Cisplatin

(sis-plat-in) Trade/other name(s): Platinol, CDDP

Why would this drug be used?

Cisplatin is used to treat testicular, bladder, and ovarian cancers that have spread. It also can be used to treat several other cancers, such as lung cancer.

How does this drug work?

Cisplatin is a platinum-compound chemotherapy drug that acts as an alkylating agent. Cisplatin stops cancer cells from growing, causing them to die.

Before taking this medicine

Tell your doctor
If you are allergic to anything, including medicines, dyes, additives, or foods. If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed. If you have ever had kidney stones. Your doctor may need to give you extra fluids and watch certain lab work more closely. If you have ever taken any type of radiation or chemotherapy, especially cisplatin or other platinum-containing medicines. Your doctor will want to watch you more closely for certain side effects. If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children. If you are breast-feeding. The drug passes into breast milk and may harm the baby. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick. Interactions with other drugs Cisplatin may injure or damage the kidneys, especially if given with other drugs that can harm the kidneys, or even drugs that are removed from the body by the kidneys, such as: aminoglycosides (a type of antibiotic that is usually given in the vein, such as gentamicin, tobramycin, amikacin, streptomycin, and others)

non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others blood pressure medicines in the ACE inhibitor group, like lisinopril, enalopril, captopril anti-viral drugs like acyclovir (Zovirax) There are many more such drugs, so be sure your doctor knows all the drugs you take. Talk to the doctor or nurse before you start any new medicine, even non-prescription drugs.

Drugs that can cause hearing loss, such as aminoglycoside antibiotics (see examples above) and certain "water pills" -- the diuretics furosemide (Lasix) and ethacrynic acide (Edecrin) -- may worsen any hearing loss from cisplatin. Probenecid can raise the blood level of cisplatin in the body and cause serious harm. Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with cisplatin. These include: vitamin E non-steroidal anti-inflammatory drugs (see above examples) warfarin (Coumadin) ticlopidine (Ticlid) clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take. Cisplatin may cause anti-seizure drugs such as phenytoin (Dilantin) to leave the body faster. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Cisplatin is given by an infusion into the vein over at least an hour, although it is sometimes given over a much longer time. Your dose will depend on the type of cancer being treated, your size, and how well your kidneys are working. Sometimes you will be given other medicines that will help flush the medicine out quickly through the kidneys. You will also get fluids by vein to help protect the kidneys, and medicine to prevent or stop nausea or vomiting. Before and after the medicine you will need to drink 2 to 3 quarts of liquid a day (an 8 oz. glass of water or fluid every hour while awake) to help protect your kidneys. Your doctor will check your kidney function, blood counts, and hearing before giving you the medicine.

Precautions
This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the doctor or nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV. Cisplatin can damage the kidneys. This risk is reduced by checking your kidney function before you get the drug, giving you extra fluids by vein, and asking you to drink extra fluids for a few days after the drug is given. This extra fluid helps to flush the medicine out of your system and protect your kidneys. Call your doctor if you see blood in your urine, or if you notice swelling in your feet or ankles. This drug can damage your hearing and inner ear (balance), and occasionally cause deafness. Let your doctor know if you notice ringing in your ears, trouble hearing high-pitched sounds, or trouble with your balance. Your doctor may test your hearing before and during treatment. You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor will give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs such as the liver and kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Keep all your appointments for lab tests and doctor visits. Cisplatin can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5 or higher), chills, pain when passing urine, a new cough, or bringing up sputum. This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to

feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Cisplatin may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get live virus vaccines during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this. This drug can cause allergic reactions in some people while the drug is being given. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives, nausea, itching, headache, coughing, tightness in the throat, shortness of breath, trouble swallowing, or swelling of the face, tongue, or eyes. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug. This drug may damage certain nerves in the body, and lead to a problem called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. Constipation can also occur. These symptoms can sometimes worsen to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better. In some people, the damage is permanent. Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor. Avoid pregnancy during and for at least a few months after treatment. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common
kidney damage* decreased blood levels of magnesium, potassium, and calcium nausea* vomiting* low white blood cell count with increased risk of infection* low platelet count with increased risk of bleeding* low red blood cell count (anemia), which can make you tired, dizzy, or easily out of breath* taste changes, including metallic taste of foods and rarely loss of taste

sensation of pins and needles or numbness in hands and/or feet caused by irritation of nerves, which usually goes away when treatment is stopped* swelling in hands, feet, or legs* fetal changes if pregnant during treatment

