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abarelix (printable page)

Class: Hormonal therapy

Generic Name: Abarelix
Trade Name: Plenaxis™

For which conditions is this drug approved? Abarelix is FDA approved for the treatment of advanced prostate cancer in patients who are not eligible for a type of hormonal therapy utilizing luteinizing hormone releasing hormone (LHRH) agonists, and who elect not to undergo the surgical removal of the testicles (orchiectomy). Patients must also have one or more of the following: severe pain caused by bone metastasis, blockage of the urinary tract, a high risk for developing neurologic complications from cancer.

Abarelix is approved for use with restrictions for safety reasons; abarelix may cause an allergic-type reaction. Only physicians enrolled in a special plenaxis PLUS program may prescribe this drug. Patients will be asked to sign a form indicating that the risks and benefits of treatment have been explained prior to initiation of treatment.

What is the mechanism of action? Abarelix is referred to as a gonadotropin releasing-hormone (GnRH) antagonist. Gonadotropin releasing hormone is produced by the hypothalamus and stimulates the production of testosterone, a male hormone that is associated with the growth of prostate cancer. Abarelix reduces the ability of GnRH to bind properly to cells, and therefore inhibits the production of testosterone stimulated by GnRH.

How is abarelix typically given (administered)? Abarelix is administered into a muscle (intramuscular).

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with abarelix. Typically, blood will be drawn to check levels of testosterone and prostate specific antigen (PSA) before and during therapy and to monitor functions of some organ systems, such as the liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

Patients are also monitored for an allergic-type reaction that may be caused by abarelix. Patients may be monitored for at least 30 minutes following administration of abarelix for low blood pressure, hives, rash, or signs of fainting. Patients experiencing difficulty breathing, dizziness, a noticeable change in heart rate or rhythm, extreme lethargy, hives or rash should tell their healthcare provider immediately.

What are the common (occur in 30% or more of patients) side effects of treatment with abarelix?

• Hot flushes
• Sleep disturbances
• Pain
• Breast enlargement

What are the less common (occur in 10% to 29% of patients) side effects of treatment with abarelix?

• Breast pain
• Nipple tenderness
• Back pain
• Constipation
• Swelling of the hands and/or feet
• Dizziness
• Headache
• Upper respiratory infection
• Diarrhea
• Urinary tract infection
• Inability to urinate, low urine volume, frequent urination, painful urination
• Nausea
• Fatigue

What are the potential long-term side effects of treatment with abarelix?

• Decrease in bone mineral density (osteoporosis)

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this regimen, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?

• Patients should inform their doctors of any side effects.
• Wear sunscreen and protective clothing; try to minimize sun exposure.
• Drink plenty of fluid. Patients should ask their physician about the amount of liquid to consume during a day.
• Maintain adequate rest and nutrition.
• Eat small meals frequently to help alleviate nausea
• If experiencing hot flushes, patients may wish to dress cool and remain in a cool environment if possible

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems. Abarelix is not indicated for use in women.
• It is important that patients inform their physician of any pre-existing condition (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, etc.), as they may worsen with this drug or can affect the doses administered.
• Patients should let their physician know of any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment. It is important for patients to inform their physician of any medications they are taking for a heart condition.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Signs of an allergic reaction – hives, rash, itching, difficulty breathing, tightness of chest, extreme lethargy, fainting,
• Noticeable change in heart rate or rhythm
• Inability to urinate, pain or burning upon urination, increased frequency of urination, and/or low volumes of urine output
• Swelling of hands or feet, or facial features
• Cough
• Fever
• Dizziness
• Yellowing of the skin or eyes
• Right upper abdominal pain
• Swelling of the feet and ankles accompanied by sudden weight gain

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.

As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment in selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.

DISCLAIMER OF WARRANTIES

CANCERCONSULTANTS.COM SPECIFICALLY DISCLAIMS AND EXCLUDES ALL EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES AS TO QUALITY, ACCURACY (INCLUDING TYPOGRAPHICAL ERRORS), MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE OF THE INFORMATION CONTAINED HEREIN. CANCERCONSULTANTS.COM DISCLAIMS ALL LIABILITY OR DAMAGES ARISING FROM ANY USE OF THE INFORMATION.

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Abraxane™ (printable page)

Class: Chemotherapy

Generic Name: Paclitaxel (pack-li-TACKS-ahl) protein-bound particles for injectable suspension

Trade Name: Abraxane™

How is this drug used? Paclitaxel protein-bound particles for injectable suspension is FDA-approved for the treatment of metastastic breast cancer that has recurred following previous combination chemotherapy therapy or for the treatment of adjuvant breast cancer that has recurred within 6 months of receiving previous combination chemotherapy. Prior therapy for patients treated with paclitaxel protein-bound particles for injectable suspension should have included a class of chemotherapy agents referred to as anthracyclines, unless the patient is medically ineligible for treatment with anthracyclines. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Paclitaxel protein-bound particles for injectable suspension belongs to a group of drugs referred to as taxanes, which are anti-microtubule agents. Paclitaxel protein-bound particles for injectable suspension produces its anti-cancer effects by causing abnormalities in microtubule formation in cells. Microtubules are components of cells that provide structural framework that enables cells to divide and grow. The abnormal microtubule formation caused by paclitaxel protein-bound particles for injectable suspension inhibits cellular replication and ultimately causes cellular death. Paclitaxel protein-bound particles for injectable suspension is unique in that the active form of the drug is bound with albumin, which is a type of protein normally found in the human body. This form of paclitaxel delivers high concentrations of the active ingredient into the cancer cells and reduces the incidence of side effects compared to the original form of the drug.

How is paclitaxel protein-bound particles for injectable suspension given (administered)? Paclitaxel protein-bound particles for injectable suspension is administered intravenously (into a vein) and the dose depends on several factors, including the size of the patient, the particular regimen being used, and the overall health of the patient.

Allergic-type reactions, although rare, may occur following treatment with paclitaxel protein-bound particles for injectable suspension. These reactions are characterized by difficulty breathing, low blood pressure, lightheadedness or dizziness. Patients will be monitored for these reactions.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with paclitaxel protein-bound particles for injectable suspension. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. A neurologic exam that includes reflex testing will be performed, as paclitaxel protein-bound particles for injectable suspension may cause numbness to the feet, hands or extremities. Patients may also have their heart function monitored, as paclitaxel protein-bound particles for injectable suspension has caused abnormalities to the heart, although this is uncommon.

What are the common (occur in 30% or more of patients) side effects of treatment with paclitaxel protein-bound particles for injectable suspension?

Low levels of white blood cells – increases risk of infection
Low levels of red blood cells – increases risk of anemia
Abnormalities on heart rhythm tests
Abnormalities or numbness in sensation to the feet, hands or extremities
Muscle aches or pain
Joint aches or pain
Nausea
Weakness
Hair loss
Changes in liver function tests

What are the less common (occur in 10% to 29% of patients) side effects of treatment with paclitaxel protein-bound particles for injectable suspension?

Infection
Shortness of breath
Fluid retention
Diarrhea
Vomiting

What can patients do to help alleviate or prevent discomfort and side effects?

Pay careful attention to the physician’s instructions and inform the physician of any side effects.
Maintain adequate rest and nutrition.
If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
Wash hands often to reduce the risk of infection.

Eat small, frequent meals in an attempt to relieve nausea.

Are there any special precautions patients should be aware of before starting treatment?

Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
Patients should check with their physician before starting any new drug or nutritional supplement.
Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

Fever
Chills
Sore throat
Cough
Flu or cold-like symptoms
Excessive or prolonged fatigue or weakness
Yellowing of skin or eyes
Changes in heart rate or rhythm
Difficulty in breathing
Chest pain
Excessive or prolonged nausea or vomiting
Severe or prolonged diarrhea
Numbness or changes in sensation in extremities
Severe pain

What is a package insert?A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Accutane® (printable page)

Class: Chemotherapy

Generic Name: Isotretinoin (eye-soe-TRE-ti-noyn), 13-cis-retinoic acid
Trade Name: Accutane®

For which conditions is this drug approved? Isotretinoin is FDA approved for the treatment of acne that is unresponsive to standard therapies. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Isotretinoin is classified as a retinoid. Isotretinoin binds to a protein forming a complex which then binds to a retinoid-dependant receptor. Binding of the complex to DNA then occurs, resulting in changes involved with cell growth, replication, and differentiation. The precise mechanism has not been fully defined.

How is isotretinoin typically given (administered)? Isotretinoin is taken orally, in the form of a capsule and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with isotretinoin. Patients may have blood tests to monitor lipid levels, liver function, sugar (glucose), and CPK. Patients may also have their levels of blood cells monitored. Female patients may also take pregnancy tests every month while on isotretinoin, as this drug may cause severe birth defects.

What are the most common side effects of treatment with isotretinoin?

• Dryness of the skin, eyes, mouth, lips and nose
• Peeling of palms and soles
• Vision changes
• Cataracts, corneal opacities, eye irritation
• Hearing changes
• Skin abnormalities, rash, photosensitivity, itching, skin fragility
• Changes in menstrual cycles
• Emotional instability, depression
• Dizziness, drowsiness, headache, fatigue, weakness
• Back pain, joint pain, muscle pain
• Gastrointestinal disturbances, abdominal pain, diarrhea, nausea, vomiting, lack of appetite
• Changes in levels of blood cells
• Changes in lipid blood levels
• Increase in blood glucose
• Changes in liver function levels
• Abnormalities of cardiac (heart) rate or rhythm
• Increase or decrease in blood pressure

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

• Female patients of childbearing age are advised to use two sources of contraception, or abstain from sexual intercourse, while being treated with isotretinoin, as well as one month prior to treatment and one month following the completion of treatment with isotretinoin, as isotretinoin is associated with severe birth defects.
• Male patients should always use a condom if engaging in sexual intercourse, or should abstain from sexual intercourse while being treated with isotretinoin and one month following the completion of treatment with isotretinoin, as isotretinoin is associated with severe birth defects.
• Caution should be taken while driving or operating heavy machinery, as isotretinoin may cause visual disturbances that occur suddenly.
• Patients may experience decreased tolerance to contact lenses.
• Patients should speak with their physician prior to taking vitamin A supplements or the antibiotic tetracycline while being treated with isotretinoin.
• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Severe depression, or thoughts of suicide, psychosis, emotional instability
• Changes in hearing
• Changes in vision
• Yellowing of skin or eyes
• Right upper quadrant pain in the abdomen
• Abdominal pain, rectal bleeding, diarrhea
• Chest pain or noticeable changes in heart rate or rhythm
• Severe headache
• Dizziness, drowsiness, nervousness, seizure, fatigue
• Signs of an allergic reaction – difficulty breathing, hives, closing of throat, changes in heart rate, bruising, red patches on skin
• Difficulty or pain when urinating
• Frequent urination
• Swelling, pain or redness of one extremity and not the other
• Sudden onset of severe headache, visual disturbances and/or difficulty speaking

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

actinomycin (printable page)

Class: Chemotherapy

Generic Name: Dactinomycin (ACK-tin-oh-MYE-sin), Actinomycin-D, Actinomycin
Trade Name: Cosmegen®

For which conditions is this drug approved?

Dactinomycin is FDA approved for use in combination with chemotherapy and/or multi-modality treatment for the following cancers: Wilms’ tumor, childhood rhabdomyosarcoma, Ewing’s sarcoma, and metastatic non-seminomatous testicular cancer. It is also approved as a single agent or as part of combination therapy for the treatment of gestational trophoblastic neoplasia and locally recurrent or locoregional solid malignancies.

It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action?

Dactinomycin is a type of antibiotic that produces its anti-cancer effects by binding to the cell’s genetic structure, DNA, and inhibiting the production of proteins that are necessary to maintain the life of a cell.

How is dactinomycin typically given (administered)?

Dactinomycin is administered intravenously (into a vein) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. It is important for patients to tell their healthcare provider if they feel any stinging or burning, or see any redness or swelling at the site of administration. If dactinomycin leaks outside of the vein during administration, it can cause severe damage to surrounding tissues. Once dactinomycin is administered, it is ultimately cleared from the body through the urine and feces.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with dactinomycin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with dactinomycin?

• Low white blood cell levels – increases risk of infection
• Low red blood cell levels- increases risk of anemia
• Low platelet levels – increased risk of bleeding
• Nausea and vomiting
• Sores in the mouth
• Hair loss
• Diarrhea
• Skin reactions – redness, peeling, acne, skin eruptions and sensitivity to sunlight

What are the less common (occur in 10% to 29% of patients) side effects of treatment with dactinomycin?

• Fatigue
• Liver damage
• Loss of appetite
• Fever
• Skin reaction – skin color changes (darkening) or skin sloughing at sites where previous radiation was given
• Sterility – inability to conceive a child

What are possible late side effects of treatment with dactinomycin?

There is risk of developing side effects months or years after treatment has been completed. In uncommon instances, a secondary malignancy may occur as a result of receiving dactinomycin. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.
Patients receiving dactinomycin should discuss the risk of other late occurring side effects with their physician.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and sod solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Flu or cold-like symptoms: fever, chills, sore throat, cough
• Signs of infection – redness, swelling, pus, tenderness
• Continued nausea or vomiting
• Severe diarrhea
• Ulcers in the mouth or on lips
• Severe fatigue
• Yellow skin or eyes
• Bleeding or bruising
• Severe abdominal pain
• Changes in color or urine or stool

What is a package insert?

A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

actinomycin-D (printable page)

Class: Chemotherapy

Generic Name: Dactinomycin (ACK-tin-oh-MYE-sin), Actinomycin-D, Actinomycin
Trade Name: Cosmegen®

For which conditions is this drug approved?

What is the mechanism of action?

How is dactinomycin typically given (administered)?

How are patients typically monitored?

What are the common (occur in 30% or more of patients) side effects of treatment with dactinomycin?

What are the less common (occur in 10% to 29% of patients) side effects of treatment with dactinomycin?

What are possible late side effects of treatment with dactinomycin?

What can patients do to help alleviate or prevent discomfort and side effects?

When should patients notify their physician?

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Adriamycin® (printable page)

Class: Chemotherapy

Generic Name: Doxorubicin (docks-oh-ROO-bi-sin)
Trade Name: Adriamycin®, Rubex®

For which conditions is this drug approved? Doxorubicin is used for the treatment of several cancers, including bladder, breast, head and neck, leukemia, liver, lung, lymphomas, mesothelioma, multiple myeloma, neuroblastoma, ovary, pancreas, prostate, sarcomas, stomach, testis (germ cell), thyroid, and uterus. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Doxorubicin belongs to a group of agents called anthracycline antitumor antibiotics. Doxorubicin produces its anti-cancer effects by binding to DNA and inhibiting the production of proteins necessary for sustaining life of a cell.

How is doxorubicin typically given (administered)? Doxorubicin is administered intravenously (into a vein). If doxorubicin escapes from the vein in which it is being administered, it may cause serious damage to tissue that it comes in contact with. Although patients will be monitored for this, they should tell their healthcare provider immediately if they experience pain, redness, or swelling at the site that doxorubicin is being administered. In addition, patients may experience a reaction to doxorubicin during treatment or immediately following administration. Patients should tell their healthcare providers if they are experiencing difficulty breathing, wheezing, swelling of throat, hives, or swelling of facial features.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with doxorubicin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

In addition, patients will have their heart function monitored prior to therapy with doxorubicin and at intervals during therapy, since damage to the heart, although rare, may occur from treatment. The risk of impaired heart function increases with cumulative doxorubicin therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with doxorubicin?

