Diarrhea is a complication of irinotecan-fluorouracil-leucovorin (IFL) regimen. Benson et al reviewed recommendations for management of chemotherapy-induced diarrhea. The authors are from the University of Chicago, M.D. Anderson Cancer Center, Thomas Jefferson University, and several other cancer centers in the United States.



(1) diarrhea

(2) response to loperamide

(3) absolute neutropenia (absolute neutrophil count < 500 per µL)

(4) fever

(5) concurrent radiation therapy


Oral loperamide is started (progressing up to a dose of 2 mg q2h) if:

(1) there is mild to moderate chemotherapy-induced diarrhea

(2) the patient is receiving radiation therapy


Oral loperamide stopped if:

(1) the diarrhea has stopped for >= 12 hours.

(2) the diarrhea persists while receiving loperamide for > 48 hours


Oral fluoroquinolone is given if:

(1) diarrhea persists on loperamide > 24 hours (treat for 7 days)

(2) presence of fever and persistent diarrhea (treat until fever and diarrhea resolve)

(3) absolute neutropenia (treat until neutropenia resolves)


All chemotherapy should be discontinued or withheld in the presence of significant diarrhea until the symptoms have resolved for >= 24 hours without antidiarrheal therapy.


The patient should be medically evaluated if the diarrhea persists while receiving loperamide for > 48 hours or if the diarrhea is severe/complicated:

(1) discontinue the oral loperamide

(2) treat with subcutaneous octreotide tid (or other second line antidiarrheal agent)

(3) rehydrate

(4) continue fluoroquinolone therapy

(5) discontinue cytotoxic chemotherapy until symptoms resolve

(6) evaluate for infection, including stool culture

(7) hospitalize if the diarrhea is severe/complicated


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