Less common
tiredness (fatigue) hearing loss, which may be permanent* poor balance due to inner ear damage* trouble walking and weakness of legs and feet due to nerve damage* loss of appetite hair thinning or loss (may include face and body hair as well as scalp hair) diarrhea sterility (inability to have children)

Rare
severe allergic reaction* uncontrolled muscle jerking due to changes in blood chemistry seizures due to changes in blood chemistry blindness or vision changes, which usually go away when treatment stopped chest pain and heart attack second cancer, which may happen years later* death due to infection or other causes

Fluorouracil (5-FU)
(floor-uh-your-uh-sill) Trade/other name(s): 5-FU, Adrucil, Efudex (topical), 5-fluorouracil

Why would this drug be used?

Fluorouracil is used to treat several types of cancer including colon, rectum, and head and neck cancers. It is also used for other types of cancer, and the skin cream is used for other conditions as well.

How does this drug work?

Fluorouracil belongs to the class of chemotherapy drugs known as anti-metabolites. It interferes with cells making DNA and RNA, which stops the growth of cancer cells.

Before taking this medicine

Tell your doctor
If you are allergic to anything, including medicines, dyes, additives, or foods. If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed. If you have been treated for cancer with radiation or chemotherapy. Your doctor may need to watch you more closely during treatment with fluorouracil. If you have ever been told you have a dihydropyrimidine dehydrogenase (DPD) deficiency. DPD is an enzyme the body uses to process this drug. This inborn genetic abnormality can cause extreme side effects if you use 5-FU (even on your skin) or capecitabine. If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. It is important to check with your doctor about what kinds of birth control can be used with this medicine. If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby. If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

The drug leucovorin can increase the risk of side effects from fluorouracil.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with fluorouracil. These include: vitamin E non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others warfarin (Coumadin) ticlopidine (Ticlid) clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take. The drug levels of phenytoin (Dilantin) and fosphenytoin (Cerebyx) may be increased by fluorouracil. Your doctor will want to watch your drug levels closely. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Fluorouracil is given as a shot in the vein (intravenously) over 5 to 10 minutes, over 20 to 60 minutes, or as a continuous infusion over 22 to 24 hours for 1 to 4 days, or longer. The treatment can be repeated weekly, every other week, or every 3 weeks, depending on the treatment regimen. The dose depends on your weight. It may be lowered if you have problems taking the drug (severe diarrhea, or low white blood cell or platelet count).

Precautions
Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for lab tests and doctor visits. This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you

have any signs of infection, such as fever (100.5 or higher), chills, pain when passing urine, a new cough, or coughing up sputum. This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or medicines containing aspirin, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. This drug may lower your red blood cell count. If this is going to happen, it usually happens a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Fluorouracil may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this. You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. Call your doctor if the medicines are not working to stop the vomiting. This drug may cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. Call your doctor or nurse right away. You may need to stop taking this drug. Your doctor or nurse can suggest ways you can still eat or brush your teeth. If needed, your doctor can prescribe medicine to help with the pain. Call your doctor if you have severe diarrhea or pain in your belly. You may need to get treatment for the problem. Your doctor may also want to stop this drug. This drug can make you very sensitive to sunlight or bright ultraviolet light. When possible, avoid being outdoors between the hours of 10 and 4. Wear sunglasses, hat, and protective clothes when outside, even on hazy days. Always apply sunscreen half an hour before going out in the sun, and follow the instructions for repeat applications. Avoid tanning beds. This drug can cause allergic reactions in some people. Symptoms include feeling lightheaded or dizzy (due to low blood pressure), itching, hives (welts on the skin), rapid heartbeat, coughing, wheezing, shortness of breath, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug This drug can cause a condition known as hand-foot syndrome, in which a person may experience pain, numbness, tingling, reddening, or swelling in the hands or feet. Peeling, blistering, or sores on the skin in these areas are also possible. Let your doctor know right away if you notice any of these symptoms. Men and women should avoid conceiving a child during and for a few months after treatment. Talk with your doctor about birth control.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common
low white blood cell count with increased risk of infection* low platelet count with increased risk of bleeding* darkening of skin and nail beds nausea* vomiting* poor appetite sores in mouth, lips, or throat* hair loss or thinning (may include face and body hair) diarrhea brittle nails increased sensitivity to sun, with risk of severe sunburn* dry, flaky, cracking skin