• Low white blood cell levels – increases risk of infection
• Low red blood cell levels – increases risk of anemia
• Low platelet levels – increases risk of bleeding
• Nausea and vomiting
• Mouth sores
• Hair loss

What are the less common (occur in 10% to 29% of patients) side effects of treatment with doxorubicin?

• Watery eyes?
• Abnormal color of urine (reddish or brownish)
• Darkening of skin at sites that received previous radiation
• Darkening of skin and nail beds
• Infertility
• Gastrointestinal ulcers, may lead to infections or bleeding
• Lack of appetite
• Diarrhea

What are the possible late side effects of treatment with doxorubicin? Treatment with doxorubicin may cause damage to the heart, and inhibits its ability to properly pump blood. Patients will be monitored for this side effect; however, they should notify their healthcare provider if they feel chest pain or tightness or extreme fatigue. In addition, patients treated with doxorubicin are at a slightly increased risk of developing a secondary malignancy caused by treatment. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Mouth sores
• Persistent nausea or vomiting
• Persistent or severe diarrhea
• Blisters, redness, pain or swelling at the site of drug administration
• Difficulty breathing, shortness of breath, wheezing
• Chest pain
• Noticeable changes in heart rate or rhythm
• Swelling of ankles or feet, lower legs
• Swelling of throat
• Hives, itching
• Swelling of facial features
• Flu or cold-like symptoms: fever, chills, sore throat, cough
• Signs of infection – redness, swelling, pus, tenderness, painful urination
• Persistent or severe fatigue
• Unexplained or pronounced bleeding (nosebleeds, bruising, blood in the urine, black tarry stools, etc.)
• Abdominal pain or blood in stools

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Adrucil® (printable page)

Class: Chemotherapy

Generic Name: Fluorouracil (fler-oh-YOO-rah-sil), 5-FU, 5-fluorouracil
Trade Name: Adrucil®, Carac®, Efudex®, Fluoroplex®

For which conditions is this drug approved? Fluorouracil is FDA approved for the treatment of the following conditions: colon cancer, rectal cancer, breast cancer, stomach (gastric) cancer, and pancreatic cancer. Fluorouracil may also come in a topical form that is FDA approved for the treatment of superficial basal cell carcinoma. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Fluorouracil belongs to a class of agents called antimetabolites. Antimetabolites produce their anti-cancer effects by inhibiting the ability of a cell to produce or repair DNA, thereby making the cell unable to replicate or repair itself and ultimately causing cellular death.

How is fluorouracil typically given (administered)? Fluorouracil may be given intravenously (into a vein), and may be applied topically as a skin cream. The information on this sheet mainly covers the intravenous formulation. The dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with flourouracil. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. In addition, patients will have their heart function monitored, as treatment with fluorouracil may produce damage to the heart. Patients should notify their healthcare provider if they notice changes in heart rate or rhythm, or experience chest pain. Patients who are using the topical fluorouracil will also undergo skin assessments.

What are the common (occur in 30% or more of patients) side effects of treatment with fluorouracil?

• Low levels of white blood cells – increases the risk of infection
• Low levels of red blood cells – increases the risk of anemia and blood transfusions
• Low levels of platelets – increases the risk of bleeding
• Mouth sores
• Diarrhea
• Loss of appetite
• Changes in taste, metallic taste in mouth following IV bolus injection
• Reactions of the eyes resulting in watery eyes or sensitivity to sunlight
• Discoloration of vein in which the drug was administered

What are the less common (occur in 10% to 29% of patients) side effects of treatment with fluorouracil?

• Pain, peeling, redness, rash, or swelling of the palms of the hands or soles of the feet (hand-foot syndrome)
• Discoloration of the skin
• Darkening of the skin where previous radiation was administered?
• Rash or itching
• Skin sensitivity to sunlight
• Hair loss
• Discoloration of nails, loss of nails
• Cracking, peeling or excessively dry skin

What are possible late side effects of treatment with fluorouracil? With the use of this drug, there is risk of developing damage to the heart after treatment is completed, although this is uncommon. Patients experiencing chest or jaw pain, difficulty breathing, sweating or noticeable changes in heart rate or rhythm should contact their healthcare provider immediately.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Chest pain or palpitations
• Noticeable changes in heart rate or rhythm
• Excessive pain or peeling of the palms of the hands or soles of the feet
• Excessive peeling or cracking of skin
• Flu or cold-like symptoms: fever, chills, sore throat, cough
• Signs of infection – redness, swelling, pus, tenderness, painful urination
• Persistent or severe fatigue
• Unexplained or pronounced bleeding (nosebleeds, bruising, blood in the urine, black tarry stools, etc.)
• Mouth sores
• Persistant nausea, vomiting or abdominal pain
• Persistant or severe diarrhea
• Vision changes
• Confusion, mental changes
• Allergic reaction including swelling of the mouth, lips, and/or throat, wheezing or difficulty breathing, hives or rash

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Agrylin® (printable page)

Class: Supportive care

Generic Name: Anagrelide (eh-NA-gre-lide)
Trade Name: Agrylin®

For which conditions is this drug approved?

Anagrelide is FDA approved for the treatment of high blood platelet levels (polycythemia) associated with myeloproliferative disease (disease in which higher than normal levels of one or more types of blood cells are produced).

What is the mechanism of action?

Anagrelide is classified as a phospholipase A2 inhibitor. Anagrelide is believed to reduce the number of platelets by blocking the enzyme called phospholipase A2, which is at least partially responsible in the maturation process of platelets.

How is anagrelide typically given (administered)?

Anagrelide is given orally and may be taken with food or on an empty stomach. The dose may be changed based on the patient’s platelet count.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with anagrelide. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

During treatment with anagrelide, patients will have their platelet levels closely monitored. Patients will also have their heart function monitored, as anagrelide may cause abnormalities with the pumping action of the heart. Patients experiencing anxiety, cold sweating, increased heart rate, severe pain in the chest and/or the jaw, neck, back, or arms, or shortness of breath should contact their healthcare provider immediately.

What are the common (occur in 30% or more of patients) side effects of treatment with anagrelide?

• Headache

What are the less common (occur in 10% to 29% of patients) side effects of treatment with anagrelide?

• Heart rhythm abnormalities (palpitations)
• Diarrhea
• Weakness
• Swelling
• Nausea
• Abdominal pain
• Dizziness, drowsiness
• Pain
• Difficulty breathing
• Gas

What are the possible late side effects of treatment with anagrelide?

Although uncommon, treatment with anagrelide may cause damage to the heart that affects its pumping action. Patients will be monitored for this condition.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients who miss an oral dose should not double up the dose, but instead should contact their physician. • Patients should keep tablets out of the reach of children and return any unused tablets to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Anxiety, cold sweats, increased or uneven heart rate, severe pain in the chest and/or the jaw, neck, back, or arms, or shortness of breath
• Persistent or severe headache
• Persistent or severe abdominal pain
• Swelling of face
• Dizziness
• Black tarry stools
• Blood in urine
• Unexplained bleeding (bruises, bloody nose)
• Swelling of the feet or ankles
• Sudden weight gain
• Difficulty breathing
• Noticeable changes in heart rate or rhythm
• Seizure

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

aldesleukin (printable page)

Class: Biologic therapy

Generic Name: Aldesleukin (al-des-LOO-kin), Interleukin-2, recombinant human interleukin 2, IL-2
Trade Name: Proleukin®

For which conditions is this drug approved?

Aldesleukin is currently FDA approved for the treatment of metastatic melanoma and metastatic renal cell carcinoma.

What is the mechanism of action?

Aldesleukin belongs to a group of agents called biologic response modifiers. Aldesleukin is similar in structure to a naturally occurring substance in the body, called interleukin-2. Aldesleukin produces anti-cancer effects by stimulating the immune system, which helps to attack the cancer.

How is aldesleukin typically given (administered)?

Aldesleukin may be administered intravenously (into a vein) or subcutaneously (with an injection under the skin). The dose of aldesleukin depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. During administration, patients receiving aldesleukin may experience serious side effects attributed to a condition called capillary leak syndrome. Capillary leak syndrome may ultimately lead to severely low blood pressure and reduced blood flow, heart and lung abnormalities, fluid retention, mental changes, kidney abnormalities and/or gastrointestinal abnormalities. Capilliary leak syndrome may be severe and can result in death. Therefore, it is advised that patients treated with higher doses of aldesleukin be closely supervised during administration, with an intensive care facility and specialists trained in cardiopulmonary care or intensive care medicine readily available. Patients should tell their healthcare provider immediately if they are experiencing light-headedness, dizziness, rapid swelling or weight gain, difficulty breathing, chest pain, a noticeable change in heart beat and/or a significantly reduced volume of urine output.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with aldesleukin. During treatment with aldesleukin, patients are monitored closely, especially those patients being treated with higher doses. Monitoring may include blood draws to measure the levels of blood cells, electrolyte levels and the functions of several organ systems, such as the kidneys or liver. In addition, assessments will be done to monitor lung and heart function, weight changes, swelling, urine volume output, and levels of specific proteins in the urine to test kidney function. Patients may also undergo scans or other measures to assess response to therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with aldesleukin?

• Low platelet levels – increases risk of bleeding
• Low red blood cell levels – increases risk of anemia
• Low white blood cell levels- increases risk of infection
• Low blood pressure
• Redness or rash of the face and body
• Fever
• Chills
• Nausea and vomiting
• Diarrhea
• Changes in heartbeat
• Water retention, (edema, weight gain)
• Mental changes, such as confusion, memory loss, or drowsiness
• Changes in liver function tests, liver damage
• Aches or pains anywhere in the body
• Reduced volumes of urine, may lead to renal failure
• Breathing problems or lung congestion
• Changes in thyroid function

What are the less common (occur in 10% to 29% of patients) side effects of treatment with aldesleukin?

• Fever
• Weakness
• Itching
• Loss of appetite
• Dizziness
• Mouth sores
• Fatigue or weakness
• Fluctuations in weight
• Peeling or dry skin
• Enlargement of the abdomen
• Changes in electrolyte levels (magnesium, calcium, phosphate, potassium, sodium)
• Disorientation
• Jaundice
• Gastrointestinal bleeding

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Maintain adequate rest and nutrition.
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
• Avoid alcohol to reduce changes in mental status.

Are there any special precautions patients should be aware of before starting therapy?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should use caution when driving or operating heavy machinery, as aldesleukin may affect alertness and may cause dizziness and drowsiness.

When should patients notify their physician?

• Difficulty or changes in breathing
• Sudden weight gain or swelling
• Dizziness or light-headedness
• Significantly reduced urine volume
• Irregular, rapid or slow heartbeat
• Chest pain
• Flu or cold-like symptoms: fever, chills, sore throat or mouth, cough
• Signs of infection – redness, swelling, pus, tenderness
• Severe and prolonged fatigue
• Severe and prolonged nausea and vomiting or diarrhea
• Severe pain
• Sustained confusion or mental changes, irritability
• Yellowing of the skin or eyes
• Severe or prolonged headache
• Rash
• Tarry or red stools
• Easy bruising or bleeding

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

alemtuzumab (printable page)

Class: Biologic therapy

Generic Name: Alemtuzumab (al-em-TOO-zoo-mab)

Trade Name: Campath®

For which conditions is this drug approved?

Alemtuzumab is FDA approved for the treatment of B-cell chronic lymphocytic leukemia (CLL) that has stopped responding to prior treatment with chemotherapy agents referred to as alkylating agents and has stopped responding to the chemotherapy agent Fludara® (fludarabine).

What is the mechanism of action?

Alemtuzumab belongs to a group of agents called monoclonal antibodies. Alemtuzumab is an agent that is made through laboratory processes and binds to a specific region that is present on B cells, a type of immune cell that is cancerous in B-cell CLL, as well as other healthy immune cells. The binding action stimulates the immune system to attack the cell to which the monoclonal antibody is bound.

How is alemtuzumab typically given (administered)?

Alemtuzumab is given intravenously (into a vein) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. Alemtuzumab has also been administered subcutaneously (as an injection under the skin). Patients typically receive an antihistamine and acetaminophen prior to the administration of alemtuzumab to reduce or prevent reactions that may occur during infusion. A low dose of alemtuzumab is given initially and then the dose is gradually escalated if the patient is able to tolerate treatment. During administration, patients will have their pulse, blood pressure and temperature monitored. Side effects that may occur during administration of alemtuzumab (usually within the first 30-60 minutes after the start of the infusion) include fever, chills, shaking, nausea and vomiting, skin rash, itching, shortness of breath, diarrhea, headache, and/or low blood pressure. Patients should tell their healthcare provider immediately if they are experiencing any of these side effects. Patients should be started on anti-infective preventive therapy to reduce the risk of serious infections.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with alemtuzumab. Typically, blood will be drawn to check levels of blood cells, particularly white blood cells, and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with alemtuzumab?

• Low white blood cell levels – increases risk for infection

• Low red blood cell levels – increases risk of anemia

• Low platelet levels – increases risk of bleeding

• Infection, including sepsis, pneumonia or opportunistic infection

• Nausea and vomiting

• Fever

• Fatigue

• Shivering

• Low blood pressure

• Rash

What are the less common (occur in 10% to 29% of patients) side effects of treatment with alemtuzumab?

• Cough and bronchitis

• Loss of appetite

• Muscle pain

• Sweating

• Headache

• Mouth sores or ulcers

• Weakness

• Dizziness

• Numbness and/or swelling of the hands and feet

• Pain in the abdomen

• Back pain

• Chest pain

• Sore throat

• High blood pressure

• Heartburn

• Changes in heart rate

• Difficulty breathing

• Insomnia

• Diarrhea

• Hives, itchiness

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.

• Wear sunscreen and protective clothing and try to minimize sun exposure.

• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)

• Maintain adequate rest and nutrition.

• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.

• Wash hands often to reduce the risk of infection.

• Avoid activities that may cause injury or bruising.

• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.

• Eat small meals frequently to help alleviate nausea.

• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.

• Patients should inform their physician if they have ever had convulsions or seizures.

• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.

• Patients should check with their physician before starting any new drug or nutritional supplement.

• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

• Patients should inform their physician of any reaction to another monoclonal antibody.

When should patients notify their physician?

• Fever

• Chills

• Sore throat

• Cough

• Unusual bleeding or bruising

• Extreme fatigue

• Any signs of infection

• Prolonged and/or severe nausea or vomiting

• Prolonged and/or severe diarrhea

• Blood in the urine, burning on urination

• Black, tarry stools

• Mouth sores

• White plaques in mouth or perianal area

• Difficulty breathing

• Chest pain or palpitations

• Rash

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Alimta® (printable page)

Class: Chemotherapy

Generic Name: Pemetrexed (pe-me-TRECKS-ate) sodium
Trade Name: Alimta®

How is this drug used? Pemetrexed is FDA approved for treatment of inoperable malignant pleural mesothelioma in combination with the chemotherapy agent cisplatin, and for the treatment of non-small cell lung cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Pemetrexed belongs to a class of drugs called anti-folates. Pemetrexed produces its anti-cancer effects by disrupting metabolic processes of a cell that are dependent upon folate. By disruption of folate-dependent pathways, development of new DNA is inhibited, and cellular replication is not able to take place.

