What are the instructions for teaching a patient on how to take Lonsurf (trifluridine/tipiracil), including dosing schedule, administration, monitoring, and management of side effects?

Lonsurf (Trifluridine/Tipiracil) Patient Teaching Guide

Teach patients to take Lonsurf exactly 35 mg/m² twice daily with food on days 1-5 and 8-12 of each 28-day cycle, swallowing tablets whole without crushing, and to never double-dose if they vomit or miss a dose. 1

Dosing Schedule and Administration

Standard Dosing Regimen

• Dose: 35 mg/m² orally twice daily 2
• Schedule: Days 1-5 and days 8-12 of each 28-day cycle 2
  • 5 days of treatment
  • 2 days rest
  • 5 more days of treatment
  • 14 days rest before next cycle

Critical Administration Instructions

• Always take with food - this is mandatory for proper absorption 1
• Swallow tablets whole - do not crush, chew, or break 1
• Two strengths available: 15 mg/6.14 mg and 20 mg/8.19 mg tablets - your provider may prescribe both strengths to achieve your exact dose 1
• Caregivers must wear gloves when handling tablets 1
• Wash hands after handling tablets 1

Missed or Vomited Doses

If you vomit immediately after taking a dose or miss a dose entirely, do NOT take extra tablets to make up for it - call your healthcare provider for specific instructions 1. This is critical to avoid overdosing.

Monitoring Requirements

Blood Count Monitoring

The most serious risk with Lonsurf is severe bone marrow suppression causing dangerously low blood counts 2. Expect:

• Neutropenia (low white blood cells): 38% of patients experience this 2
• Leukopenia: 21% of patients 2
• Anemia: Common occurrence 2
• Febrile neutropenia: 4% risk 2

You will need regular blood tests before each cycle and potentially during cycles to monitor for these complications 3, 4.

Side Effect Management

Most Common Side Effects (When Used Alone)

In order of frequency 1:

1. Low blood counts (most common and serious)
2. Tiredness and weakness
3. Nausea
4. Decreased appetite
5. Diarrhea
6. Vomiting
7. Stomach pain
8. Fever

When Combined with Bevacizumab

Additional concerns include 1:

• Abnormal liver function tests
• Low sodium levels in blood

Managing Specific Side Effects

Nausea/Vomiting/Diarrhea:

• Report if severe or persistent 1
• Anti-nausea medications can be prescribed
• Maintain hydration

Fatigue:

• Extremely common - plan activities accordingly 5
• Rest when needed

Neutropenia Management:

• Watch for fever, chills, or signs of infection
• Fever with low white counts is a medical emergency - go to ER immediately
• Some patients may receive G-CSF (growth factor injections) to prevent severe neutropenia, typically starting around day 15 of the cycle 6

Dose Modifications

Your provider may reduce your dose or delay cycles if side effects are severe 3, 4. This is standard practice and helps maintain your safety while continuing treatment.

Special Precautions

Pregnancy and Contraception

• Can cause severe birth defects 1
• Females: Use effective contraception during treatment and for 6 months after last dose 1
• Males: Use condoms during sex with partners who can become pregnant during treatment and for 3 months after last dose 1
• Notify provider immediately if pregnancy occurs

Breastfeeding

• Do not breastfeed during treatment and for 1 day after last dose 1

Storage and Handling

• Store at room temperature 68°F-77°F (20°C-25°C) 1
• Keep in original bottle when possible
• If removed from original bottle, discard unused tablets after 30 days 1
• Keep out of reach of children 1

Adherence Strategies

Since Lonsurf is completely oral, your adherence is critical to treatment success 3, 5. Strategies to help:

• Use pill organizers or medication tracking apps
• Set alarms for twice-daily dosing
• Keep a treatment calendar marking on/off days
• Have a caregiver help with medication management if needed
• Report side effects early so they can be managed before they worsen

When to Call Your Provider Immediately

• Fever (especially with known low white blood cell counts)
• Severe or persistent nausea, vomiting, or diarrhea 1
• Signs of infection (chills, cough, burning with urination)
• Unusual bleeding or bruising
• Severe fatigue preventing daily activities
• Any new or worsening symptoms

Clinical Context

Lonsurf is used for metastatic colorectal cancer that has progressed after standard chemotherapy regimens 7, 2. It improved overall survival by approximately 2 months compared to placebo in the pivotal RECOURSE trial (7.1 vs 5.3 months) 2. While this may seem modest, it provides meaningful benefit in quality of life and survival for patients with limited remaining options 7.

The key to successful treatment is maintaining dose intensity while managing side effects proactively 3, 4. Work closely with your oncology team, report symptoms early, and don't skip doses without consulting your provider.