Less common
darkening and hardening of vein used for giving the drug headache weakness muscle aches

Rare
trouble walking, trouble forming words, and poor coordination irritated eyes increased tears, watering eyes blurred vision

heart problems (chest pain, heart attack, heart failure, changes in electrical conduction and more) that usually get better after the drug is stopped confusion tingling, numbness, or swelling in the hands and feet* severe allergic reaction* death due to infection, bleeding, not being able to process the drug (DPD deficiency), or other causes

Carboplatin
(kar-bo-PLAT-in) Trade/other name(s): Paraplatin, CBDCA

Why would this drug be used?

Carboplatin is used to treat ovarian, lung, and other cancers.

How does this drug work?

Carboplatin is a platinum chemotherapy drug that acts like an alkylating agent. It stops the growth of cancer cells, causing the cells to die.

Before taking this medicine

Tell your doctor
If you are allergic to anything, including medicines, dyes, additives, or foods. If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed. If you have taken carboplatin or other platinum-containing medicines before. You will need to be watched more closely for certain side effects. If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could affect the baby. If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If taken with other medicines that can harm the kidneys, like aminoglycosides (a type of antibiotic that is usually given in the vein, such as gentamicin, tobramycin, amikacin, streptomycin, and others), there is a higher risk of kidney damage with this drug. Drugs that can cause hearing loss, such as aminoglycoside antibiotics (see above examples) and some "water pills" -- the diuretics furosemide (Lasix) and ethacrynic acide (Edecrin) -- may worsen the risk of hearing loss from carboplatin.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with carboplatin. These include: vitamin E non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others warfarin (Coumadin) ticlopidine (Ticlid) clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take. Carboplatin may cause anti-seizure drugs such as phenytoin (Dilantin) to leave the body faster. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Carboplatin is given as an infusion in the vein over 15 to 60 minutes. You will probably be given an antinausea drug before receiving this medicine. The dose will depend on your size but may be lowered or not given if your blood counts are low. It can also be given as an infusion into a vein over 24 hours or directly into the peritoneal cavity in advanced ovarian cancer.

Precautions
This drug can cause allergic reactions in some people while the drug is being given. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives, nausea, itching, headache, coughing, shortness of breath, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug. Carboplatin is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Carboplatin may affect your immune system. This could make vaccinations ineffective, or

even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this. Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Keep all your appointments for lab tests and doctor visits. This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5 or higher), chills, pain when passing urine, a new cough, or bringing up sputum. Carboplatin may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. To avoid dehydration, call your doctor or nurse if these medicines aren't helping. Carboplatin may damage certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. Constipation can also occur. These symptoms can sometimes progress to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of these symptoms. If they are severe enough, this drug may need to be stopped or the dose reduced until they get better. Rarely, the loss of sensation may not go away. Avoid pregnancy during and for at least a few months after treatment, since exposure to the drug can harm the fetus. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common
Low white blood cell count with increased risk of infection* Low platelet count with increased risk of bleeding* Low red blood cell count (anemia), which can make you tired, dizzy, or easily out of breath Brittle hair

Kidney function can be altered at high doses Fetal abnormalities if you get pregnant while taking this drug

Less common
Nausea* Vomiting* Loss of appetite Diarrhea Constipation Taste changes Allergic reaction* Sensation of pins and needles in hands and/or feet related to nerve irritation* Temporary or permanent infertility (inability to have children)

Rare
Confusion Changes in vision or vision loss (which improves after drug is stopped) Ringing in ears or hearing loss, which may be permanent Rash Dehydration Sores in the mouth or throat Severe allergic reaction* Kidney damage (may go away when drug is stopped) Liver problems Hair loss or thinning, including face and body hair Dizziness Death due to allergic reaction, infection, or other causes

*see "Precautions" section for more detailed information There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

Docetaxel
(doe-suh-tax-uhl) Trade/other name(s): Taxotere

Why would this drug be used?