How is pemetrexed given (administered)? Pemetrexed is administered into a vein (intravenous) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. Patients also receive daily injections of vitamin B12 as well as daily oral doses of folic acid to reduce side effects caused by pemetrexed. Corticosteroids may be given a few days prior to treatment with pemetrexed to reduce the incidence or severity of side effects to the skin caused by treatment.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with pemetrexed. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients will also be monitored for blood clots. Patients experiencing swelling, pain or redness in one extremity and not the other, sudden difficulty or pain in breathing, sudden and severe headache or visual disturbances should tell their healthcare provider immediately.

What are the common (occur in 30% or more of patients) side effects of treatment with pemetrexed?

• Low levels of white blood cells – increases risk of infection
• Low levels of red blood cells – increases risk of anemia
• Low levels of platelets – increases risk of bleeding
• Inflammation, irritation or sores of the lining of the mouth or lips
• Inflammation or sores of the throat
• Fever
• Infection
• Rash
• Scaly or peeling skin
• Loss of appetite accompanied by weight loss
• Nausea and vomiting
• Diarrhea
• Fatigue
What are the less common (occur in 10% to 29% of patients) side effects of treatment with pemetrexed?
• Constipation
• Shortness of breath, difficulty breathing
• Chest pain
• Mood alteration or depression
• Changes in kidney function levels as determined by blood tests
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Fever, chills
• Sore throat
• Cough
• Areas of redness, swelling, pus, pain
• Extreme or persistent fatigue
• Unexplained or prolonged bleeding or bruising
• Blood in the urine
• Black, tarry stools
• Sores or severe pain in the mouth, lips or throat
• Severe or persistent diarrhea
• Severe or persistent nausea or vomiting
• Severe or persistent constipation
• Swelling of the feet and ankles
• Sudden weight gain
• Extreme weight loss
• Chest pain
• Difficulty breathing or shortness of breath
• Swelling, redness or pain in one extremity and not the other
• Severe or prolonged rash or itching

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Alkaban-AQ® (printable page)

Class: Chemotherapy

Generic Name: Vinblastine (vin-BLASS-teen), Vinblastine sulfate, vincaleukoblastine, VLB
Trade Name: Velban®, Alkaban-AQ®

How is this drug used? Vinblastine is FDA approved for the treatment of advanced Hodgkin’s disease, lymphocytic lymphoma, histiocytic lymphoma, advanced Mycosis fungoides, advanced testicular cancer, Kaposi’s sarcoma, choriocarcinoma that has stopped responding to previous chemotherapy agents and advanced breast cancer that has stopped responding to surgery and hormonal therapy. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Vinblastine belongs to a group of drugs called anti-microtubule agents or vinca alkaloids. Vinblastine produces its anti-cancer effects by causing abnormalities in microtubule formation in cells. Microtubules are components of cells that provide structural framework that enables cells to divide and grow. The abnormal microtubule formation caused by vinblastine inhibits cellular replication and ultimately causes cell death. Vinblastine may also inhibit DNA, RNA and protein synthesis, all of which can lead to cell death.

How is vinblastine given (administered)? Vinblastine is administered into a vein (intravenous), and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. If vinblastine escapes from the vein in which it is administered it may cause serious damage to the tissue that it comes in contact with. Although patients will be monitored for this, they should tell their healthcare provider immediately if they experience pain, redness or swelling at the site in which the drug is being administered. In addition, patients may experience an allergic-type reaction with the administration of vinblastine. Patients experiencing shortness of breath or closing of the throat should tell their healthcare provider immediately.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with vinblastine. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients are also monitored for signs of an allergic reaction (shortness of breath, closing of the throat).

What are the common (occur in 30% or more of patients) side effects of treatment with vinblastine?

• Low white blood cell levels – increases risk of infection
• Low red blood cell levels – increases risk of anemia
• Low platelet levels – increases risk of bleeding
• Fatigue

What are the less common (occur in 10% to 29% of patients) side effects of treatment with vinblastine?

• Nausea and vomiting
• Loss of appetite
• Numbness or tingling of feet or hands
• Diarrhea
• Constipation
• Mouth sores
• Headache
• Jaw pain
• Depression
• High blood pressure
• Shortness of breath
• Changes in taste, metallic taste in mouth
• Hair loss

What are the possible late side effects of treatment with vinblastine? Patients treated with vinblastine are at a slightly increased risk of developing a secondary malignancy. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, patients should avoid large crowds or persons who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Numbness or tingling in hands, fingers or toes
• Shortness of breath, difficulty breathing
• Closing of throat
• Chest pain, jaw pain
• Severe depression
• Mouth sores
• Dizziness
• Headache
• Blisters, pain, redness or swelling at site of drug administration
• Persistent or severe fatigue
• Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
• Flu or cold-like symptoms – fever, chills, sore throat, cough, fatigue, painful urination
• Signs of infection – redness, swelling, pus, tenderness
• Persistent or extreme nausea or vomiting
• Skin rash or itching

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Alkeran® (printable page)

Class: Chemotherapy

Generic Name: Melphalan (MEL-fah-lan), L-PAM, L-Sarcolysin, Phenylalanine Mustard
Trade Name: Alkeran®

How is this drug used? Melphalan is FDA approved for the treatment of multiple myeloma, breast cancer, ovarian cancer, and in treatment regimens prior to bone marrow or stem cell transplantation. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Melphalan belongs to a class of agents referred to as alkylating agents and is a derivative of nitrogen mustard. It produces its anti-cancer effects by causing a chemical reaction with DNA in cells. The chemical reaction, called interstrand cross-linking, inhibits the cancer cell to grow or replicate and/or ultimately causes cellular death.

How is melphalan given (administered)? Melphalan may be administered orally or in a vein (intravenous). The route of administration, as well as the doses, depends upon the condition being treated, the overall health of the patient, the particular regimen being used, and the height and weight of the patient.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with melphalan. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Physical examinations, scans, and/or other measures may be performed to assess side effects and response to therapy.

Uncommonly, patients may experience an allergic-type reaction during administration of melphalan. Patients are monitored closely for these symptoms, and if they experience difficulty breathing, wheezing, swelling of the throat or facial features or hives, they should tell their healthcare provider immediately, as these symptoms are indicative of an allergic reaction, which needs immediate attention.

What are the common (occur in 30% or more of patients) side effects of treatment with melphalan?

• Low white blood cell levels – increases the risk of infection
• Low red blood cell levels – increases the risk of anemia and blood transfusions
• Low platelet levels – increases the risk of bleeding
• Nausea and vomiting

What are the less common (occur in 10% to 29% of patients) side effects of treatment with melphalan?

• Allergic reaction—difficulty breathing, swelling of throat or facial features, hives, itching, wheezing, low blood pressure, fast heart rate
• Mouth sores or ulcers
• Hair loss
• Diarrhea
• Kidney abnormalities
• Changes in heart rhythm
• Loss of fertility

What are possible late side effects of treatment with melphalan? With the use of this drug, there is a risk of developing side effects months or years after treatment has been completed. In uncommon instances, a secondary malignancy may occur as a result of receiving melphalan. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients treated with melphalan should discuss the risk of late occurring side effects with their physician.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting chemotherapy?

• If patients are being treated with melphalan as an oral agent, they should take the drug on an empty stomach – 1 hour before eating or 2 hours after eating. However, patients should speak with their healthcare provider regarding scheduling of taking melphalan.
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Difficulty breathing, wheezing
• Swelling of the throat
• Swelling of facial features
• Hives, skin rash, itching
• Flu or cold-like symptoms: fever, chills, sore throat, cough
• Signs of infection – redness, swelling, pus, tenderness
• Prolonged nausea or vomiting
• Extreme or prolonged diarrhea
• Painful urination
• Yellowing of the skin or eyes
• Prolonged or severe mouth sores
• Unexplained bleeding or bruising
• Black, tarry stools
• Blood in the urine or stool
• Extreme, prolonged fatigue
• Redness, pain or swelling at injection site
• Unusual lumps or masses
• Weight loss

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

all-trans retinoic acid (printable page)

Class: Chemotherapy

Generic Name: Tretinoin (TRE-ti-noyn), All-trans retinoic acid, ATRA
Trade Name: Vesanoid®

How is this drug used? Tretinoin is FDA approved for the treatment of acute promyelocytic leukemia that has not responded to other standard treatments. However, physicians often prescribe a drug for treatment of medical conditions other than its specific FDA approval. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Tretinoin belongs to a class of agents referred to as retinoids. Retinoids are related to vitamin A and play a part in controlling growth, maturation and death of a cell. Tretinoin binds to specific retinoid receptors in a cancer cell and affects cellular growth and maturation.

How is tretinoin given (administered)? Tretinoin is given in capsule form orally and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. It may also be in lotion form that is placed on the skin for treatment of acne or certain rashes.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with tretinoin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. In addition, blood levels of fat and cholesterol will also be evaluated prior to and during treatment for all patients treated with tretinoin.

Patients treated with tretinoin will be monitored closely for a serious side effect that may occur referred to as APL differentiation syndrome. The syndrome causes high fever, difficulty breathing, lung and heart problems, organ dysfunction and sudden weight gain. APL differentiation syndrome often occurs within the first month of treatment, and may occur following the first dose. It can be treated with high-dose steroids and treatment with tretinoin often continues. It is extremely important that patients contact their healthcare provider immediately if they experience fever, difficulty breathing, chest pain, a noticeable change in heart rate or rhythm, dizziness or sudden weight gain.

Women treated with tretinoin will also be tested for pregnancy prior to treatment and regularly during treatment as this drug is known to cause birth defects.

What are the common (occur in 30% or more of patients) side effects of treatment with tretinoin?

• Headache
• Fever
• Weakness or fatigue
• Dry skin
• Dry mouth, dry nose
• Bone pain
• Rash
• Mouth sores
• Swelling of feet or ankles
• Abdominal pain
• Bone pain
• Joint pain
• Chills
• Malaise
• Unexplained bleeding (i.e. nosebleeds or bruising)
• Nausea and vomiting
• Increased in cholesterol and triglyceride levels
• Increased in liver function test results
• Diffficulty breathing
What are the less common (occur in 10% to 29% of patients) side effects of treatment with tretinoin?

• Heart rate or rhythm changes, chest discomfort
• Loss of appetite
• Weight loss
• Weight gain
• Dizziness
• Diarrhea
• Constipation
• Heartburn
• High blood pressure
• Low blood pressure
• Difficulty sleeping
• Confusion
• Depression
• Numbness or tingling of hands and feet
• Earache or ear discomfort
• Redness of the face or neck
• Itching
• Sensitivity to sunlight
• Agitation, anxiety
• Changes in eyesight
• Itching or dry eyes
• Sweating
• Infections

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug causes birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Tretinoin is known to cause birth defects. Therefore, patients must use extreme caution against conceiving a child. Women should use two forms of birth control or practice complete abstinence.
• Patients should not dissolve, crush or chew tretinoin capsules.
• Keep tretinoin capsules away from light
• If patients miss a dose of tretinoin, they should not double up on the next dose, but contact their healthcare provider.
• Since tretinoin is related to vitamin A, patients should be particularly careful of any supplement that contains extra doses of vitamin A. Patients should discuss this with their healthcare provider.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• Patients should use caution when driving or completing tasks that require mental alertness until effects of the drug are known, as they may experience fatigue, vision changes, and confusion.
• Patients with dry, irritated eyes may want to avoid wearing contact lenses.

When should patients notify their physician?

• Fever
• Sudden weight gain
• Difficulty breathing
• Chest pain
• Heart rate or rhythm changes
• Prolonged diarrhea or constipation
• Prolonged nausea and vomiting
• Vision changes
• Swelling
• Bleeding, including black, tarry stools, blood in the urine, nosebleeds, etc.
• Severe abdominal pain, particularly right after a meal
• Yellowing of the skin or eyes
• Mouth sores
• Skin rash, hives or itching
• Signs of infection (fever, chills, sore throat, cough)
• Headache
• Dizziness, confusion, depression, agitation, hallucinations, seizures, slow speech

What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

allopurinol (printable page)

Class: Supportive care

Generic Name: Allopurinol (al-oh-PYOOR-in-ol)
Trade Name: Aloprim®, Zyloprim®

For which conditions is this drug approved?

Allopurinol is FDA approved for management of patients with cancer who are receiving cancer therapy that causes elevations of uric acid levels in association with tumor lysis syndrome.

What is the mechanism of action?

Allopurinol works by reducing the formation of uric acid.

Tumor lysis syndrome (TLS) is the development of electrolyte and metabolic disturbances that may occur following the treatment of cancer and can result in life-threatening complications if not managed appropriately. TLS is caused by the sudden, rapid death of cells, particularly cancer cells in patients with leukemia or lymphoma, in response to cancer therapies. TLS may occur spontaneously, although this is uncommon. When cancer cells are killed by therapy, they spill their inner (intracellular) contents, which accumulate in the body faster than can be eliminated. These intracellular contents cause the metabolic and electrolyte disturbances that result in TLS. Hyperuricemia is a component of TLS and refers to excess uric acid in the blood. Uric acid is the end product of the digestion of certain proteins and is normally eliminated through the urine. When excess uric acid is present, it is converted to crystals formed of sodium urate. These crystals may deposit in the tiny tubes that are part of the kidney and cause acute kidney damage, which can ultimately lead to kidney failure.

How is allopurinol typically given (administered)?

Allopurinol is usually given orally as a tablet, but also may be given intravenously (into a vein). Patients taking the oral tablet will take the tablet after a meal and with plenty of fluid. Patients may have an allergic-type reaction to treatment with allopurinol, although this is uncommon. Patients should tell their healthcare provider immediately at the first signs of a rash or other skin abnormalities, as more severe side effects may follow.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with allopurinol. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. In addition, levels of electrolytes and products of metabolism will be measured frequently to monitor the possibility of developing TLS. Patients will also be monitored for allergic-type reactions that may occur with treatment with allopurinol, including skin abnormalities and liver dysfunction.

What are the most common side effects associated with treatment with allopurinol?

• Skin rash
• Nausea and vomiting
• Abnormalities of the kidneys
• Diarrhea

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should use caution when driving or operating heavy machinery, as allopurinol may cause drowsiness.
• Patients should avoid the use of alcohol, as it may decrease the effectiveness of allopurinol.

When should patients notify their physician?

• Skin rash or skin abnormalities (discontinue allopurinol at first sign of a rash)
• Yellowing of skin or eyes
• Irritation of the eyes
• Swelling of the lips or mouth
• Swelling of ankles or feet
• Swelling of abdomen
• Severe abdominal pain
• Sudden weight gain
• Persistent or severe nausea, vomiting or diarrhea
• Painful urination or blood in the urine
What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Aloprim® (printable page)

Class: Supportive care

Generic Name: Allopurinol (al-oh-PYOOR-in-ol)
Trade Name: Aloprim®, Zyloprim®

For which conditions is this drug approved?

