Onivyde (irinotecan liposome injection) is a prescription drug used to treat pancreatic cancer in certain situations. Onivyde can cause side effects that range from mild to serious, including severe diarrhea and extremely low neutrophil count.

Specifically, Onivyde is used in adults for the following:

  • as a first-line treatment for metastatic pancreatic cancer, used in combination with oxaliplatin, fluorouracil, and leucovorin
  • to treat metastatic pancreatic cancer that has worsened after treatment with gemcitabine, used in combination with the drugs fluorouracil and leucovorin

The active ingredient in Onivyde is irinotecan. The drug comes as a liquid solution for intravenous (IV) infusion (an injection into a vein given over time). These infusions are given in a healthcare facility and usually last 90 minutes.

Keep reading to learn about the common, mild, and serious side effects that Onivyde can cause. For a general overview of the drug, including details about its uses, see this article.

Onivyde has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Side effects explained” section below.

Some people may experience mild to serious side effects during Onivyde treatment. Examples of the drug’s commonly reported side effects include:

  • diarrhea*
  • fatigue
  • nausea
  • vomiting
  • appetite loss

* Onivyde has a boxed warning about the risk for severe diarrhea. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about this side effect, see the “Side effects explained” section below.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Onivyde, visit MedWatch.

Mild side effects have been reported with Onivyde. These include:

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or bothersome, talk with your doctor or pharmacist. And do not stop treatment with Onivyde unless your doctor recommends it.

Onivyde may cause mild side effects other than those listed above. See the drug’s prescribing information for details.

Serious side effects have been reported with Onivyde. These include:

If you develop serious side effects during Onivyde treatment, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* To learn more about this side effect, see the “Side effects explained” section below.

Allergic reaction

For some people, Onivyde can cause an allergic reaction, though this was not common in the drug’s studies.

In general, symptoms of an allergic reaction can be mild or serious. You can learn more about possible symptoms in this article.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They can suggest ways to help manage your symptoms and can determine whether you should continue Onivyde treatment.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Onivyde, they may have you switch to a different treatment.

Learn more about some of the side effects Onivyde may cause.

Boxed warning: Risk of severe diarrhea

Onivyde has a boxed warning about the risk of severe diarrhea. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Diarrhea was common in studies of Onivyde. Mild diarrhea was more common than severe diarrhea. But severe diarrhea caused by Onivyde can be life threatening in extreme cases.

Severe diarrhea caused by Onivyde follows one of two patterns:

  • Early diarrhea: diarrhea begins within 24 hours of receiving Onivyde plus chemotherapy
  • Late diarrhea: diarrhea begins more than 24 hours after receiving Onivyde plus chemotherapy

It’s possible to experience both early and late diarrhea from Onivyde treatment.

To help lower your risk of severe diarrhea, it’s recommended that you do the following during Onivyde treatment:

  • Stop consuming products that contain lactose, such as milk and cheese.
  • Consume a low fat diet.
  • Stay hydrated by drinking plenty of water.

Because of this risk, you should not receive Onivyde treatment if you have a blockage in your intestines.

What might help

If you have diarrhea during Onivyde treatment, talk with your doctor immediately. They’ll likely recommend temporarily pausing Onivyde treatment while you’re having diarrhea symptoms. And they can recommend a treatment for these symptoms, such as:

  • prescribing atropine for early diarrhea symptoms
  • prescribing loperamide (Imodium) for late diarrhea symptoms
  • prescribing other drugs, such as diphenoxylate plus octreotide or atropine, for diarrhea that doesn’t improve within 48 hours

Once your diarrhea symptoms resolve, your doctor will likely reduce your Onivyde dosage before continuing your treatment. Or they may suggest exploring treatment options other than Onivyde.

Boxed warning: Risk of severe neutropenia

Onivyde has a boxed warning about the risk of severe neutropenia. This is a low level of neutrophils, a type of white blood cell that fights infection.

Neutropenia was common in studies of Onivyde. Mild or moderate neutropenia was more common than severe neutropenia. But this condition can be life threatening in extreme cases.

Symptoms of severe neutropenia can include:

  • fever
  • gingivitis (inflammation in your gums)
  • infection, such as pneumonia or a sinus infection (symptoms vary based on the type of infection)

What might help

During treatment with Onivyde, your doctor will order tests to check your blood cell counts, including your neutrophil level. If your neutrophil count is low, your doctor will pause your Onivyde treatment until this resolves. If your neutropenia is severe, your doctor will likely have you resume your Onivyde treatment at a lower dose.

Interstitial lung disease

While rare, interstitial lung disease was reported in people taking Onivyde in studies. This side effect can be serious or even life threatening.

Interstitial lung disease causes scarring in your lungs. Symptoms can include:

Factors that increase your risk of interstitial lung disease from Onivyde include:

What might help

If you develop symptoms of interstitial lung disease, let your doctor know right away. They’ll want to evaluate your symptoms in person. If they suspect you do have this condition, they’ll likely stop your Onivyde treatment.

Keeping track of side effects

During your Onivyde treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start a new drug or combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were receiving when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how your symptoms affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Taking notes and sharing them with your doctor will help them learn more about how Onivyde affects you. They can then use this information to adjust your treatment plan if needed.

Below is important information you should consider before starting Onivyde.

Boxed warning: Risk of severe diarrhea and severe neutropenia

Onivyde has boxed warnings. A boxed warning is the most serious warning from the FDA. For details, see the “Side effects explained” section above.

Other warnings

Onivyde can sometimes cause harmful effects in people with certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether Onivyde is a good treatment option for you. Talk with your doctor about your health history before starting this medication. Be sure to tell them if any of the following factors apply to you:

  • breathing or lung condition, such as COPD
  • chronic (long-term) diarrhea
  • blood cell problem, such as low white blood cell count
  • past treatment with radiation therapy
  • previous allergic reaction to Onivyde
  • pregnancy
  • breastfeeding
  • alcohol consumption

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.