This drug is used to treat breast, lung, stomach, prostate, and head and neck cancers. Your doctor might use it to treat other types of cancer as well.

How does this drug work?

Docetaxel is a type of chemotherapy drug known as a taxane. It interferes with microtubules, which are part of the internal structure cells need when they are dividing. This leads to cell death. Because cancer cells divide faster than normal cells, they are more likely than normal cells to be affected by this drug.

Before taking this medicine

Tell your doctor
If you are allergic to any medicines, dyes, additives, or foods. If you have any type of liver disease (including hepatitis). This drug is cleared from the body mainly by the liver. Reduced liver function might result in more drug than expected staying in the body, which could lead to serious side effects. Your doctor may need to adjust your dose accordingly. If you have ever been treated with cisplatin or carboplatin (platinum drugs) for lung cancer. You might have a higher risk of certain serious side effects from docetaxel. If you have any other medical conditions such as kidney disease, heart disease, diabetes, gout, high blood pressure, or infections. These conditions may require changing your medicine dose, regimen, or timing.

If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems with the fetus if taken at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. In pregnant women, treatment with this drug should be used only if the potential benefit to the mother outweighs the risk to the fetus. If you are breast-feeding. While no studies have been done, this drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug. If you think you might want to have children in the future. Talk with your doctor about the possible fertility risk with this drug and the options that may preserve your ability to have children. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Docetaxel may interact with a number of drugs and supplements, which may either raise or lower the level of docetaxel in your blood. This can worsen side effects or make the drug less effective. Tell your doctor if you are taking any of the following: Antidepressant drugs nefazodone (Serzone), trazodone (Desyrel), fluvoxamine (Luvox), or buspirone (Buspar) Antibiotics erythromycin or clarithromycin Anti-fungal antibiotics such as ketoconazole and itraconazole The anti-nausea drug aprepitant Blood pressure medicines such as diltiazem and verapamil HIV drugs such as indinavir, ritonavir, amprenavir, fosamprenavir, and nelfinavir Anti-seizure drugs carbamazepine, phenobarbital, and phenytoin TB drugs rifampin and rifabutin Tranquilizers such as alprazolam (Xanax), diazepam (Valium), triazolam (Halcion), and midazolam (Versed) St. John's wort (an herbal supplement) Methadone Sildenafil (Viagra)

If you are on one of these medicines when you start taking docetaxel, talk to your doctor before you stop them. Many other medicines may also affect docetaxel, and changing any of your medicines may change the actual amount of the drug that stays in your body. Research on interactions with other drugs is incomplete at this time. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and if alcohol can cause problems with this medicine.

Interactions with foods

Grapefruit or grapefruit juice may change the level of docetaxel in your blood. Check with your doctor, nurse, or pharmacist about whether these or other foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Docetaxel is given by an infusion into a vein over 1 hour, usually either every week or every 3 weeks. You will probably get steroid pills, such as dexamethasone, to take the day before you start treatment and for the next 2 days to lessen the chance you will have an allergic reaction or get swelling in your body. You may also get an anti-nausea medicine before the docetaxel, especially if the medicine is given every 3 weeks. The dose will depend on your size, how well your liver works, and how often you will be given the medicine. Your blood will be checked before treatment; if your blood counts are too low or other test results are not normal, the dose may be lowered or the treatment delayed.

Precautions
This drug can cause allergic reactions in some people when the drug is given, especially with the first few treatments. Although you will be given medicine ahead of time to lower this risk, reactions are still possible. Mild reactions may consist of fever, chills, skin itching, or feeling flushed. More serious reactions happen rarely, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), chest tightness, shortness of breath, back pain, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug. This drug can cause your body to retain fluid. This can lead to swelling in your hands or feet. Fluid may also collect in your abdomen, which could make you feel bloated. In more serious cases, fluid may collect in your chest, which can lead to trouble breathing. Let your doctor or nurse know right away if you suddenly gain weight, notice swelling in any part of your body, or develop shortness of breath. You might have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. This drug can cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. Your doctor or nurse can

suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain. This drug can cause diarrhea, which in some cases may be severe. If left unchecked, this could lead to dehydration and chemical imbalances in the body. Your doctor may prescribe medicine to help prevent or control this side effect. It is very important that you take this medicine as prescribed. Make sure you get the medicine right away, so that you will have it at home when you need it. This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. These are sometimes related to being exposed to hot or cold temperatures. These symptoms can sometimes worsen to include trouble walking or holding something in your hands. You will be watched closely for these symptoms. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better. This drug can increase liver enzyme levels in your blood. Your doctor will likely check your liver function with blood tests on a regular basis. The drug might need to be stopped if the changes are severe. If you have liver metastasis or other liver problems before starting treatment, the doctor may need to monitor you more carefully. This drug can cause a condition known as hand-foot syndrome, in which a person may experience pain, numbness, tingling, reddening, or swelling in the hands or feet. Peeling, blistering, or sores on the skin in these areas are also possible. Let your doctor know right away if you notice any of these symptoms. Your doctor will probably test your blood frequently throughout your treatment, looking for possible effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you might be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Be sure to keep all appointments for lab work and doctor visits. This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting a serious, or even life-threatening, infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5 or higher), chills, pain when passing urine, a new cough, or bringing up sputum. This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor can give you medicines to help prevent or treat this condition, or you may need to get blood transfusions. In rare cases, this drug may lower your platelet count in the weeks after it is given, which can increase your risk ofbleeding. Speak with your doctor before taking any drugs or supplements that might affect your bodys ability to stop bleeding, such as aspirin or aspirin -containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctors OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common
Low white blood cell count with increased risk of serious infection* Retaining fluid (may include swelling in hands or feet, shortness of breath)* Nausea* Diarrhea* Hair loss, including face and body hair Feeling weak Low red blood cell count (anemia)* Stopping of menstrual cycles (periods) in women Rash, which can be severe

Less common
Allergic reaction (fever, flushing, itching, rapid heart rate, shortness of breath, throat swelling, dizziness)* Numbness, tingling, or pain in the hands, feet, or elsewhere* Weakness in the hands and feet Sores in the mouth or on the lips* Vomiting Fever Feeling tired Change in how things taste Loss of appetite Nails changing color or becoming brittle

Skin rash Abnormal blood test results which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)*

Rare
Low blood platelet count with increased risk of bleeding* Redness, pain, swelling, or blisters on hands or feet (hand-foot syndrome)* Muscle or joint pain Shortness of breath Excess tears from the eyes Darkening of skin where prior radiation was given (radiation recall) Death from infection, bleeding, or other complication

*See "Precautions" section for more detailed information.

Methotrexate
(meth-oh-TREKS-ate) Trade/other name(s): Folex, Mexate, MTX, Methotrex (formerly Amethopterin)

Why would this drug be used?

Methotrexate is used to treat choriocarcinoma, leukemia in the spinal fluid, osteosarcoma, breast cancer, lung cancer, non-Hodgkin lymphoma, and head and neck cancers. It is also used to treat other cancers and non-cancerous conditions.

How does this drug work?

Methotrexate is part of a general group of chemotherapy drugs known as anti-metabolites. It prevents cells from using folate to make DNA and RNA. Because cancer cells need these substances to make new cells, methotrexate helps to stop the growth of cancer cells.