Allopurinol is FDA approved for management of patients with cancer who are receiving cancer therapy that causes elevations of uric acid levels in association with tumor lysis syndrome.

What is the mechanism of action?

Allopurinol works by reducing the formation of uric acid.

How is allopurinol typically given (administered)?

How are patients typically monitored?

What are the most common side effects associated with treatment with allopurinol?

• Skin rash
• Nausea and vomiting
• Abnormalities of the kidneys
• Diarrhea

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should use caution when driving or operating heavy machinery, as allopurinol may cause drowsiness.
• Patients should avoid the use of alcohol, as it may decrease the effectiveness of allopurinol.

When should patients notify their physician?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Aloxi® (printable page)

Class: Supportive care

Generic Name: Palonosetron (pal-eh-OSS-eh-tron)
Trade Name: Aloxi®

How is this drug used? Palonosetron is FDA approved for the prevention of acute and delayed nausea and vomiting caused by chemotherapy that is strongly associated with nausea and vomiting. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Palonosetron belongs to a class of drugs called antiemetics. Nausea and vomiting may be caused by the release of serotonin with the use of some chemotherapy agents. The serotonin binds to cell receptors called 5-HT3 which stimulates the vomiting reflex. Palonosetron helps to prevent nausea and vomiting by blocking 5-HT3 receptors so that the serotonin is not able to bind to the receptor and initiate the vomiting reflex.

How is palonsetron given (administered)? Palonsetron is administered into a vein (intravenous) prior to chemotherapy.

How are patients monitored? Patients will usually have scheduled meetings and physical exams with their healthcare provider while they are being treated with palonosetron given in association with chemotherapy. Patients may undergo physical examinations or other measures to assess side effects and response to therapy. Monitoring for palonosetron includes assessments of its ability to prevent nausea and/or vomiting caused by chemotherapy.
What are the most common side effects of treatment with palonsetron?

• Headache
• Constipation
• Diarrhea
• Dizziness

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Severe or persistent headache
• Severe or persistent dizziness
• Confusion
• Severe weakness
• Swelling of the feet or ankles
• Change in heart rate or rhythm

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

alpha interferon (printable page)

Class: Biologic response modifier

Generic Name: Interferon alpha (in-ter-FEER-on), alpha interferon, IFN-alpha
Trade Name: Intron® A (interferon alfa-2b), Roferon-A® (interferon alfa-2a)

How is this drug used? Interferon alpha is FDA approved for the treatment of hairy cell leukemia, malignant melanoma, AIDS-related Kaposi’s sarcoma, follicular non-Hodgkin’s lymphoma, and Condylomata Acuminata. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Interferon alpha belongs to a group of agents called cytokines. Interferon alpha produces its anti-cancer effects by stimulating the immune system to help fight the cancer.

How is interferon alpha given (administered)? Interferon alpha may be administered as an injection under the skin (subcutaneous), as an injection into a muscle (intramuscular), as an injection directly into the cancer (intralesional) or as an injection into a vein (intravenous) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular treatment regimen being used, and the overall health of the patient.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with interferon alpha. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients will also have their thyroid function monitored and undergo an eye exam, as interferon alfa may produce side effects that affect the thyroid or eyes. Patients may also undergo examinations of their lungs and heart. In addition, patients may be assessed for emotional stability, as interferon alpha has been associated with depression.

What are the common (occur in 30% or more of patients) side effects of treatment with interferon alfa?

• Fever
• Chills
• Generalized achiness
• Generalized pains
• Headache
• Loss of appetite
• Fatigue
• Weakness
• Low white blood cell levels – increases the risk of infection
• Low red blood cell levels – increases the risk of anemia
• Low platelet levels – increases the risk of bleeding
• Abnormalities in some electrolyte levels
• Abnormalities in glucose levels
• Abnormalities in triglyceride levels
• Loss of hair
• Weight loss

What are the less common (occur in 10% to 29% of patients) side effects of treatment with interferon alfa?

• Nausea and vomiting
• Diarrhea
• Changes in blood pressure
• Cough
• Difficulty breathing
• Depression
• Dry mouth
• Inflammed gums (gingivitis)
• Dizziness
• Abdominal pain
• Numbness or tingling of hands or feet
• Changes in taste
• Sweating
• Irritability
• Constipation
• Confusion
• Memory loss
• Impaired concentration
• Sleepiness
• Fluid retention resulting in swelling of feet or ankles
• Anxiety
• Dry skin
• Redness, pain at the site of injection
• Insomnia
• Itching
• Rash
• Sore throat

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Change in mental status (confusion, hallucinations, paranoia)
• Depression/feelings of suicide
• Seizures, tremors
• Persistent fever
• Swelling of ankles or feet
• Chest pain
• Difficulty breathing, cough
• Noticeable changes in heart rate or rhythm
• Vision changes
• Excessive urinating and extreme thirst
• Yellowing of skin or eyes
• Abdominal pain
• Numbness or tingling of hands or feet
• Dizziness
• Flu or cold-like symptoms – fever, sore throat, cough, chills
• Signs of infection – redness, swelling, pus, tenderness
• Persistent or severe fatigue
• Unusual bleeding or bruising
• Mouth sores
• Allergic type reaction (rash, hives, tightness of throat, difficulty breathing)

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

altretamine (printable page)

Class: Chemotherapy

Generic Name: Altretamine (al-TRET-uh-meen), hexamethylmelamine, HMM
Trade Name: Hexalen®

For which conditions is this drug approved?

Altretamine is FDA approved as a single agent for the treatment of ovarian cancer that has stopped responding to previous therapy with a cisplatin and/or alkylating-based chemotherapy regimen.

What is the mechanism of action?

Altretamine produces anti-cancer effects through several possible mechanisms. The most widely accepted explanation of its effects on cancer cells is the fact that it produces a chemical reaction that damages the DNA of a cell. The DNA damage caused by altretamine results in inhibition of cellular growth and/or cellular death.

How is altretamine typically given (administered)?

Altretamine is a capsule that is taken orally. Typically, patients are instructed to take altretamine in divided doses following a meal and at bedtime. Precise doses and scheduling will be determined by a patient’s physician.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with altretamine. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients may also undergo neurologic assessments, as altretamine may cause damage to the nervous system, although this is uncommon.

What are the most common (occur in 30% or more of patients) side effects of treatment with altretamine?

• Nausea and vomiting
• Loss of appetite
• Diarrhea
• Low levels of white blood cells – increases risk of infection
• Low platelet levels – increases risk of bleeding
• Low levels of red blood cells – increases risk of anemia

What are the less common (occur in 10% to 29% of patients) side effects of treatment with altretamine?

• Numbness and/or tingling of fingers and/or toes
• Fatigue
• Changes in mood, consciousness or balance, depression, agitation

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Maintain adequate rest and nutrition.
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• Take altretamine following meals, as this may help relieve nausea or stomach upset.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should use caution when driving or operating heavy machinery, as altretamine may affect mental status or balance.
• Patients who miss an oral dose should not double up on doses, but instead should contact their physician. • It is important that patients keep capsules out of the reach of children and return any unused tablets to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Fever
• Chills
• Sore throat
• Cough
• Signs of infection
• Prolonged nausea or vomiting
• Prolonged diarrhea
• Prolonged or severe confusion
• Severe fatigue
• Unusual bleeding or bruising
• Black, tarry stools
• Blood in the urine
• Significant numbness or pain of fingers or toes
• Severe or persistent depression

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

amethopterin (printable page)

Class: Chemotherapy

Generic Name: Methotrexate (meth-oh-TRECKS-ate), Amethopterin, Methotrexate Sodium, MTX
Trade Name: Rheumatrex®, TrexallTM

How is this drug used? Methotrexate is FDA approved for the following cancers: gestational choriocarcinoma, chorioadenoma destruens and hydatidiform mole, acute lymphocytic leukemia, meningeal leukemia, breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides, lung cancer, advanced non-Hodgkin’s lymphomas, and osteosarcoma. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Methotrexate belongs to a group of agents classified as antimetabolites. Antimetabolites produce their anti-cancer effects by inhibiting the ability of a cell to produce or repair DNA, thereby making the cell unable to replicate or repair itself and ultimately causing cellular death.

How is methotrexate given (administered)? Methotrexate may be administered into a vein (intravenous), into a muscle (intramuscular), into the spinal fluid (intrathecal or intraventricular), or by mouth as a pill. The dose and method of administration depend on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. Patients who are treated with high doses of methotrexate will often receive hydration in the form of intravenous fluids, prior to and after administration of the drug.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with methotrexate. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

In addition, patients will be monitored for inflammation of the membrane surrounding the brain and spinal column (meninges), if they receive methotrexate intrathecally or intraventricularly. Inflammation of the meninges may cause stiff neck, (?seizures), vomiting, fever, back pain and severe headache, which typically occur immediately following administration of the drug. Patients will also be monitored for side effects affecting the central nervous system, which may produce paralysis of the arms and legs, difficulty with speaking, confusion, sleepiness, seizures, or coma. These symptoms may occur up to approximately 6 days following treatment, so patients experiencing any of these symptoms should contact their healthcare provider immediately.

What are the common (occur in 30% or more of patients) side effects of treatment with methotrexate?

• Low white blood cell levels – increases the risk of infection
• Low red blood cell levels – increases the risk of anemia
• Low platelet levels – increases the risk of bleeding
• Mouth sores
• Loss of appetite
• Nausea and vomiting

What are the less common (occur in 10% to 29% of patients) side effects of treatment with methotrexate?

• Kidney problems – abnormalities will be detected on blood draws, swelling of ankles and feet may occur, difficulty in urination may occur
• Diarrhea
• Hair loss
• Irritation of the eye
• Abnormalities of liver function levels, as detected by blood tests
• Liver damage (generally only after prolonged use)
• Infertility
• Darkening of skin at previous sites of radiation
• Skin rash, itching
• Reddening of skin, sensitivity to sunlight
• Fatigue
• Chills and fever

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Swelling of feet or ankles
• Sudden weight gain
• Little or no urine output for 8 – 12 hours
• Signs of inflammation of the meninges – severe headache, vomiting, stiff neck, seizures, fever
• Signs of central nervous system toxicity – paralysis of the arms/legs, difficulty speaking, seizures, coma, drowsiness, confusion, dizziness
• Flu or cold-like symptoms – fever, sore throat, cough, chills
• Signs of infection – redness, swelling, pus, tenderness, painful or frequent urination
• Persistent or severe fatigue
• Unexplained or pronounced bleeding (nosebleeds, bruising, blood in the urine, black tarry stools, etc.)
• Persistent or extreme nausea or vomiting
• Mouth sores
• Persistent or extreme diarrhea
• Acute joint pain
• Dry, non productive cough, shortness of breath,
• Skin rash, itching, hives, wheezing, difficulty breathing
• Yellowing of skin or eyes
• Blurred vision

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

amifostine (printable page)

Class: Supportive care

Generic Name: Amifostine (a-mi-FOSS-teen)

Trade Name: Ethyol®

For which conditions is this drug approved?

Amifostine is FDA approved to reduce side effects to the kidneys caused by repeated administration of the chemotherapy agent cisplatin (Platinol®) in patients with advanced ovarian cancer. It is also FDA approved to reduce dry mouth caused by radiation therapy following surgery in patients with head and neck cancer.

What is the mechanism of action?

Amifostine belongs to a group of agents called cytoprotectants, which protect normal tissue from some of the side effects caused by some treatments for cancer. Amifostine provides these protective effects after being broken down in the body to specific metabolites. Through chemical reactions, the metabolites from amifostine deactivate molecules from cisplatin or radiation therapy that cause side effects. The protective metabolites of amifostine tend to accumulate more in healthy cells than in cancerous cells, so that cancer cells are not protected from the anti-cancer effects of treatment.

How is amifostine typically given (administered)?

Amifostine is typically administered intravenously (into a vein). Amifostine is given approximately 15 to 30 minutes prior to treatment with chemotherapy or radiation therapy. Because low blood pressure may occur during amifostine administration, patients typically receive the drug while lying down, have their blood pressure frequently monitored, and may receive intraveneous fluid to help maintain their blood pressure. Uncommonly, patients may experience other side effects during the administration of amifostine. These side effects include fever, chills, difficulty breathing, low levels of oxygen in the blood, chest tightness, skin abnormalities, inflammation of the larynx, or heart attack. Patients should inform their healthcare provider if they are experiencing lightheadedness, fever, chills, difficulty breathing, chest tightness or pain, difficulty speaking, or skin abnormalities during the administration of amifostine.

How are patients typically monitored?

Patients will usually have their blood pressure monitored frequently – approximately every 5 minutes – during the administration of amifostine and periodically after administration. Patients may also be monitored for calcium levels in their blood.

What are the common (occur in 30% or more of patients) side effects of treatment with amifostine?

• Low blood pressure

• Nausea and vomiting

• Flushing

(All side effects occur during administration.)

What are the less common (occur in 10% to 29% of patients) side effects of treatment with amifostine?

• Dizziness

• Fatigue

• Somnolence

• Chills

• Hiccups

• Redness of the face or neck

• Sneezing

(All side effects occur during administration.)

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.

• Wear sunscreen and protective clothing and try to minimize sun exposure.

• Drink plenty of water or liquid prior to receiving amifostine.

• Eat small meals frequently to help alleviate nausea.

• Maintain adequate rest and nutrition.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they have ever had convulsions or seizures.

• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.

• Patients should check with their physician before starting any new drug or nutritional supplement.

• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

• Patients should inform their physician if they are taking antihypertensive medication (medication to treat high blood pressure) before receiving amifostine because amifostine causes low blood pressure.

When should patients notify their physician? (If any of these problems occur during infusion of amifostine)

• Difficulty breathing

• Skin reactions

• Lightheadedness, dizziness

• Prolonged or severe nausea or vomiting

• Chest pain or chest tightness

• Fever

• Chills

• Tremors or shaking

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

aminoglutethimide (printable page)

Class: Hormonal therapy

Generic Name: Aminoglutethimide (uh-MEE-noe-gloo-TETH-I-mide)
Trade Name: Cytadren®

For which conditions is this drug approved?

Aminoglutethimide is FDA approved for the treatment of Cushing’s syndrome.

What is the mechanism of action?

Aminoglutethimide is classified as an adrenal steroid inhibitor. Aminoglutethimide produces its effects by suppressing hormones that are produced by the adrenal glands. Normally, the hormones produced by adrenal glands stimulate the production of other hormones in the body, including estrogen, androgens, and corticosteroids. Cancer of the adrenal glands may be associated with excess steroid production in the body, which may ultimately cause Cushing’s syndrome. Aminoglutethimide suppresses the production of the steroids, resulting in a decrease in symptoms. Furthermore, estrogens and androgens may play a role in the growth of some types of cancer cells. Inhibiting their production may reduce the growth of cancers such as hormone responsive advanced breast and prostate cancers.

How is aminoglutethimide typically given (administered)?

Aminoglutethimide is given orally in the form of a tablet. Some patients may also receive steroids while they are taking aminoglutethimide to replace the steroids normally produced by the body.

How are patients typically monitored?

