurse will give you irinotecan as a drip (infusion) over two hours, then a drip of folinic acid over two hours. After this, they will give you an injection of 5FU into your cannula or line.
You will then have a drip of 5FU, which takes 20 hours. If you have a cannula, you need to stay in hospital for this part of the treatment. If you have a line, you can have 5FU through a small, portable pump you carry on a belt or in a holster. You can go home once the pump is connected to your line and the drip has started. Your chemotherapy nurse will explain how to look after the pump and what to do if there’s a problem.
On the second day, you have the treatment repeated, but without irinotecan. You will also have your pump changed. A nurse will disconnect it when your treatment is finished on the third day. You may need to go back to the hospital to have this done. Sometimes a district nurse can do this at home. If you have your treatment in hospital, you can go home when your 5FU is finished.
You have a rest period with no chemotherapy for the next 11 days. This completes a cycle of your chemotherapy treatment.
On the first day, your nurse will give you irinotecan as a drip (infusion) that lasts for 1–2 hours, then a drip of folinic acid over two hours. After this, they will give you an injection of 5FU into your cannula or line.
You will then have a drip of 5FU, which takes 46 hours. If you have a cannula, you need to stay in hospital for this part of the treatment. If you have a line, you can have 5FU through a small portable pump you carry on a belt or in a holster. You can go home once the pump is connected to your line and the drip has started. Your chemotherapy nurse will explain how to look after the pump and what to do if there’s a problem.
A nurse will disconnect the pump when your treatment is finished on the third day. You may need to go back to the hospital to have this done. Sometimes a district nurse can do this at home. If you have your treatment in hospital, you can go home when your 5FU is finished.
You have a rest period with no chemotherapy for the next 11 days. This completes a cycle of your chemotherapy treatment.
When the chemotherapy is being given
Some people might have side effects while they are having chemotherapy.
Rarely, 5FU may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, your nurse will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy, flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
Irinotecan reaction (acute cholinergic syndrome)
Some people may have side effects within 24 hours of having irinotecan. These include:
- tummy cramps
- sweating more than usual
- producing a lot of saliva.
This is called acute cholinergic syndrome. It can usually be prevented or controlled by a drug called atropine. Your nurse will give you atropine as an injection under the skin (subcutaneously). Tell your doctor or nurse if you have any of these symptoms.
Your course of FOLFIRI
You will have chemotherapy as a course of several sessions (cycles) of treatment over a few months. Each cycle of FOLFIRI takes 14 days (two weeks). You will start the next cycle of your treatment after the rest period, which is two weeks after your first injection. The treatment is usually given for 12 cycles over a period of six months. Your doctor or nurse will tell you the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness (anti-emetic) drugs to take. Take all your tablets exactly as your nurse or pharmacist has explained to you.
Possible side effects of FOLFIRI Back to top
We explain the most common side effects of FOLFIRI here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means the drugs will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
More information about these drugs
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your number of white blood cells is still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
FOLFIRI can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
FOLFIRI can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen more than 24 hours after the treatment and can sometimes be severe. If you get diarrhoea, take the anti-diarrhoea drugs you were given straight away. It’s important to take them exactly as your nurse or pharmacist explained and follow any other advice you were given. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If the drugs don’t work quickly, or you still have diarrhoea after 24 hours, contact the hospital straight away on the numbers your nurse gave you. You might need to go to hospital to have fluids through a drip (infusion), or you may need antibiotics.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures in the morning, at night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your hair will thin or you may lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun. Your nurse can give you advice about coping with hair loss.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Changes in the way the liver works
FOLFIRI may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
FOLFIRI may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. 5FU can cause a rash, which may be itchy.
During treatment and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat. Your skin may darken. It will return to its normal colour after you finish treatment.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops.
Less common side effects of FOLFIRIBack to top
Changes in the way the heart works
5FU can affect the way the heart works, but this is usually temporary. You may have tests to see how well your heart is working before treatment. If you have any of the following at any time during or after treatment, tell a doctor straight away:
- pain or tightness in your chest
- changes to your heartbeat.
These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Other information about FOLFIRIBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this.
A clot can cause symptoms such as:
- pain, redness and swelling in a leg
- chest pain.
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact or be harmful when you are having chemotherapy. This includes ones you can buy in a shop or chemist. 5FU interacts with certain drugs, including phenytoin (Epanutin ®), and it may affect the way drugs such as warfarin work. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Chemotherapy may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You might not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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