Before taking this medicine

Tell your doctor

If you are allergic to anything, including medicines, dyes, additives, or foods. If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, infections, or if you have had kidney stones. These conditions may require that your medicine dose, regimen, or timing be changed. If you have stomach ulcers or ulcerative colitis. Methotrexate may worsen these problems. If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. It is not known if this drug might cause problems if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. If you are breast-feeding. The drug passes into breast milk and may harm the baby. If you think you might want to have children in the future. This drug may cause sterility. Talk with your doctor about the possible risk associated with this drug and the options that may preserve your ability to have children. If you have ever been treated for cancer with radiation or chemotherapy. Some of these treatments may affect your response to this medicine. If you drink heavily, or if you have abused alcohol in the past. This can increase your chances of liver damage with methotrexate. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Medicines such as aspirin and other non-steroid medicines for pain, fever, or inflammation, like ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), fenoprofen, diclofenac, fenaprofen, indomethacin, suprofen, tolmetin, meclofenamate, and others can cause methotrexate to stay in your system longer. This can seriously worsen its side effects. Check with your doctor, nurse, or pharmacist to find out if any of the medicines you are taking are NSAIDs. Most of these medicines must be stopped a few days before you get methotrexate, and cannot be resumed until the third day after the dose is given. Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with methotrexate. These include: Vitamin E Non-steroid anti-inflammatory drugs (see examples above) Warfarin (Coumadin) Ticlopidine (Ticlid) Clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take. Penicillins, probenicid, phenylbutazone, and the anti-seizure drug phenytoin can also worsen methotrexate's side effects. Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, and pantoprazole, that are used to reduce stomach acid can worsen the bad effects of methotrexate. People taking certain drugs along with methotrexate may have a higher risk of liver damage: Sulfasalazine (Azulfidine) Azathioprine (Azasan or Imuran) Retinoids such as isotretinoin (Accutane), acitretin (Soriatane), bexarotene (Targretin) etretinate (Tegison), tretinoin (Vesanoid), and others

Trimethoprim-sulfa (Bactrim, Septra) and other sulfa drugs may worsen methotrexate's effects on blood counts. Vitamins that contain folic acid may interfere with methotrexate. Certain antibiotics such as tetracycline or chloramphenicol may block methotrexate from being absorbed when methotrexate is taken in pill form. Theophylline levels may be increased by methotrexate, which can worsen the side effects of theophylline. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements that may cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Methotrexate is given in different ways: as a pill by mouth (usually as a single dose at bedtime), as an injection in a vein for up to 20 minutes, or as an injection into a muscle. This drug is also sometimes injected directly into the spinal cord in order to kill cells there. The pills may cause stomach upset; if you have problems, take an antacid or anti-nausea pill 1 hour before taking the methotrexate. If you're receiving medium or high doses of methotrexate, you will be given leucovorin calcium 24 hours later, then every 6 hours for up to 8 doses to "rescue" normal cells. Your dose based on several factors:

your size, the type of cancer being treated, and how well your kidneys are working. It is very important to take this medicine on time and exactly as prescribed. Your doctor or nurse will tell you if you need to drink extra fluids and take bicarbonate pills to reduce your risk of kidney damage. If you are taking methotrexate pills, take them exactly as directed by your doctor. If you have any questions or do not understand the instructions, talk to your doctor or nurse. Store the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions
Do not drink alcohol while drinking methotrexate, to reduce the risk of serious liver damage. Be sure your doctor knows about all the medicines, vitamins, herbs, and supplements that you are taking before you start methotrexate (see "Interactions with other drugs", above.) This drug can cause the rapid killing of tumor cells, which in some cases has led to serious kidney damage within the first 24 hours of treatment (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids to help prevent this. Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on the liver or kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for lab tests and doctor visits. This drug can lower your white blood cell count, especially in the weeks after the drug is given. A low white blood cell count increases your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5 or higher), chills, pain when passing urine, a new cough, or bringing up sputum. This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. This drug may lower your red blood cell count. If this occurs, it is usually a few weeks after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Methotrexate may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this. If you are taking high-dose methotrexate, you will get fluids with a substance called sodium bicarbonate to flush the medicine through your kidneys. This is given through your vein. After the treatment, drink extra liquids and take the bicarbonate tablets as directed by your nurse or doctor to help protect your kidneys.

While you're taking this drug, you will likely be very sensitive to sunlight or bright ultraviolet light and can get severely burned. When possible, avoid being outdoors between the hours of 10 and 4. Wear sunglasses, hat, and protective clothes when outside, even on hazy days. Always apply sunscreen half an hour before going out in the sun, and follow the instructions for repeat applications. Avoid tanning beds. Methotrexate can also cause radiation recall. When a person receives this drug, the skin or tissue damage from priorradiation therapy can become red and appear damaged again. Tell your doctor or nurse if your skin gets red in areas where radiation was given. Let your doctor know right away if you have cough, shortness of breath, fever, vomiting, diarrhea, stomach pain, mouth sores, or if you suspect that you are getting dehydrated. While taking this medicine, and for a few days afterward, there is a slight chance of a serious skin reaction.Symptoms often start as a skin rash with redness or blistering in the mouth, nose, or eyes, along with fever and body aches. If this happens, stop the drug and get help right away. Methotrexate works to treat many cancers, and is given at low, medium, and high doses. At medium and high doses, severe side effects are prevented by giving it with leucovorin. Leucovorin MUST be taken exactly as directed. Leucovorin is also given when methotrexate is injected into the spinal canal to kill cancer cells in the spinal fluid. Avoid pregnancy during and for at least a few months after treatment, since exposure to the drug can harm the fetus. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common
Nausea (high dose) Vomiting (high dose) Sores in mouth or on lips* Diarrhea Increased risk of sunburn* Skin changes in areas previously treated with radiation* Loss of appetite