Patients will usually have scheduled meetings with their healthcare provider while they are being treated with aminoglutethimide. Patients will typically have blood tests to monitor hormones and steroid levels in their body. Patients may also be monitored for specific signs that indicate a hormone or steroid deficiency, such as nausea, vomiting, weight loss, poor appetite, dizziness, diarrhea and weakness. Patients should contact their healthcare provider if they are experiencing these symptoms.

What are the common (occur in 30% or more of patients) side effects of treatment with aminoglutethimide?

• Fatigue
• Drowsiness
• Nausea and loss of appetite
• Skin rash

What are the less common (occur in 10% to 29% of patients) side effects of treatment with aminoglutethimide?

• Problems with balance, coordination and mobility
• Dizziness
• Low blood pressure
• Headache
• Jaundice
• Muscle aches
• Lung damage
• Kidney damage

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should use caution when driving or operating heavy machinery, as aminoglutethimide may affect balance and coordination and may cause drowsiness.
• Patients who miss an oral dose should not double up the dose, but instead should contact their physician. • Patients should keep tablets out of the reach of children and return any unused tablets to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Extreme weight loss
• Extreme loss of balance, coordination or dizziness
• Severe nausea
• Diarrhea
• Severe or prolonged fatigue or drowsiness
• Difficulty breathing or fast breathing
• Persistant skin rash
• Allergic reaction (hives, itching, tightness of chest, fast heart beat, swelling of tongue, lips or throat, etc)

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

anagrelide (printable page)

Class: Supportive care

Generic Name: Anagrelide (eh-NA-gre-lide)
Trade Name: Agrylin®

For which conditions is this drug approved?

What is the mechanism of action?

How is anagrelide typically given (administered)?

Anagrelide is given orally and may be taken with food or on an empty stomach. The dose may be changed based on the patient’s platelet count.

How are patients typically monitored?

What are the common (occur in 30% or more of patients) side effects of treatment with anagrelide?

• Headache

What are the less common (occur in 10% to 29% of patients) side effects of treatment with anagrelide?

• Heart rhythm abnormalities (palpitations)
• Diarrhea
• Weakness
• Swelling
• Nausea
• Abdominal pain
• Dizziness, drowsiness
• Pain
• Difficulty breathing
• Gas

What are the possible late side effects of treatment with anagrelide?

Although uncommon, treatment with anagrelide may cause damage to the heart that affects its pumping action. Patients will be monitored for this condition.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have ever had convulsions or seizures.
• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients who miss an oral dose should not double up the dose, but instead should contact their physician. • Patients should keep tablets out of the reach of children and return any unused tablets to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

What is a package insert?

A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Anandron® (printable page)

Class: Hormonal therapy

Generic Name: Nilutamide (ni-LOO-te-mide)
Trade Name: Nilandron®, Anandron®

How is this drug used? Nilutamide is approved for the treatment of stage D2 prostate cancer, where cancer has spread from its site of origin to different sites in the body. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Nilutamide belongs to a group of drugs referred to as anti-androgens. Prostate cancer is stimulated to grow by the male hormone, testosterone. Anti-androgens inhibit the effects of testosterone on cancer cells, removing the growth stimulus. Nilutamide is often given in combination with another hormone agent, classified as a luteinizing hormone – releasing hormone (LHRH) agonist, which helps to block the production of testosterone in the body.

How is nilutamide given (administered)? Nilutamide is a tablet that is taken orally. It is typically taken once daily, and should be taken at approximately the same time each day. Nilutamide can be taken with or without food. Patients and their physicians will discuss optimal scheduling for nilutamide.

How are patients monitored? Patients will usually have scheduled meetings for follow-up treatment with nilutamide. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems such as the kidneys and liver. Patients may also undergo physical examinations, scans and other measures to assess tolerance and response to therapy.

Uncommonly, patients treated with nilutamide will experience a side effect called pneumonitis, which is associated with lung irritation leading to difficulty breathing and cough. Pneumonitis typically occurs within the first 3 months of treatment, and although patients will be monitored for pneumonitis, patients should notify their physician if they are experiencing difficulty breathing or a cough.

What are the common (occur in 30% or more of patients) side effects of treatment with nilutamide?

• Hot flashes
• Delayed vision adjustment to darkness

What are the less common (occur in 10% to 29% of patients) side effects of treatment with nilutamide?

• Breast enlargement
• Breast pain or tenderness
• Decreased libido
• Nipple discharge
• Erectile dysfunction
• Nausea
• Loss of appetite
• Constipation
• Diarrhea
• Liver function test abnormalities
• Difficulty sleeping
• Drowsiness
• Headache
• Dizziness
• Pain
• Weakness
• Swelling

What can patients do to help alleviate or prevent discomfort and side effects?

• Patients who experience hot flashes may wish to wear light clothing, stay in a cool environment, and place cool cloths on their body or head to relieve their symptoms.
• Patients may experience an alteration in their vision; adaptation to darkness may be impaired or delayed. Driving or operating heavy machinery should be done with caution at night. Use caution in poorly lighted or changing light situations (tunnels).
• Consuming alcoholic beverages while being treated with nilutamide may cause a reaction. Therefore, it is recommended that alcohol be avoided. Patients should discuss this with their physician.
• Eat small meals frequently to help alleviate nausea.
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)

Are there any special precautions patients should be aware of before starting chemotherapy?

• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients taking warfarin may require additional monitoring.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• Patients may experience drowsiness, dizziness or blurred vision. Avoid driving, operating heavy machinery or tasks acquiring mental alertness until effects of the drugs are known.

When should patients notify their physician?

• Fever
• Cough
• Difficulty breathing, shortness or breath
• Sore throat
• Signs of infection – redness, swelling
• Chest pain
• Jaw pain
• Inability to urinate, difficulty in voiding
• Changes in eyesight
• Swelling of feet or ankles
• Yellowing of skin or eyes
• Changes in color of urine or stool
• Abdominal pain
• Loss of appetite
• Prolonged headache
• Prolonged nausea and vomiting
• Persistent constipation
• Lightheadedness or dizziness

Important Limitations of Use

DISCLAIMER OF WARRANTIES

CANCERCONSULTANTS.COM SPECIFICALLY DISCLAIMS AND EXCLUDES ALL EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES AS TO QUALITY, ACCURACY (INCLUDING TYPOGRAPHICAL ERRORS), MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE OF THE INFORMATION CONTAINED HEREIN. CANCERCONSULTANS.COM DISCLAIMS ALL LIABILITY OR DAMAGES ARISING FROM ANY USE OF THE INFORMATION.

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Anandron® (printable page)

Class: Hormonal therapy

Generic Name: Nilutamide (ni-LOO-te-mide)
Trade Name: Nilandron®, Anandron®

What are the common (occur in 30% or more of patients) side effects of treatment with nilutamide?

• Hot flashes
• Delayed vision adjustment to darkness

What are the less common (occur in 10% to 29% of patients) side effects of treatment with nilutamide?

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting chemotherapy?

When should patients notify their physician?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

CANCERCONSULTANTS.COM SPECIFICALLY DISCLAIMS AND EXCLUDES ALL EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES AS TO QUALITY, ACCURACY (INCLUDING TYPOGRAPHICAL ERRORS), MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE OF THE INFORMATION CONTAINED HEREIN. CANCERCONSULTANS.COM DISCLAIMS ALL LIABILITY OR DAMAGES ARISING FROM ANY USE OF THE INFORMATION.

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

anastrozole (printable page)

Class: Hormonal therapy

Generic Name: Anastrozole (ah-NAS-tre-zole)
Trade Name: Arimidex®

For which conditions is this drug approved? Anastrozole is FDA approved for the treatment of postmenopausal women with hormone-positive breast cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Anastrozole belongs to a group of drugs referred to as aromotase inhibitors. Anastrozole produces its anti-cancer effects by inhibiting the production of the female hormone estrogen in the body. A significant portion of breast cancers, referred to as estrogen- or hormone-positive, are stimulated to grow by estrogen, which circulates in the blood stream and binds to cancer cells. By inhibiting estrogen production, the growth stimulus of the cancer cells is removed, causing cancer cells to stop growing and/or die.

How is anastrozole typically given (administered)? Anastrozole is administered as a pill once daily. It is eliminated in the body through the urine and feces.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with anastrozole. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. If a physician feels that a patient is at risk for osteoporosis (reduction in bone density), scans to determine bone density may be ordered prior to or during treatment with anastrozole, as the risk of bone fractures may be increased during treatment.

What are the common (occur in 30% or more of patients) side effects of treatment with anastrozole?
• Hot flashes

What are the less common (occur in 10% to 29% of patients) side effects of treatment with anastrozole?
• Joint aches or pain
• Weakness
• Mood changes
• Nausea and vomiting
• Pain
• Sore throat
• Cough
• Headache
• Back pain, bone pain

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• For hot flashes, light clothing, cool environment and cool cloths on the body or head may help relieve these symptoms.
• Over the counter pain medications may help to alleviate the aches or pains that may be caused by treatment; it is important to thoroughly discuss these options with a physician.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
Are there any special precautions patients should be aware of before starting treatment?

• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• Patients should inform their physician if they are pregnant or breastfeeding as anastrazole is not administered to women who are pregnant.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Prolonged or severe nausea or vomiting
• Severe weakness
• Bone pain after a fall or trauma, as this may indicate a bone fracture
• Extreme pain

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Anzemet® (printable page)

Class: Supportive care

Generic Name: Dolasetron (dol-ASE-tron)
Trade Name: Anzemet®

For which conditions is this drug approved? Dolasetron belongs to a group of drugs called antiemetics. Dolasetron is FDA approved for the prevention of nausea and vomiting associated with some types of chemotherapy. It is also approved for the prevention and treatment of nausea and vomiting after surgery. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Dolasetron works by blocking the effects of serotonin, a chemical produced by the body that is present in the brain.

How is dolasetron typically given (administered)? Dolasetron can be given orally or intravenously (into a vein) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. Once the drug is given, it will clear from the patient’s body through the kidneys.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with dolasetron. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Blood pressure may be monitored. Heart function may be monitored in patients with cardiovascular disease.

What are the common side effects of treatment with dolasetron?

• Headache
• Diarrhea – if this persists, dehydration may occur
• Taste alterations
• Changes in blood pressure
• Dizziness or lightheadedness
• Change in heart rhythm

What can patients do to help alleviate or prevent discomfort and side effects?

When should patients notify their physician?

• Headache
• Dizziness
• Fever
• Severe pain
• Irregular heart beat
• Change in breathing
• Diarrhea
• Confusion
• Severe fatigue or bleeding
• Yellowing of the skin or eyes
• Extreme weight loss

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

aprepitant (printable page)

Class: Supportive care

Generic Name: Aprepitant (uh-PREP-I-tent)
Trade Name: Emend®

For which conditions is this drug approved? Aprepitant is FDA approved for the use with other antiemetic (anti-nausea) agents for the prevention of acute or delayed nausea and vomiting caused by chemotherapy that is highly or moderately associated with nausea and vomiting, including high doses of the chemotherapy agent Platinol® (cisplatin). It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Aprepitant belongs to a class of drugs called antiemetics. Antiemetics help prevent nausea and vomiting caused by chemotherapy. Aprepitant produces its anti-nausea effects by binding to a specific receptor in cells in the brain called P/neurokinin 1 (NK1). This binding blocks a pathway that normally triggers nausea or vomiting.

How is aprepitant typically given (administered)? Aprepitant is administered orally and the dose depends on several factors, including the condition being treated, the particular regimen being used and the overall health of the patient. The regimen of aprepitant includes an additional antiemetic (5-HT3 antagonist) and a corticosteroid, such as ondansetron and dexamethasone. Aprepitant is taken for three days, typically an hour before chemotherapy, and for the two days following chemotherapy.
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with aprepitant. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Since aprepitant has drug interactions with several agents, patients who are receiving agents that interact with aprepitant may be closely monitored in ways specific to their individual situation.

Side effects of treatment with aprepitant are uncommon, and include the following:

• Fatigue, weakness
• Hiccups
• Dizziness
• Diarrhea
• Constipation
• Loss of appetite
• Abdominal discomfort
• Heartburn
• Changes in liver or kidney function laboratory tests

• Treatment with aprepitant may reduce the effectiveness of oral contraceptives and back-up methods of contraception should be considered.
• Treatment with aprepitant may interact with the drug warfarin.
• Aprepitant does interact with some other drugs. Patients who are receiving drugs that interact with aprepitant may be closely monitored.
• Avoid grapefruit juice.
• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Difficulty breathing
• Chest pain
• Fever
• Prolonged diarrhea
• Extreme or prolonged fatigue
• Severe heartburn
• Yellowing skin or eyes

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Ara-C (printable page)

Class: Chemotherapy

Generic Name: Cytarabine (sigh-TARE-a-been), Ara-C, Arabinosylcytosine
Trade Name: Cytosar-U®

For which conditions is this drug approved? Cytarabine is FDA approved in combination with other anticancer drugs for the treatment of acute myelogenous leukemia, acute lymphocytic leukemia, and the blast phase of chronic myelocytic leukemia. It is also indicated for intrathecal administration in the prevention and treatment of meningeal leukemia. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Cytarabine belongs to a group of drugs called antimetabolites. Cytarabine produces its anti-cancer effects by inhibiting the ability of a cell to produce DNA or repair DNA. By inhibiting the production and repair of DNA, cytarabine suppresses the ability of a cell to replicate or repair itself, ultimately causing cellular death.

How is cytarabine typically given (administered)? Cytarabine may be administered intravenously (into a vein), subcutaneously (injection under the skin), intramuscularly (injection into a muscle), or intrathecally (into the spinal fluid). Cytarabine also comes in a long-acting form (DepoCyt™) that may be placed under the skin in a reservoir, with a catheter leading to the brain. The route, dose and scheduling in which cytarabine is administered is dependent upon many factors, including the condition being treated, the particular treatment regimen being utilized, the patient’s height and weight, overall health, and the patient’s tolerance of therapy.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with cytarabine. Typically, blood may be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Physical examinations, scans, or other measures may also be utilized to assess side effects and response to therapy.

In addition, some patients are susceptible to developing a condition called tumor lysis syndrome, in which electrolyte and metabolic disturbances occur. Tumor lysis syndrome can be prevented if managed aggressively at the beginning of treatment. Blood tests will measures levels of electrolyte and metabolic products, and patients should contact their healthcare provider if they experience symptoms such as nausea and vomiting, shortness of breath, an irregular heartbeat, clouding of urine, lethargy and/or joint discomfort.

What are the common (occur in 30% or more of patients) side effects of treatment with cytarabine?

