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Trifluridine and tipiracil is a combination medication used to treat metastatic gastric, gastroesophageal, and colorectal cancer. It may also be prescribed for other conditions.

Dose and Schedule

It is essential to take Lonsurf as instructed to ensure your treatment is as effective as possible. Below are key points to remember:

  • Your dose is determined based on various factors, including your height, weight, overall health, and diagnosis.
  • You should take your Lonsurf twice daily on Days 1-5 and Days 8-12 of each 28-day cycle. You will then have a two-week break before starting the next cycle.
  • Lonsurf should be taken twice daily with water, within one hour after your morning and evening meals, at the same time each day.
  • Lonsurf should be swallowed whole and not crushed, cut, or dissolved. If you have difficulty swallowing Lonsurf, consult your doctor for alternative options.
  • If you miss a dose, do not take an extra dose or two doses at once. Simply take the next dose at the regularly scheduled time. Be sure to note any missed doses and inform your doctor at your next appointment.
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Drug and Food Interactions

  • Lonsurf interacts with many drugs. Please inform your doctor if you are taking over-the-counter medications, vitamins, or herbal products.
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Storage and Handling

  • Store Lonsurf at room temperature (below 25°C) in a dry location, away from light.
  • Keep Lonsurf out of reach of children and pets.
  • Do not remove Lonsurf from its packaging until it is time to take it.
  • Whenever possible, administer Lonsurf to yourself.
  • If a family member, friend, or caregiver needs to administer Lonsurf, they should wear gloves when handling the tablets.
  • If you use a pill box or reminder, keep a separate one for Lonsurf. Do not mix other medications with Lonsurf. The person filling the box should wear gloves (gloves are not necessary if you are filling the box yourself). After use, wash the box with soap and water before refilling, and wash your hands thoroughly afterward.
  • If you have unused Lonsurf, do not dispose of it in the trash or flush it down the toilet. Return all unused medication to your practice for proper disposal.
  • When travelling, place your Lonsurf in a sealed plastic bag.
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Side Effects of Lonsurf

Below are common side effects that may affect more than one-third of patients taking Lonsurf. Please note, you may not experience these side effects.

Decreased white blood cells (WBCs) and increased risk of infectionA blood test will be done two weeks after starting Lonsurf and before starting a new cycle to monitor your white blood cells, haemoglobin, platelet count, and kidney function. Take the following precautions to protect yourself from infection:
– Wash your hands often, especially before eating and after using the bathroom.
– Avoid crowds and individuals with fevers, flu, or other infections.
– Maintain good personal hygiene.
Signs of infection:– Fever (temperature over 38°C)
– Chills
– Sore throat
– Burning sensation while urinating
Decreased haemoglobin (part of the red blood cells that carry iron and oxygen)Low haemoglobin may make you feel more tired or fatigued.
– Aim for 7–8 hours of sleep per night.
– Balance work and rest.
– Stay as active as possible, but rest when needed.
– You might notice you are paler than usual.
Low platelet count and increased risk of bleedingWhen your platelet count is low, you may bruise or bleed more easily.
– Be cautious to avoid bruises, cuts, or burns.
– Blow your nose gently, and avoid picking your nose.
– Brush your teeth gently with a soft toothbrush and maintain good oral hygiene.
– When shaving, use an electric razor instead of a blade.
– Use a nail file instead of nail clippers.
Contact us if you experience any of the following bleeding symptoms:
– A bloody nose lasting more than 5 minutes despite pressure
– A cut that continues to bleed despite pressure
– Gums that bleed excessively when brushing or flossing
If you experience any severe headaches, blood in your urine or stool, or cough up blood, visit the emergency room immediately.
Nausea or vomiting– Eat and drink slowly.
– Drink 8–10 glasses of water or fluids daily unless your doctor advises otherwise.
– Eat smaller, more frequent meals instead of large ones.
– Avoid spicy, fried, and greasy foods.
– Rest after meals and avoid vigorous exercise immediately after eating.
Fatigue– You may feel more tired than usual.
– Stay active, but take rest when needed.
– Try to do activities when you feel most energetic.
Diarrhoea (loose and/or urgent bowel movements)– Drink 8–10 glasses of water or fluids daily unless your doctor advises otherwise.
– Eat smaller, more frequent meals.
– Eat bland, low-fibre foods (e.g., bananas, rice, chicken, potatoes).
– Avoid high-fibre foods (e.g., raw vegetables, fruits, whole grains).
– Avoid gas-causing foods (e.g., beans, broccoli, onions).
– Avoid lactose-containing foods (e.g., milk, yogurt).
– Try grated apple that has stood until brown, or porridge made with Maizena.
Decreased appetite or weight lossTalk to your doctor if you notice any sudden weight loss while taking Lonsurf.
When you feel like eating:
– Eat smaller, frequent meals.
– Keep snacks nearby for easy access.
– Consider liquid nutritional supplements.
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Handling Body Fluids and Waste

Because Lonsurf remains in your body for several days after administration, the drug may be present in your urine, stool, sweat, or vomit. Follow these instructions every day while taking Lonsurf to keep yourself, loved ones, and the environment safe:

  • Pregnant women should avoid contact with anything that may be soiled with body fluids from the patient.
  • You may use your usual toilet, septic tank, and/or sewer. Close the lid and flush twice to ensure all waste is discarded.
  • Clean any toilet surfaces that become soiled with urine, stool, or vomit before others use it.
  • Wash hands thoroughly with soap and water after using the toilet.
  • If using a bedpan, caregivers should wear gloves when cleaning it and wash it with soap and water daily.
  • For bladder or bowel incontinence, use disposable pads, diapers, or sheets to absorb body waste.
  • Wash any exposed skin with soap and water if it comes into contact with body waste or Lonsurf.
  • Wash soiled linens or clothing separately from other laundry, and wash hands with soap and water afterward.
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Pregnancy, Sexual Activity, and Contraception

  • Women should avoid pregnancy while taking Lonsurf, and men should avoid fathering a child during treatment. Both men and women of childbearing potential should use effective contraception during therapy and for at least 6 months after the last dose.
  • Do not breastfeed while taking Lonsurf, and for at least 1 day after the last dose.
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Compiled by: Karin Mouton

Registered Oncology Nurse

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