Less common
Low white blood cell count with increased risk of infection* Low platelet count with increased risk of bleeding*

Kidney damage Chills and fever

Rare
Nausea (low and medium dose) Vomiting (low and medium dose)* Liver damage that can cause poor appetite, weakness, yellow skin and eyes (usually only with prolonged use) Lung collapse (high dose) Inflammation or scarring of the lung with cough and shortness of breath* Hair loss or thinning, which can include face and body hair Rash, itching Severe skin reaction that can blister and become burn-like* Dizziness Blurred vision Stroke-like symptoms such as seizures, paralysis, confusion, or coma (more risk with high doses) Death from infection, lung damage, skin reactions, holes in the intestines, and other causes

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Ifosfamide
(eye-foss-fuh-mide) Trade/other name(s): Ifex, Isophosphamide

Why would this drug be used?

Ifosfamide is used to treat certain testicular cancers. It is sometimes used for bone and soft tissue sarcomas or other types of cancer.

How does this drug work?

Ifosfamide is a member of a general group of chemotherapy drugs known as alkylating agents. It stops or slows the growth of cancer cells.

Before taking this medicine

Tell your doctor
If you are allergic to anything, including medicines, dyes, additives, or foods. If you have ever had any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, or gout. These conditions may require that your medicine dose, regimen, or timing be changed. If you have any infection or problem with passing your urine. This drug may worsen these problems. If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. If either the male or female is taking it at the time of conception or during pregnancy, there's a chance it may cause birth defects. Check with your doctor about what kinds of birth control can be used with this medicine. If you are breast-feeding. The drug passes into breast milk and may harm the baby. If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children. If you have ever been treated for cancer with radiation or chemotherapy. Your doctor may watch you more closely for certain side effects. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

The following drugs may affect ifosfamide levels in your body: anti-seizure drugs phenobarbital (Luminal) and phenytoin (Dilantin) rifampin (a TB drug) thiotepa, an anti-cancer drug (Thioplex) ticlopidine, a blood thinner (Ticlid)

Be sure your doctor knows if you start or stop taking any of these drugs while you are getting ifosfamide.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with ifosfamide. These include: vitamin E non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others warfarin (Coumadin) ticlopidine (Ticlid) clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take. Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Ifosfamide is given in a vein over a period of time from half an hour to 24 hours for a few days. Because ifosfamide can hurt your bladder, you will likely be given fluids in the vein to help flush out the drug. You should also be given mesna, a drug that helps protect the bladder. If you take mesna by mouth, make sure you take it exactly as prescribed by your doctor. Drink plenty of fluids: 3 or more quarts of fluid a day, or at least twelve 8-oz glasses of juice, water, or sports drink (like Gatorade or Powerade) during the first 24 hours after treatment. This will flush your kidneys and make you pass your urine frequently, which will help protect your bladder. The dose of ifosfamide depends on several factors: your size, how well your kidneys are working, your blood counts, and the type of cancer being treated.

Precautions
This drug can affect the brain. Do not drive or do anything requiring alertness until you know how the drug affects you. Call your doctor if you notice extreme sleepiness, dizziness, confusion, depression, seizures, or hallucinations(seeing or hearing things that aren't there). These symptoms usually go away when the drug is stopped, but you may need extra help until they do.