• Low levels of white blood cells – increases risk of infection
• Low levels of red blood cells – increases risk of anemia and blood transfusions
• Low levels of platelets – increases risk of bleeding
• Nausea and vomiting
• Abnormalities in liver function levels, as determined by blood tests
• Mouth sores
• Increase in levels of uric acid – can lead to a condition called tumor lysis syndrome if not treated
• Fever
What are the less common (occur in 10% to 29% of patients) side effects of treatment with cytarabine?
• Diarrhea
• Loss of appetite
• Skin reactions, rash
• Chills
• Achiness
• Hand-foot syndrome (skin peeling, pain, redness of the palms of the hands or soles of the feet)
• Central neurotoxicity characterized by confusion, loss of balance, headache, dizziness, excessive drowsiness
• Eye reactions characterized by vision changes, tearing, pain, or sensitivity to light, eye irritation
• Hair loss
• Bone pain
• Abdominal pain
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Keep hands and feet moisturized to help prevent hand-foot syndrome – patients should speak with their physician regarding the best products to use for this side effect.
• Minimize friction, excessive heat and cold to the palms of the hands and soles of the feet to help reduce the incidence and severity of hand-foot syndrome.
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Fever
• Chills
• Sore throat
• Cough
• Flu or cold-like symptoms
• Signs of infection (redness, swelling, tenderness, drainage, painful or frequent urination)
• Excessive and persistent fatigue
• Unexplained bleeding (nosebleeds, bruising, blood in urine, black tarry stools, etc.)
• Symptoms that may be indicative of tumor lysis syndrome – nausea, joint pain, lethargy, irregular heartbeat, shortness of breath and/or cloudy urine
• Mouth sores
• Yellowing of skin or eyes
• Shortness of breath, difficulty breathing
• Inability to urinate
• Abdominal pain
• Loss of balance and coordination, dizziness, extreme lethargy, confusion, headache, mood swings
• Severe or persistant diarrhea
• Severe or persistant nausea or vomiting
• Mouth sores (painful redness, swelling or ulcers)
• Excessive sleepiness or confusion
• Changes in vision or burning/or tearing of eyes, sensitivity to light, dry,irritated eyes
• Swelling, redness and pain in one leg or arm and not the other
• Slurred speech
• Numbness, tingling or pain in fingers, toes
• Bone, muscle or chest pain
• Change in heart rhythm
• Swelling of feet or lower legs
• Skin rash or itching

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

arabinosylcytosine (printable page)

Class: Chemotherapy

Generic Name: Cytarabine (sigh-TARE-a-been), Ara-C, Arabinosylcytosine
Trade Name: Cytosar-U®

What are the common (occur in 30% or more of patients) side effects of treatment with cytarabine?

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Aranesp® (printable page)

Class: Supportive Care

Generic Name: Darbepoetin Alfa (dar-be-POE-e-tin AL-fe)
Trade Name: Aranesp®

For which conditions is this drug approved? Aranesp® is approved for the treatment of anemia (low levels of red blood cells) caused by chemotherapy in patients with non-myeloid cancers. This FDA approval means that Aranesp® has been compared to standard therapies or supportive care in several clinical trials involving patients with this condition, and has been demonstrated to be safe and effective for this indication. If your doctor has prescribed this drug for a different condition, keep in mind that doctors have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA, and you should discuss this issue with your doctor.

What is the mechanism of action? Aranesp® alleviates anemia that can be caused by chemotherapy by increasing low levels of red blood cells to normal levels. Red blood cells transport necessary oxygen to tissues throughout the body and carry some waste products from cells. Aranesp® works by stimulating cells in the bone marrow to produce functioning red blood cells, ultimately providing sustained normal levels of red blood cells in the body.

How is Aranesp® typically given (administered)? Aranesp® may be given as a subcutaneous (under the skin) injection or rarely into a vein (intravenous). It is typically administered every two weeks, allowing patients to visit their doctor less frequently and avoid unnecessary injections. Increased red blood cell levels in response to Aranesp® may take several weeks. The response time is different for every person. The dose and frequency of Aranesp® administration may vary, depending on how the patient responds, and may change over time while using Aranesp®.

How are patients typically monitored? Patients will usually have their blood levels monitored closely to assess their response to Aranesp® and to refine the dosage that will provide optimal results. Two important blood levels which will be reviewed are called hemoglobin and hematocrit. Hemoglobin is an iron-containing molecule inside every red blood cell that is responsible for the delivery of oxygen to tissues that have low levels of oxygen. Hematocrit is the proportion of red blood cells that are in blood. Blood draws will be continually taken throughout treatment with Aranesp®, as needs may change in response to chemotherapy or your specific condition. Blood pressure will also be monitored frequently.

What are the common (occur in 30% or more of patients) side effects of treatment with Aranesp®?

There are no common side effects attributable to Aranesp® in cancer patients treated with chemotherapy. Common side effects experienced by patients being treated with chemotherapy and Aranesp® appear to be associated with chemotherapy.

What are the less common (occur in 10% to 29% of patients) side effects of treatment with Aranesp®?

• Fluid retention
• Diarrhea

What are possible late side effects of treatment with Aranesp®? There are no known late side effects associated with the appropriate use of Aranesp®.

What can patients do to alleviate or prevent discomfort and side effects?

• Although the risk is small, blood clots may occur while taking Aranesp®. Therefore, it is important that patients take all prescribed doses of blood pressure medication if they have high blood pressure.
• Patients should speak with their physician about iron supplementation while taking Aranesp®, as it is recommended by the manufacturer. Only patients’ physicians can accurately advise patients about any type of supplementation.
• Maintain adequate rest.
• Maintain good nutrition.
• Patients should speak to their healthcare provider about any side effects they are experiencing.
• If patients are allowed to administer Aranesp® at home, they should be sure to understand proper storage and administration of Aranesp®, as well as the safe and proper way to handle and discard needles.

Are there any special precautions patients should be aware of before starting therapy with Aranesp®?

• Patients should tell their physician if they are pregnant, breast feeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician regarding wanting children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney stones, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should let their physician know of any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should tell their doctor if they had any reactions to prior therapy with Procrit®.

When should patients notify their physician?

• Tremors or seizures
• Difficulty breathing
• Blurry vision
• Severe, sudden headache
• Chest pain
• Extreme fatigue (unable to carry on self-care activities)
• Swelling, redness and/or pain in one leg or arm and not the other.
• Dizziness
• Diarrhea
• Fever
• Joint pain
• Rash
• Fluid retention

Important Limitations of Use

DISCLAIMER OF WARRANTIES

CANCERCONSULTANTS.COM SPECIFICALLY DISCLAIMS AND EXCLUDES ALL EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES AS TO QUALITY, ACCURACY (INCLUDING TYPOGRAPHICAL ERRORS), MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE OF THE INFORMATION CONTAINED HEREIN. We DISCLAIMS ALL LIABILITY OR DAMAGES ARISING FROM ANY USE OF THE INFORMATION.

Arimidex® (printable page)

Class: Hormonal therapy

Generic Name: Anastrozole (ah-NAS-tre-zole)
Trade Name: Arimidex®

How is anastrozole typically given (administered)? Anastrozole is administered as a pill once daily. It is eliminated in the body through the urine and feces.

What are the common (occur in 30% or more of patients) side effects of treatment with anastrozole?
• Hot flashes

What can patients do to help alleviate or prevent discomfort and side effects?

When should patients notify their physician?

• Prolonged or severe nausea or vomiting
• Severe weakness
• Bone pain after a fall or trauma, as this may indicate a bone fracture
• Extreme pain

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Aromasin® (printable page)

Class: Hormonal therapy

Generic Name: Exemestane (ecks-uh-MESS-tane)
Trade Name: Aromasin®

For which conditions is this drug approved? Exemestane is FDA approved for the treatment of hormone-positive breast cancer in postmenopausal women who have already been treated with the anti-estrogen agent tamoxifen (Nolvadex®). It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Exemestane belongs to a group of drugs referred to as anti-aromatase agents. Exemestane produces its anti-cancer effects by inhibiting the production of the female hormone estrogen in the body. A significant portion of breast cancers, referred to as estrogen- or hormone-positive, are stimulated to grow by estrogen, which circulates in the blood stream and binds to cancer cells. By inhibiting estrogen production, the growth stimulus of the cancer cells is removed, causing cancer cells to stop growing and/or die.

How is exemestane typically given (administered)? Exemestane is taken orally, once per day after a meal. Patients should try to take exemestane around the same time every day.

How are patients typically monitored? Patients will usually have scheduled meetings for follow-up during treatment with exemestane. Physicians may perform a physical examination, scans or other measures to assess side effects and response to therapy. If a physician feels that a patient is at risk for osteoporosis (reduction in bone density), scans to determine bone density may be ordered prior to or during treatment with exemestane, as the risk of bone fractures may be increased during treatment.

What are the common (occur in 30% or more of patients) side effects of treatment with exemestane?

There are no documented side effects that occur in 30% or more of patients treated with exemestane.

What are the less common (occur in 10% to 29% of patients) side effects of treatment with exemestane?

• Nausea
• Hot flashes
• Depression
• Bone pain
• Difficulty sleeping
• Anxiety
• Difficulty breathing
• Fatigue

• Patients who experience hot flashes may wish to wear light clothing, stay in a cool environment, and place cool cloths on their body or head to relieve their symptoms.
• Over the counter pain medications may help to alleviate the aches or pains that may be caused by treatment; it is important to thoroughly discuss these options with a physician.
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Eat small meals frequently to help alleviate nausea.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant or breastfeeding as exemestane is typically only administered to postmenopausal women.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Due to potential dizziness, drowsiness or confusion, patients should avoid driving or other tasks which require mental alertness until their individual response to the medication is known.

When should patients notify their physician?

• Prolonged or severe nausea
• Severe weakness or fatigue
• Bone pain after a fall or trauma, as this may indicate a bone fracture
• Extreme pain
• Extreme depression or anxiety

What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

arsenic trioxide (printable page)

Class: Chemotherapy

Generic Name: Arsenic trioxide (ARE-sen-ik try-OX-ide)
Trade Name: Trisenox®

For which conditions is this drug approved? Arsenic trioxide is FDA approved for the treatment of acute promyelocytic leukemia (APL) with specific genetic subtypes in patients who have already received prior treatment with an anthracycline and/or retinoid. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Arsenic trioxide is a chemotherapy agent that kills cancer cells. The way in which arsenic trioxide works is not completely understood at present; however, it is believed to cause damage to the cancer cell and its DNA, which prompts the cell to destroy itself. Arsenic trioxide may also inhibit the cell from replicating, and inhibit the supply of nutrients to the cell needed for growth. It is cleared from the body mainly through the urine.

How is arsenic trioxide typically given (administered)? Arsenic trioxide is given in a vein (intravenous), typically over 1 to 2 hours. The dose depends on several factors, including the condition being treated, the size of the patient, the particular treatment regimen being used, and the overall health of the patient.

How are patients typically monitored? While being treated with arsenic trioxide, patients typically have frequent blood tests to monitor their electrolyte levels, blood cell levels, glucose levels, kidney function and blood coagulation time. In addition, patients typically receive an electrocardiogram (ECG) to monitor heart function prior to treatment and possibly while on treatment with arsenic trioxide. Patients may also undergo scans or other measures to assess response to therapy. Uncommonly, a serious condition called APL differentiation syndrome may occur with treatment involving arsenic trioxide. Differentiation syndrome may produce fever, difficulty breathing, lung problems, heart problems, fluid retention and weight gain. Therefore, patients may also be checked for these symptoms. If patients experience fever, sudden weight gain, difficulty breathing or chest discomfort at any time, they should call a healthcare provider immediately. APL differentiation syndrome can be successfully treated with high-dose steroids.

What are the common (occur in 30% or more of patients) side effects of treatment with arsenic trioxide?

• APL differentiation syndrome (see above)
• Nausea and vomiting
• Cough
• Fatigue
• Fever
• Headache
• Changes in heart rate or rhythm
• Abdominal pain
• Diarrhea
• Difficulty breathing
• Abnormalities in electrolyte levels or glucose levels as determined by blood tests
• Fluid retention and swelling of the face, hands, feet or legs
• Sore throat
• Difficulty sleeping
• Rash
• Joint pain
• Muscle pain
• Itching
• Numbness or tingling of hands or feet
• Chills
• Anxiety

What are the less common (occur in 10% to 29% of patients) side effects of treatment with arsenic trioxide?

• Leukocytosis (temporary increase in number of white blood cells)
• Low levels of white blood cells – increases risk of infection
• Low levels of red blood cells – increases risk of anemia and need for blood transfusions
• Low levels of platelets – increases risk of bleeding
• Constipation
• Chest pain
• Low blood pressure
• Loss of appetite
• Unexplained bleeding or bruising
• Depression
• Muscle, bone or generalized pains
• Dizziness
• Runny nose
• Inflamed sinuses
• Abnormal liver function levels
• Weight gain
• Vaginal bleeding
• Dry skin
• Pleural effusion (fluid in the space between the lungs and chest wall)

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Patients who experience hot flashes may wish to wear light clothing, stay in a cool environment, and place cool cloths on their body or head to relieve their symptoms.
Are there any special precautions patients should be aware of before starting treatment?

• Fever
• Difficulty breathing
• Sudden weight gain
• Cough
• Sore throat
• Chills
• Signs of infection
• Noticeable changes in heart rate or rhythm
• Chest pain
• Prolonged diarrhea
• Prolonged nausea and vomiting
• Extreme pain
• Blood in the urine
• Black, tarry stools
• Nosebleeds
• Bruising
• Fainting
• Persistent or severe fatigue
• Lightheadedness
• Headache
What is a package insert?

A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

CANCERCONSULTANTS.COM SPECIFICALLY DISCLAIMS AND EXCLUDES ALL EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES AS TO QUALITY, ACCURACY (INCLUDING TYPOGRAPHICAL ERRORS), MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE OF THE INFORMATION CONTAINED HEREIN. CancerConsultants.com DISCLAIMS ALL LIABILITY OR DAMAGES ARISING FROM ANY USE OF THE INFORMATION.

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

asparaginase (printable page)

Class: Chemotherapy

Generic Name: Asparaginase (a-SPARE-a-ji-naze), L-asparaginase, Erwinia L-asparaginase
Trade Name: Elspar®, Kidrolase®

For which conditions is this drug approved? Asparaginase is FDA approved for the treatment of acute lymphocytic leukemia. It is recommended that asparaginase be used in conjunction with other agents, if not contraindicated in patients, in a regimen for the induction of remission, not as maintenance therapy for acute lymphocytic leukemia. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Asparaginase is an enzyme. Asparaginase produces its anti-cancer effects by “breaking down” asparagine, a substance normally found in the body that is involved in biological processes that are essential for cells to maintain life. Healthy cells are able to create asparagine for themselves; however, cancer cells are not able to create asparagine. Therefore, the depletion of asparagine by asparaginase kills cancer cells, while healthy cells are not as affected.

How is asparaginase typically given (administered)? Asparaginase may be given in a vein (intravenous) or as an injection into a muscle (intramuscular), and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. Patients will often receive a small “test” dose under the skin (intradermal) prior to therapy to detect an allergic reaction to asparaginase. During administration of asparaginase, patients will be closely monitored as they may experience a serious allergic reaction. If patients experience difficulty in breathing, wheezing, itching, agitation, lightheadedness, or swelling of the face during administration of asparaginase, they should notify their healthcare provider immediately.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with asparaginase. Typically, blood will be drawn to check levels of blood sugar, levels of electrolytes, functions of organs, such as the pancreas, liver and kidneys, function of blood clotting and levels of blood cells. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.
What are the common (occur in 30% or more of patients) side effects of treatment with asparaginase?

• Fever
• Chills
• Nausea and vomiting
• Allergic reaction during administration consisting of difficulty breathing, wheezing, itching, rash, swelling of face, agitation, fever, low blood pressure
• Loss of appetite
• Abdominal cramping
• Excessive fatigue or sleepiness
• Depression
• Hallucinations
• Agitation
• Disorientation or confusion
• Seizure

What are the less common (occur in 10% to 29% of patients) side effects of treatment with asparaginase?

