SIDE EFFECTS: See also Warning section. Nausea, vomiting, diarrhea, tiredness, loss of appetite, weakness, and fever may occur. If these effects persist or worsen, tell your doctor or pharmacist promptly. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. Diarrhea can also be severe and may require treatment in a hospital. Tell your doctor right away if you have any diarrhea with fever, diarrhea with stomach pain, or diarrhea 3 or more times a day. Temporary hair loss may occur. However, normal hair growth should return after treatment has ended. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: lung problems (such as cough, shortness of breath). This medication may affect male and female fertility. Consult your doctor for more details. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using topotecan, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood/bone marrow disorders, kidney problems. This drug may make you feel weak or tired. Alcohol or marijuana can make you more tired. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana. Topotecan can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details. Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose). To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports. Older adults may be more sensitive to the effects of this drug, especially diarrhea and decreased bone marrow function. This medication is not recommended for use during pregnancy. It may harm an unborn baby. Discuss reliable forms of birth control with your doctor. If you become pregnant or think you may be pregnant, tell your doctor right away. Female patients should use reliable forms of birth control during and for 1 month after treatment with topotecan. Male patients and their female partner should use reliable forms of birth control during and for 3 months after treatment with topotecan since this medication may damage sperm. It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Other medications can affect the removal of topotecan from your body, which may affect how topotecan works. Examples include azole antifungals (such as ketoconazole), cyclosporine, macrolide antibiotics (such as erythromycin), HIV protease inhibitors (such as ritonavir), among others.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.