Ifosfamide can damage the kidneys and cause serious bleeding in the bladder, so it should always be given with fluids in the vein and mesna, a drug that helps to protect the bladder wall. Your doctor should tell you how to best get all the fluids you will need. While taking this drug, drink plenty of fluids and empty your bladder often. Your doctor will check your urine for tiny amounts of blood. Call your doctor if you see any blood in your urine, or if it becomes painful to urinate. You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Ifosphamide may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this. Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on organs such as the kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Be sure to keep all your appointments for lab tests and doctor visits. This drug can lower your white blood cell count, especially in the weeks after the drug is given. A low white blood cell count increases your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5 or higher), chills, pain when passing urine, a new cough, or bringing up sputum. This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. Wounds may not heal well while you are getting this drug, so your doctor may want to stop the drug if you need surgery. Avoid conceiving a baby while you are on this medicine and for some time afterward. This drug can harm a growing fetus.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common
nausea* vomiting* hair loss*

bladder irritation and bleeding, blood in the urine* frequent or painful urination* abnormal kidney function poor appetite diarrhea low white blood cell count with increased risk of infection*

Less common
pain or inflammation where the drug was injected low platelet count with increased risk of bleeding* agitation dizziness constipation

Rare
tiredness (fatigue) confusion* sleepiness* seizures* hallucinations (seeing or hearing things that aren't there)* severe kidney damage or kidney failure* allergic reaction abnormal heart rhythm death due to effects on the brain or other causes

*See "Precautions" section for more detailed information.

Bleomycin

(blee-oh-my-sin) Trade/other name(s): Blenoxane

Why would this drug be used?

Bleomycin is used to treat several types of cancer including testicular cancer, lymphoma, squamous cell cancer of the head, neck, cervix, and other sites. It is also used to treat cancer that has spread to the lungs, to keep fluid from building up between the lungs and chest wall.

How does this drug work?

Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. It stops the growth of cancer cells, which causes the cell to die.

Before taking this medicine

Tell your doctor
If you are allergic to anything, including medicines, dyes, additives, or foods. If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed. If you have ever had any breathing problems or lung diseases. If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby. If you think you might want to have children in the future. Some chemotherapy drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children. About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

No serious interactions are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Bleomycin is given by infusion into a vein, either over 10 minutes or as a continuous infusion for 24 hours. It can also be injected into the muscle or under the skin. You may get a very small test dose before you get the full dose of this drug. The dose depends on your size. Before you get bleomycin, you are usually given a special breathing test, which is repeated a few times during treatment. If the drug is being used to keep fluid from building up around the lungs, it is injected into a tube inserted in your chest. You may be asked to change position to be sure that the medicine reaches all parts of the chest.

Precautions
After you get this drug, it is important to let your doctor know you've had it before you get oxygen, for example, during surgery. Your lungs can be damaged much more easily after you get this drug. Be sure all your doctors know about your treatment with bleomycin. There is a very small chance that patients with lymphoma will have a serious allergic reaction while receiving bleomycin or the first few hours afterward. Symptoms can include feeling confused or dizzy (due to low blood pressure), fever or chills, shortness of breath, or wheezing. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug. If you are at home, call for emergency help (EMS or 911). Your doctor may give you a test dose of the medicine before you receive the full dose to find out if this will be a problem. Bleomycin causes many patients to have a fever the night they get the drug. Tell your doctor and you will probably get medicine before your next dose to prevent the fever. Bleomycin can cause serious lung problems in some people. You probably will have a lung test and possibly a chest x-ray before you get the drug. These tests may be repeated several times during treatment. After you have begun taking the drug, tell your doctor or nurse right away if you notice shortness of breath or trouble breathing, especially when it is cold. Avoid pregnancy during and for at least a few months after treatment, since exposure to this drug may harm the fetus. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them. Common fever and chills nausea vomiting loss of appetite

hair loss, including face and body hair sores in mouth, throat, or on lips skin changes, such as darkened, thickened areas, redness, rash, or dry skin peeling at the fingertips, which can show up 2 or 3 weeks after you get the drug

Less common
pain at tumor site pain at place of injection irritation of vein used for giving the drug inflammation of lungs* weight loss

Rare
scarring and stiffness of lungs, with trouble breathing or shortness of breath* serious allergic reaction with dizziness, confusion, fever, chills, rapid heart rate, wheezing, or facial swelling, which can happen during or hours after the drug* liver or kidney damage blood clots (heart attack, stroke, or lung damage) inflamed blood vessels death due to lung damage, heart attack, stroke, or other cause