• Mouth sores
• Pancreatitis (inflammation of the pancreas) in up to 10% of patients.
• Increased levels of sugar in the blood
• Abnormalities of liver or kidney function tests
• Increased risk of bleeding
• Increased risk of blood clotting

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any history of pancreatitis.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Allergic reaction (hives, itching, tightness of chest, difficulty breathing, swelling)
• Wheezing
• Severe nausea
• Prolonged vomiting
• Fever or chills
• Signs of infection
• Prolonged upper abdominal pain or pain that increases after eating
• Itching, rash
• Abdominal swelling
• Severe or prolonged diarrhea
• Unusual bleeding or bruising
• Swelling, redness and/or pain in one leg or arm
• Extreme fatigue
• Yellowing of the skin or eyes
• Unusual thirst, need to urinate frequently
• Confusion, excessive sleepiness, hallucinations, agitation, anxiety, or disorientation
• Seizures

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

ATRA (printable page)

Class: Chemotherapy

Generic Name: Tretinoin (TRE-ti-noyn), All-trans retinoic acid, ATRA
Trade Name: Vesanoid®

Women treated with tretinoin will also be tested for pregnancy prior to treatment and regularly during treatment as this drug is known to cause birth defects.

What are the common (occur in 30% or more of patients) side effects of treatment with tretinoin?

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Avastin™ (printable page)

Class: Biologic Therapy

Generic Name: Bevacizumab (be-vuh-SIZZ-eh-mab)
Trade Name: Avastin™

For which conditions is this drug approved? Bevacizumab is FDA approved for the treatment of advanced colorectal cancer, either as initial therapy or treatment for recurrent cancer. The FDA indication specifies that bevacizumab is to be used in combination with 5-fluorouracil and leucovorin. Bevacizumab is also approved as initial therapy for the treatment of locally advanced or advanced non-small cell lung cancer that cannot be surgically removed, or recurrent non-small cell lung cancer. This approval specifies that bevacizumab is to be used in combination with the chemotherapy agents paclitaxel and carboplatin. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

How is bevacizumab typically given (administered)? Bevacizumab is administered into a vein (intravenous) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. Bevacizumab therapy should not be initiated for at least 28 days following major surgery and the surgical incision should be fully healed prior to initiation of therapy.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with bevacizumab. Patients may undergo physical examination, scans or other measures to assess side effects and response to therapy. Patients will be monitored during the infusion for signs of an allergic reaction and changes in blood pressure. In addition, patients may be closely monitored for abdominal pain, nausea, vomiting, constipation, or coughing up of blood, as these could be symptoms of abdominal hemorrhage or gastrointestinal performation. Patients may also undergo tests to check their blood pressure, protein levels in their urine, and their heart function. In addition, wound healing may be closely monitored, as this can be inhibited with bevacizumab.

What are the common (occur in 30% or more of patients) side effects of treatment with bevacizumab?

• Weakness, lack of energy
• Pain, abdominal pain
• Changes in blood pressure, usually increased
• Vomiting
• Significant weight loss
• Constipation
• Mouth sores or mouth inflammation
• Nosebleeds
• Protein in the urine
• Low levels of white blood cells
• Upper respiratory infection
• Lack of appetite

What are the less common (occur in 10% to 29% of patients) side effects of treatment with bevacizumab?

• Headache!
• Indigestion
• Flatulence
• Bleeding
• Irritation, inflammation, bleeding of the bowel
• Low levels of potassium in the blood
• Muscle aches
• Respiratory infection
• Dizziness
• Difficulty breathing
• Dry, scaly skin
• Skin discoloration
• Taste abnormalities
• Excessive tearing
• Constipation

What are the side effects of bevacizumab that occur in less than 10% of patients?

• Low levels of platelets – increases risk of bleeding
• Abnormal gait
• Skin ulcer
• Nail abnormalities
• Voice changes
• Hair loss
• Elevated levels of billirubin in the blood
• Dry mouth
• Pain
• Abdominal pain
• Confusion
• Frequency in urination
• Fainting
• Blood clots

What are the possible late side effects of treatment with bevacizumab? There is a slight chance that the addition of bevacizumab to chemotherapy may cause changes to heart function. Patients will have their heart function monitored prior to and during treatment with bevacizumab. Patients should discuss this potential side effect, although uncommon, with their physician.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have high blood pressure.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Bevacizumab therapy should not be initiated for at least 28 days following major surgery and the surgical incision should be fully healed prior to initiation of therapy.
• Bevacizumab therapy should be discontinued prior to elective surgery because of the potential for impaired wound healing.

When should patients notify their physician?

• Coughing up blood
• Unusual bleeding (nosebleeds, black tarry stools, bruising, bloody diarrhea, etc.)
• Redness, swelling or pain in one extremity and not the other
• Sudden weight gain
• Swelling of the ankles or feet
• Pain in flank
• Abdominal pain
• Nausea or vomiting
• Changes in urinary habits or low urine volume
• Noticeable changes in heart rate or rhythm
• Sores or pain in the mouth
• Difficulty breathing
• Dizziness or confusion, feeling faint
• Yellowing of the skin or eyes
• Fever, cough, sore throat, aches, runny nose – signs of cold or flu
• Wounds that won’t heal
• Changes in blood pressure
What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Azacitadine (printable page)

Class: Chemotherapy

Generic Name : Azacitadine (aye-zuh-CYE-ta-deen)
Trade Name: Vidaza™

For which conditions is this drug approved? Azacitadine is FDA-approved for the treatment of the following types of myelodysplastic syndromes: refractory anemia or refractory anemia with ringed sideroblasts (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts, and refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Azacitadine belongs to a group of drugs called a nucleoside analogue. Azacitadine produces its anti-cancer effects by inhibiting the ability of DNA replication. The suppression of DNA replication tends to affect faster replicating cells, such as cancer cells, ultimately causing cellular death.

How is azacitadine typically given (administered)? Azacitadine is typically administered subcutaneously (injection under the skin). The dose and scheduling in which azacitadine is administered is dependent upon many factors, including the condition being treated, the particular treatment regimen being utilized, the patient’s height and weight, overall health, and the patient’s tolerance of therapy. Patients may also receive anti-nausea medication prior to treatment with azacitadine.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with azacitadine. Typically, blood may be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Physical examinations, scans, or other measures may also be utilized to assess side effects and response to therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with azacitadine?

Nausea
Vomiting
Redness or irritation at injection site

What are the less common (occur in 10% to 29% of patients) side effects of treatment with azacitadine?

Low levels of platelets
Diarrhea
Fever
Fatigue
Constipation
Low levels of white blood cells
Cough
Shortness of breath
Red spots on skin
Areas of bruising
Shaking
Pain at injection site
Headache
Joint pain
Limb pain
Significant decrease in weight or loss of appetite
Inflammation of the throat
Back pain
Dizziness
Chest pain
Low levels of white blood cells accompanied by fever
Muscle pain
Inflammation of the nasal area
Anxiety
Bruising at injection site
Injection site reaction
Abdominal tenderness

What are the rare (occur in less than 10% of patients) side effects of treatment with azacitadine?

Bleeding gums
Enlarging of lymph nodes
Runny nose
Heart murmur
Increased sweating
Pain
Pneumonia
Upper abdominal pain
Crackles heard in the lungs
Insomnia
Cough
Depression
Rash
Decreased appetite
Skin abnormalities
Water retention
Paleness
Bloody nose
Weakness

What can patients do to help alleviate or prevent discomfort and side effects?

Pay careful attention to the physician’s instructions and inform the physician of any side effects.
Maintain adequate rest and nutrition.
If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
Wash hands often to reduce the risk of infection.
Eat small meals frequently to help alleviate nausea.
Avoid activities that may cause injury or bruising.
Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)

Are there any special precautions patients should be aware of before starting chemotherapy?

Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
Patients should check with their physician before starting any new drug or nutritional supplement.
Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

Fever
Chills
Sore throat
Cough
Flu or cold-like symptoms
Signs of infection – redness, swelling, pus, tenderness, painful or more frequent than usual urination
Blistering or severe pain/redness/swelling at administration site
Persistent and severe fatigue
Unexplained bleeding (nosebleeds, bruises, black tarry stools, blood in the urine, etc.)
Persistent or severe nausea and vomiting
Persistent diarrhea or constipation
Signs of an allergic reaction – wheezing, difficulty breathing, hives, rash, closing of throat
Noticeable changes in heart rate or rhythm
Chest pain
Difficulty breathing
Abdominal pain
Yellowing of skin or eyes
Swelling of ankles or feet
Severe or persistent pain

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

B

Bacillus Calmette-Guerin (printable page)

Class: Biologic therapy

Generic Name: Bacillus Calmette-Guerin, BCG
Trade Name: TheraCys®, TICE®

For which conditions is this drug approved? BCG is FDA approved for the treatment of superficial bladder cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? BCG is classified as a biologic response modifier and is comprised of an inactivated form of the bacteria Mycobacterium bovis which is responsible for causing tuberculosis. BCG produces its anti-cancer effects by being recognized as “foreign” by the immune system. This stimulates the immune system to mount an inflammatory response in the bladder where the BCG is administered. The immune responses that occur produce anti-cancer activity within the bladder.

How is BCG typically given (administered)? BCG is administered directly into the bladder and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. It is typically given on an outpatient basis, during which time it is delivered through a catheter. Once inserted, the catheter is clamped so that the solution remains in the bladder, and the patient is often asked to move from side to side so that the solution comes in contact with the entire bladder. Following a pre-determined time, the catheter is unclamped and the solution is allowed to drain.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with BCG. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Due to the uncommon side effect of a patient experiencing a systemic infection of tuberculosis, physicians will monitor for signs indicative of an active infection. These signs may include fever that persists for 2-3 days, chills, weakness or flu-like symptoms that increase following therapy, joint pain, cough, skin rash, and/or urinary symptoms including burning, pain, urgency, frequency or blood in the urine that increases or persists, and/or confusion, lightheadedness, dizziness, and/or swelling of the testicles. Patients experiencing any of these symptoms should contact their healthcare provider immediately.
What are the common (occur in 30% or more of patients) side effects of treatment with BCG?

• Increased frequency in urination
• Painful urination
• Blood in the urine
• Fever
• Chills
• Generalized weakness
• Generalized aches and pains

What are the less common (occur in 10% to 29% of patients) side effects of treatment with BCG?

• Bladder irritation/inflammation
• Anemia
• Urinary tract infection
• Urinary urgency
• Kidney damage
• Headache
• Nausea or vomiting
• Lack of appetite
• Genital pain

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Avoid caffeine or alcohol on the day of treatment.
• Avoid drinking large quantities of liquid 6-10 hours prior to treatment and approximately 2 hours following treatment, to allow maximum exposure to BCG.

Are there any special precautions patients should be aware of before starting treatment?

• Since BCG is a live bacterium, it is possible to transmit the infection. To help avoid transmission of infection to others, patients should be seated while urinating to reduce splashing.
• Urine should be disinfected with 2 cups of household bleach (let bleach sit in toilet water for 15-20 minutes) after voiding.
• Men should avoid sexual intercourse for 48 hours following treatment, as sex can transmit infection of BCG to a partner.
• Men should wear a condom if engaging in sexual activity during the treatment course (after 48 hours following treatment with BCG) and for 6 weeks following the completion of treatment.
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they are at high risk of HIV infection or tuberculosis, are known to be immunocompromised, or have an active infection.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Fever lasting 2 days or more
• Chills
• Joint pain
• Increase in urinary frequency, pain on urination, blood in the urine, difficulty in urinating, or sense of urgency to urinate
• Lightheadedness, confusion, dizziness
• Swelling of testicle(s)
• Yellowing of skin or eyes
• Difficulty breathing
• Extreme, persistent fatigue
• Increase in flu-like symptoms

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

BCG (printable page)

Class: Biologic therapy

Generic Name: Bacillus Calmette-Guerin, BCG
Trade Name: TheraCys®, TICE®

• Increased frequency in urination
• Painful urination
• Blood in the urine
• Fever
• Chills
• Generalized weakness
• Generalized aches and pains

What are the less common (occur in 10% to 29% of patients) side effects of treatment with BCG?

• Bladder irritation/inflammation
• Anemia
• Urinary tract infection
• Urinary urgency
• Kidney damage
• Headache
• Nausea or vomiting
• Lack of appetite
• Genital pain

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

What is a package insert?

Important Limitations of Use
The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

BCNU (printable page)

Class: Chemotherapy

Generic Name: Carmustine (kar-MUS-teen), BCNU
Trade Name: BiCNU®

For which conditions is this drug approved? Carmustine is FDA approved for the treatment of the following conditions: several types of brain tumors (including glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma and metastatic brain tumors); multiple myeloma in combination with prednisone; recurrent Hodgkin’s lymphoma in combination with other agents; recurrent non-Hodgkin’s lymphoma in combination with other agents. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Carmustine belongs to a group of drugs referred to as nitrosoureas. Carmustine produces its anti-cancer effects by causing chemical reactions that result in damage to both DNA and amino acids in a cell. The DNA and amino acid damage caused by carmustine ultimately result in cell death.

How is carmustine typically given (administered)? Carmustine is given intravenously (into a vein), and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. Carmustine is also produce in a wafer form that can be directly implanted into the brain (see Gliadel® wafer). Carmustine is unique from several chemotherapy agents in that it is able to pass through the blood-brain barrier (a protective barrier surrounding the brain and spinal cord).

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with carmustine. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems such as the liver and kidneys. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Although uncommon, treatment with carmustine may cause serious damage to the lungs. Therefore, pulmonary function tests may also be performed prior to treatment and during treatment with carmustine. Blood pressure is typically monitored during administration.

What are the common (occur in 30% or more of patients) side effects of treatment with carmustine?

• Low white blood cell levels – increases risk of infection
• Low platelet levels – increases risk of bleeding
• Nausea and vomiting
• Pain or burning at administration site, usually associated with rapid infusion rate
• Redness of face, skin flushing, usually associated with rapid infusion rate

What are the less common (occur in 10% to 29% of patients) side effects of treatment with carmustine?

• Abnormalities in liver function levels as determined by blood tests; hepatic disease with high dose therapy
• Low red blood cell levels – increases risk of anemia and transfusions
• Dizziness
• Loss of balance or coordination
• Abnormalities of the eye (redness, visual changes)
• Reduced blood pressure

What are the possible late side effects of treatment with carmustine? With the use of this drug, there is risk of developing side effects months or years after treatment has been completed. In some instances a secondary malignancy may occur as a result of receiving carmustine. A secondary malignancy is a new cancer that is unrelated to the cancer that was initially treated. Secondary malignancies occur as a result of previous treatment with radiation or chemotherapy. Sterility may also occur as a result of treatment with carmustine. In addition, damage to the lungs can occur years following treatment. Patients should discuss these late side effects with their physician.

