Comprehensive medication guide to Hycamtin including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$50–$75 copay per fill for most insured patients; approximately 96% of insurance plans cover the most common (generic) version of Hycamtin. Prior authorization is typically required. Medicare coverage varies by plan.
Estimated Cash Pricing
$122–$1,250+ per 4 mg vial depending on brand vs. generic; generic topotecan IV starts at approximately $122 per vial, while brand Hycamtin IV runs $1,250+. A full 5-day treatment cycle of brand Hycamtin can cost $8,000–$12,000 without insurance.
Medfinder Findability Score
60/100
Summarize with AI
On this page
Hycamtin is the brand name for topotecan hydrochloride, a prescription chemotherapy medication first approved by the FDA in 1996. It belongs to a class of drugs called topoisomerase I inhibitors — agents that interfere with the DNA copying process inside cancer cells, causing them to die. Hycamtin is derived from camptothecin, a natural compound originally extracted from the bark of the Camptotheca acuminata ("Happy Tree") plant.
Hycamtin is FDA-approved for three specific cancer indications: metastatic ovarian cancer (after prior chemotherapy failure), small cell lung cancer (SCLC) that has relapsed at least 60 days after first-line platinum-based chemotherapy, and Stage IV-B or recurrent cervical cancer (in combination with cisplatin). Both intravenous (IV) and oral capsule formulations are available.
Brand-name Hycamtin is manufactured by Novartis Pharmaceuticals Corporation. FDA-approved generic versions of topotecan are available from multiple manufacturers including Mylan, Teva, and Sun Pharmaceutical. Generic topotecan is therapeutically equivalent to brand-name Hycamtin and significantly less expensive.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Hycamtin (topotecan) works by targeting topoisomerase I, a nuclear enzyme that cancer cells need to copy their DNA during division. Normally, topoisomerase I relieves torsional stress in the DNA double helix by making a temporary cut in one strand, allowing the DNA to unwind and rotate, and then re-joining the cut. This is essential for DNA replication.
Topotecan intercalates into the DNA at the point where topoisomerase I has made its cut, trapping the enzyme in what is called the cleavage complex — physically preventing it from re-joining (ligating) the cut strand. When the cell's DNA-replication machinery collides with this trapped complex, it converts the single-strand break into a lethal double-strand break. Human cells cannot efficiently repair double-strand breaks, so the cell triggers apoptosis (programmed cell death).
Because this mechanism only causes damage during active DNA replication, rapidly dividing cancer cells are particularly vulnerable. This also explains why bone marrow cells — which divide frequently to produce blood cells — are a major site of "collateral damage," leading to the drug's primary toxicity: myelosuppression (suppression of blood cell production).
4 mg (free base) — IV vial (lyophilized powder for injection)
Single-dose vial; reconstituted and administered IV over 30 min daily x 5 days per 21-day cycle
0.25 mg — Oral capsule
White/yellowish-white capsule; swallow whole, do not open or chew; refrigerate at 36–46°F
1 mg — Oral capsule
Pink capsule; swallow whole, do not open or chew; refrigerate at 36–46°F
Hycamtin is a specialty chemotherapy drug that requires special handling, storage, and dispensing protocols. It is not stocked at standard retail pharmacies like CVS or Walgreens. The IV formulation is administered in hospital infusion centers and oncology clinics; the oral capsule form is dispensed only through specialty pharmacies. As of 2026, there is no active nationwide FDA-listed shortage of topotecan — generic topotecan IV is available from multiple manufacturers. However, patients can experience real-world difficulty accessing it due to insurance prior authorization requirements, limited specialty pharmacy networks, and the oral capsule's niche stocking patterns.
If you are having trouble locating Hycamtin or generic topotecan at a pharmacy near you, medfinder calls pharmacies near your location to check which ones have it in stock and can fill your specific prescription. Results are texted directly to you, eliminating the need to call pharmacies yourself.
Hycamtin (topotecan) is not a DEA-scheduled controlled substance, so there are no DEA licensing requirements specifically for prescribing it. However, as a cytotoxic chemotherapy agent, it is in practice prescribed exclusively by oncology specialists with expertise in chemotherapy regimen selection, toxicity management, and the monitoring required throughout treatment.