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Fever
• Chills
• Flu or cold-like symptoms
• Signs of infection – redness, pus, swelling, tenderness
• Sore throat
• Severe, prolonged fatigue
• Unexplained bleeding (nosebleeds, blood in urine, black tarry stools, bruising, etc.)
• Visual changes
• Hearing changes
• Dizziness, loss of balance
• Yellowing of skin or eyes
• Change in color or urine or stool
• Swelling of ankles, feet or face
• Persistent nausea and vomiting
• Difficulty breathing

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

bevacizumab (printable page)

Class: Biologic Therapy

Generic Name: Bevacizumab (be-vuh-SIZZ-eh-mab)
Trade Name: Avastin™

What is the mechanism of action? Bevacizumab belongs to a class of drugs called monoclonal antibodies. It is not a chemotherapy drug. Bevacizumab produces its anti-cancer effects by targeting vascular endothelial growth factor (VEGF) and preventing the interaction of VEGF to its receptors. VEGF is a type of protein that is important in a process leading to cellular growth, replication and spread, and new blood vessel formation. Bevacizumab binds to VEGF and inhibits its normal effects. It reduces the growth and spread of cancer cells by inhibiting the growth of new blood vessels, marking it harder for the tumor to grow.
How is bevacizumab typically given (administered)? Bevacizumab is administered into a vein (intravenous) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. Bevacizumab therapy should not be initiated for at least 28 days following major surgery and the surgical incision should be fully healed prior to initiation of therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with bevacizumab?

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and sod solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have high blood pressure.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Bevacizumab therapy should not be initiated for at least 28 days following major surgery and the surgical incision should be fully healed prior to initiation of therapy.
• Bevacizumab therapy should be discontinued prior to elective surgery because of the potential for impaired wound healing.

When should patients notify their physician?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

bexarotene (printable page)

Class: Chemotherapy

Generic Name: Bexarotene (becks-AIR-oh-teen)
Trade Name: Targretin®

For which conditions is this drug approved? Bexarotene is FDA approved for the treatment of cutaneous T-cell lymphoma that has not responded to prior therapies. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Bexarotene belongs to a class of agents called retinoids. Retinoids are a form of vitamin A and are involved in cellular growth and maturation. Bexarotene produces its anticancer effects by binding to retinoid receptors within a cell and disrupting the differentiation and excessive replication of cancer cells. This action inhibits the growth and proliferation of the cancer.

How is bexarotene typically given (administered)? Bexarotene is given by mouth, in capsule form, or as a gel that is administered directly onto the skin. If taken orally, bexarotene should be taken with a meal and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with bexarotene. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. In addition, patients will have their blood cholesterol, triglyceride, and glucose levels measured, as bexarotene may affect these levels. Patients may also have their thyroid hormone levels measured.

What are the common (occur in 30% or more of patients) side effects of treatment with bexarotene?

• Skin irritation or abnormalities at the site of gel application
• Abnormalities in blood cholesterol or triglyceride levels
• Headache
• Abnormal levels of thyroid hormone
• Weakness
• Low white blood cell levels – increases risk of infection

What are the less common (occur in 10% to 29% of patients) side effects of treatment with bexarotene?

• Swelling of the hands or feet
• Nausea and vomiting
• Lack of appetite
• Abdominal pain
• Chills
• Infection
• Eye abnormalities (cataracts), visual field effects, dry eyes
• Sensitivity to sunlight
• Diarrhea
• Low red blood cell levels – increased risk of anemia
• Dry skin, rash, itchiness

What can patients do to help alleviate or prevent discomfort and side effects?

• Patients often develop sensitivity to sunlight while being treated with bexarotene, and precautions against sunburn should be taken. Light clothing, hats, sunglasses and suntan lotion should all be used when going outdoors.
• Patients taking the oral form of bexarotene should take the medication with a meal containing some fat.
• Patients should not take the oral form of bexarotene with grapefruit juice.
• Avoid vitamin A supplements due to potential vitamin A toxicity (dry skin, abdominal pain, liver changes)
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.

Are there any special precautions patients should be aware of before starting treatment?

• Retinoids are known to significantly increase the risk of birth defects. Women should use two types of contraception if engaged in sexual activity, or completely abstain from sexual intercourse during treatment and for at least 1 month after treatment . Women of childbearing age are required to take a pregnancy test prior to treatment with bexarotene, and at pre-planned intervals during treatment with bexarotene.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physicians if they have cataracts or high cholelesterol.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep capsules out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Yellowing of skin or eyes
• Severe or persistent headache
• Severe abdominal pain or back pain
• Persistent nausea or vomiting
• Sudden increase in abdominal size
• Persistent or severe weakness, fatigue
• Severe or persistent diarrhea
• Changes in vision
• Swelling of feet or hands
• Fever, chills, sore throat, cough, flu or cold-like symptoms
• Signs of infection – redness, swelling, pus, tenderness
• Irregular heartbeat
• Shortness of breath

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Bexxar® (printable page)

Class: Biologic agent

Generic Name: Tositumomab and Iodine 131 (I131) tositumomab (toe-si-TOO-moe-mab)
Trade Name: Bexxar®

How is this drug used? Tositumomab and I131 is FDA approved for the treatment of patients with CD20 positive, follicular, non-Hodgkin’s lymphoma, with and without transformation, whose disease is refractory to rituximab and has relapsed following chemotherapy. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Tositumomab and I131 tositumomab is a type of agent called a radioimmunotherapeutic. It is comprised of two different portions: a monoclonal antibody designed to recognize a specific target (tositumomab) and a radioactive isotope as a source of radiation (I131). The monoclonal antibody portion has been developed through laboratory processes to bind to B-cells which comprise the majority of cancerous cells in non-Hodgkin’s lymphoma. It is thought that this binding action stimulates the immune system to attack the cancer cells. In addition, the radioisotope that is attached to the monoclonal antibody emits radiation, killing the cancer cells in a second manner.

How is tositumomab given (administered)? Tositumomab and I131 tositumomab are administered into a vein (intravenous). The regimen is administered in two steps; the dosimetric step, in which the therapeutic dose is determined, and the therapeutic step, where the patient actually receives the dose for treatment. Each step consists of administration of tositumomab followed by I131 tositumomab.

In the dosimetric step, patients will be administered tositumomab, followed by a small dose of the radioactive material, I131 tositumomab. The radioactive material emits radiation detectable by a special scanner or camera, called a gamma camera. Physicians will take a picture of the radiation to determine the patient’s clearance rate, or how well the radiation is eliminated from the body. Patients will come in two more times, usually within the week of the first visit, for additional gamma ray scans.

The dose of I131 administered in the second step of treatment, called the therapeutic step, is specifically calculated based on the patient’s clearance rate of. The therapeutic dose of tositumomab and I131 tositumomab is administered seven to fourteen days after the first visit.

Treatment with tositumomab and I131 tositumomab may be administered on an outpatient basis. Physicians and nurses who are trained in administration and management of radioactive agents, called nuclear medicine specialists, are in charge of patients treated with this type of drug. Patients may need to travel to special medical facilities for treatment or larger hospitals may have nuclear medicine facilities within the hospital. Prior to infusion of the radioactive substance, patients will be given an iodine medication to protect their thyroid from damaging effects of treatment, an agent to help reduce fever (e.g. acetaminophen), and an agent to reduce the risk of allergic-type reactions (e.g. diphenhydramine). The drug for protecting the thyoid will be taken for 14 days after the therapeutic dose is administered.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with tositumomab. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients may also have levels of their thyroid hormones monitored.

During infusion and up to 2 days following infusion of tositumomab, patients may experience a reaction to the agent with symptoms including fever, chills, sweating, difficulty breathing, nausea or dizziness from low blood pressure. Patients experiencing these symptoms should tell their healthcare provider.

What are the common (occur in 30% or more of patients) side effects of treatment with tositumomab?

• Low levels of white blood cells – increases risk of infection
• Low levels of red blood cells – increases risk of anemia usions
• Low levels of platelets – increases risk of bleeding
• Generalized weakness
• Fever
• Nausea

What are the less common (occur in 10% to 29% of patients) side effects of treatment with tositumomab?

• Infection
• Pain
• Chills
• Headache
• Abdominal pain
• Diarrhea
• Vomiting
• Loss of appetite resulting in severe weight loss
• Muscle or joint aches
• Cough
• Runny nose
• Swollen throat
• Rash
• Itching
• Shortness of breath

What are the possible late side effects of treatment with tositumomab? Patients treated with tositumomab and I131 tositumomab have a slightly increased risk of developing a secondary malignancy. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment. In addition, thyroid hormone levels should be checked annually, as late effects to the thyroid may occur.

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Fever, chills, runny nose, sore throat, cough
• Signs of infection – redness, swelling, pus, painful urination
• Extreme or prolonged fatigue
• Unexplained bleeding or bruising – nosebleeds, blood in the urine, black or tarry stools
• Persistent nausea, vomiting or diarrhea
• Extreme weight loss
• Shortness of breath, difficulty breathing
• Infusion reactions, including fever, chills, sweating, difficulty breathing, nausea or dizziness, facial swelling, rash
• Chest pain
• Swelling of extremities

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

bicalutamide (printable page)

Class: Hormonal therapy

Generic Name: Bicalutamide (bye-keh-LOO-ta-mide)
Trade Name: Casodex®

For which conditions is this drug approved? Bicalutamide is FDA approved for the treatment of advanced prostate cancer (stage D2), in combination with a luteinizing hormone-releasing hormone (LHRH) analogue. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Bicalutamide belongs to a group of drugs referred to as anti-androgens. Prostate cancer is stimulated to grow by the male hormone, testosterone. Anti-androgens inhibit the effects of testosterone on cancer cells, removing the growth stimulus. Bicalutamide is often given in combination with another hormone agent, classified as a luteinizing hormone – releasing hormone (LHRH) agonist, which helps to block the production of testosterone in the body.

How is bicalutamide typically given (administered)? Bicalutamide is given orally once per day. Patients should take bicalutamide at approximately the same time each day. Patients should speak with their physician about the optimal time to take their medication.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with bicalutamide. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients’ liver function levels will be monitored prior to treatment and at pre-planned intervals during treatment.

What are the common (occur in 30% or more of patients) side effects of treatment with bicalutamide?

• Hot flashes
• Pain
• Decreased libido, impotence
• Swelling of breasts, breast tenderness

What are the less common (occur in 10% to 29% of patients) side effects of treatment with bicalutamide?

• Back pain
• Weakness
• Constipation
• Pelvic pain
• Infection
• Nausea
• Shortness of breath
• Swelling of the ankles, feet or hands
• Diarrhea
• Blood in the urine
• Increased urinating at night, difficulty urinating
• Low levels of red blood cells – increases the risk of anemia or blood transfusions

Are there any special precautions patients should be aware of before starting treatment?

• Patients may notice a “flare” in their symptoms (pain or side effects caused by the cancer) after beginning bicalutamide. However, these symptoms are temporary and should decrease over time.
• Patients should inform their physician if they are ??pregnant, ??breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Treatment with bicalutamide may interfere with the drug warfarin.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Treatment with bicalutamide may cause dizziness, confusion or drowsiness. Patients should exercise caution when engaging in activities involving mental alertness or when driving (until the response or effects to the drug are known).
• Monitor blood glucose and notify your physician of any changes. This drug may alter your glucose level if you are diabetic.
• If an oral dose is missed, do not double up on doses. Patients should contact their doctor in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Chest pain or palpitations
• Difficulty breathing
• Inability to urinate or low urine volume, change in urine color
• Persistent nausea or vomiting
• Persistent or severe diarrhea or constipation
• Swelling of hands, feet or ankles
• Yellowing of skin or eyes
• Tingling of the hands or feet, or inability to move hands or feet
• Persistent or severe fatigue
• Any pain that is severe or continues

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

BiCNU® (printable page)

Class: Chemotherapy

Generic Name: Carmustine (kar-MUS-teen), BCNU
Trade Name: BiCNU®

What are the common (occur in 30% or more of patients) side effects of treatment with carmustine?

What are the less common (occur in 10% to 29% of patients) side effects of treatment with carmustine?

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

Important Limitations of Use

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Blenoxane® (printable page)

Class: Chemotherapy

Generic Name: Bleomycin (blee-oh-MY-sin), bleomycin sulfate
Trade Name: Blenoxane®

For which conditions is this drug approved? Bleomycin is approved for treatment of the following cancers: squamous cell carcinoma of the head and neck (including mouth, tongue, tonsil, nasopharynx, oropharynx, sinus, palate, lip, buccal mucosa, gingivae, epiglottis, skin, larynx), penis, cervix, and vulva; Hodgkin’s disease, non-Hodgkin’s lymphoma; testicular carcinoma- embryonal cell, choriocarcinoma, and teratocarcinoma; and malignant pleural effusion. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Bleomycin belongs to a group of drugs referred to as antitumor antibiotics. Bleomycin is believed to produce its anticancer effects by binding to the DNA causing breaks in the strand of bases that make up DNA. This results in inhibition of the DNA production and cellular death.

How is bleomycin typically given (administered)? Bleomycin can be administered in several different ways. Bleomycin may be administered into a vein (intravenous), under the skin (subcutaneous), into a muscle (intramuscular), or into the pleura (lining between the lung and chest cavity) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with bleomycin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans, blood draws and other measures to assess side effects and response to therapy.

Rarely, patients will experience an allergic reaction to bleomycin, either immediately following administration or several hours following administration, so they will be closely monitored for symptoms including low blood pressure, fever, chills, difficulty breathing, wheezing, and mental confusion. Patients with lymphoma are at increased risk of developing a reaction.

In addition, other rare, but potentially serious side effects that patients will be monitored for include a heart attack or stroke, Raynaud’s phenomenon (a condition affecting the small blood vessels mainly of the fingers or toes), or lung problems. Patients experiencing chest pain, severe headache, vision changes, difficulty speaking, darkening of hands, feet or lips, or difficulty breathing should contact their healthcare provider immediately.
What are the common (occur in 30% or more of patients) side effects of treatment with bleomycin?

• Fever and chills
• Nail abnormalities: nail thickening, dark banding
• Hair loss
• Darkening or reddening of skin
• Peeling of skin
• Thickening of skin
• Ulceration of the skin
• Stretch marks
• Skin tenderness
• Skin itching

What are the less common (occur in 10% to 29% of patients) side effects of treatment with bleomycin?

• Vomiting
• Loss of appetite
• Weight loss
• Lung problems – increased risk with increased age and increased doses of bleomycin
• Mouth sores

What are possible late side effects of treatment with bleomycin?
With the use of bleomycin, there is a risk of developing side effects months or years after treatment has been completed. In rare instances, a secondary malignancy may occur as a result of receiving bleomycin. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients receiving bleomycin should discuss the risk of late occurring side effects with their physician.

Are there any special precautions patients should be aware of before starting chemotherapy?

When should patients notify their physician?

• Difficulty breathing, cough, shortness of breath, any changes in respiratory status
• Wheezing
• Mental confusion
• Mouth sores
• Persistent nausea, vomiting or loss of appetite
• Fever
• Chest pain
• Visual changes
• Severe, sudden headache
• Difficulty speaking
• Lightheadedness
• Confusion
• Darkening of fingers and toes, especially in the cold
• Skin ulcerations
• Persistent fever or chills
• Allergic reaction including swelling of the lips, mouth, or throat, rash, hives, itchy and/or watery eyes

What is a package insert?

Important Limitations of Use

DISCLAIMER OF WARRANTIES