Prescriber types who typically order Hycamtin include:
Medical oncologists — the most common prescribers for all three approved indications
Gynecologic oncologists — for ovarian cancer and cervical cancer indications
Thoracic oncologists — for small cell lung cancer
Hematologist-oncologists — for general oncology cases
Nurse practitioners (NPs) and physician assistants (PAs) — working within oncology practices under physician supervision, depending on state law
The IV formulation of Hycamtin is only administered in clinical infusion settings — patients do not self-administer IV topotecan. The oral capsule formulation is prescribed for home use (SCLC indication only). Some oncology practices offer telehealth follow-up visits for patients stable on oral Hycamtin, but initial treatment decisions and monitoring require in-person care.
No. Hycamtin (topotecan) is not a DEA-scheduled controlled substance and does not fall under the Controlled Substances Act. There are no special DEA licensing requirements to prescribe it, no restrictions on refills due to scheduling, and no limit on prescription quantities imposed by scheduling law.
However, Hycamtin is still subject to strict prescribing and dispensing controls due to its nature as a cytotoxic chemotherapy drug. It must be prescribed by a licensed prescriber familiar with its indications and toxicity profile, dispensed by pharmacies equipped to handle cytotoxic agents, and monitored with regular blood count assessments throughout treatment. These controls exist for patient safety, not due to controlled substance scheduling.
Hycamtin carries a boxed warning for severe myelosuppression. Common side effects include:
Severe neutropenia (Grade 4 in 78% of IV patients)
Anemia (Grade 3/4 in 37%)
Thrombocytopenia (Grade 4 in 27%)
Nausea and vomiting
Fatigue and weakness
Diarrhea (more common with oral form)
Alopecia (hair loss)
Headache
Serious side effects requiring immediate medical attention:
Fever ≥100.4°F during neutropenia — possible infection/sepsis emergency
Neutropenic enterocolitis (typhlitis) — fever, neutropenia, abdominal pain
Interstitial lung disease (ILD) — new dry cough, chest pain, shortness of breath
IV extravasation — pain, redness, or swelling at infusion site
Embryo-fetal toxicity — teratogenic; contraindicated in pregnancy
Know what you need? Skip the search.
Lurbinectedin (Zepzelca)
FDA-approved for relapsed SCLC after platinum-based chemotherapy; IV every 3 weeks; ORR ~35%
Irinotecan (Camptosar)
Topoisomerase I inhibitor; used off-label for relapsed SCLC; FDA-approved for colorectal cancer
Etoposide (VePesid)
Topoisomerase II inhibitor; used in first-line SCLC regimens with cisplatin or carboplatin
Carboplatin + Etoposide (rechallenge)
Preferred re-challenge regimen for platinum-sensitive SCLC relapse per NCCN guidelines
Prefer Hycamtin? We can find it.
Cyclosporine (Neoral, Sandimmune)
majorP-gp inhibitor; significantly increases oral topotecan levels. Avoid concomitant use.
Ketoconazole
majorPotent P-gp and CYP3A4 inhibitor; increases topotecan exposure. Avoid or use alternative.
Nilotinib (Tasigna)
majorP-gp inhibitor; increases topotecan levels. Avoid or use alternative drug.
Abiraterone (Zytiga)
majorP-gp inhibitor; increases topotecan levels. Avoid or use alternative.
Felodipine (Plendil)
majorP-gp inhibitor; increases topotecan levels. Avoid with oral topotecan.
G-CSF (filgrastim, pegfilgrastim)
moderateProlongs neutropenia if started before Day 6 of cycle. Do not initiate until 24 hours after last topotecan dose.
Cisplatin
moderateCombination increases myelosuppression severity. Monitor CBC closely in cervical cancer regimen.
Olaparib (Lynparza)
moderatePharmacodynamic synergism; both suppress bone marrow. Monitor closely.
Hycamtin (topotecan) is an important second-line chemotherapy option for patients with relapsed ovarian cancer, platinum-sensitive small cell lung cancer, and advanced cervical cancer. While the drug itself is not in active nationwide shortage as of 2026, access challenges remain real for patients — particularly for the oral capsule form — due to specialty pharmacy requirements, prior authorization processes, and high costs without insurance assistance.
Key takeaways for Hycamtin patients: Ask your oncologist about generic topotecan (it's therapeutically equivalent and significantly cheaper); work with your care team to initiate prior authorization early; explore patient assistance programs like the PAN Foundation and HealthWell Foundation if cost is a barrier; and don't skip doses — contact your oncology team immediately if you have trouble accessing your medication.
If you're struggling to find a pharmacy with Hycamtin in stock, medfinder can help. medfinder calls pharmacies near you to identify which ones have topotecan available and can fill your prescription — so you can focus on your treatment, not the pharmacy search.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini