Non Hodgkin's Lymphoma
Cyberfamily
Support Drugs
During your cancer treatment you will be given many different drugs in addition to your chemotherapy drugs. Many of them are to control the side effects, and many are also to manage other health conditions that can be aggravated by chemotherapy. This list is not intended to be an exhaustive or comprehensive list. It is just to give you an idea of what to expect at some point in your treatment history.
It is often very difficult to keep track of all the possible interactions that can occur between your various medications. Medscape offers a drug checker webpage that allows you to enter two or more medications, and it will list any interactions between them. You can enter up to twenty medications at one time.
Medscape Drug
Interaction Checker
Anti-nausea medications
These drugs are usually called antiemetics and they are a chemotherapy patients best friend. The days of nausea an vomiting are for the most part only part of TV movies and not part of the life of most chemotherapy patients. These drugs do an amazing job of not just reducing nausea and vomiting, but for most patients they totally eliminate it, and allow you to live a relatively normal life during your treatment.
Ondansetron
The most common one, and perhaps the best of them is Ondansetron (brand
name Zofran in the U.S.) Ondanzetron is usually given as one 8mg pill twice per
day. For many patients all that is needed is 3-4 pills (36-48 hour supply). Most
patients will find that with Ondansetron there will be no nausea or vomiting at
all. To learn more about Ondansetron click the link below
http://www.rxlist.com/cgi/generic/ondansetron.htm
Granisetron
Granisetron (brand name Kytril in the U.S.) is another drug that is
highly effective. To learn more about Granisetron click the link below:
http://www.rxlist.com/cgi/generic/granisetron.htm
Dolasetron mesylate
Dolasetron (Brand name Anzemet) is another antiemetic that is very
effective for some people. It is less commonly used than the two above. There is
also a small risk of it causing abnormal heart rhythms. Read more about it by
clicking the link below.
http://www.rxlist.com/cgi/generic2/dolaset.htm
Prochlorperazine
Prochlorperazine is another anti-emetic. (Brand name Compazine in the
U.S. and Stemetil in Canada). Although effective, it is not as effective as
Ondanzetron or Granisetron, and it comes with a long list of side effects which
may be too bothersome for many patients. It is also used as a tranquilizer in
some situations. To read more about Prochlorperazine click the link below:
http://www.rxlist.com/cgi/generic2/compazinespan.htm
Palonosetron
Palonesetron (brand name Aloxi) is a newer class of antiemetics. It
can be given alone or with Ondansetron or Kytril for even greater effectiveness.
http://www.rxlist.com/cgi/generic/aloxi.htm
Palonosetron: a second-generation 5-hydroxytryptamine receptor antagonist
New drugs for chemotherapy-induced nausea and vomiting: focus on palonosetron.
Aprepitant
Aprepitant (brand name Emend) is the second of two
recent anti-emetics which may have improved efficacy.
http://www.rxlist.com/cgi/generic/emend.htm
Aprepitant: a substance P antagonist for chemotherapy induced nausea and vomiting
Efficacy of aprepitant in management of chemotherapy-induced nausea and vomiting
Tropisetron
Brand name Navoban is like Ondansetron, and Granisetron. All three
are 5-HT3 receptor blockers. Tropisetron is not available in North America. It
is available in Europe, Australia, and New Zealand.
Click here for
more information about Tropisetron
Blood boosters
Neupogen (Filgrastim)
Neupogen - Granulocyte Colony Stimulating Factor (or G-CSF) helps
stimulate the production of Neutrophils. Neutrophils are the infection fighting
white blood cells, so Neupogen can help prevent chemotherapy induced
neutropenia, and opportunistic infections. Its use during regular chemotherapy
is not required, but often used anyway, especially for patients who already have
compromised white cell counts. During stem cell/bone marrow transplants it
is almost 100% certain the patient will be given Neupogen injections. Injections
are given daily, usually at the 5mcg per kilogram of body weight dose, for one
week or longer. To read more about Neupogen click the link below.
http://www.neupogen.com/pi.html
Neulasta (Peg Filgrastim)
Neulasta is the once per chemotherapy cycle version of Neupogen. Instead
of daily injections just one injection is required for each cycle of
chemotherapy. For more information about Neulasta click the link below:
http://www.neulasta.com/patient/index.jsp
Leukine (Sargramostim)
Similar to Neupogen, Leukine also stimulates the production of
Neutrophils, but it goes one step further and also promotes the macrophages.
Therefore it is called GM-CSF (Granuloctye Macrophage-Colony Stimulating
Factor) Recent studies have shown that for the purposes collecting enough
CD34+ Stem Cells for transplant, Neupogen is more effective than Leukine, and
Neupogen plus Leukine offers no additional benefit, but the cost is
significantly higher. For more information about Leukine click the link below:
http://www.leukine.com
AMD3100
(MOZOBIL™
)
This drug is still in clinical trials. It has been showing great promise of
producing even larger quantities of stem cells in the peripheral blood when
combined with G-CSF (Neupogen) than
Neupogen alone. Read more about it from:
AnorMED's web site.
Procrit
Procrit (Epoetin Alfa) is a red blood cell stimulating factor. It helps
boost the red blood cell production and reduce chemotherapy induced anaemia.
Anaemia can be a major cause of fatigue for cancer patients, and since the red
blood cells take much longer to recover than the white ones do, anaemia can last
much longer than neutropenia. To read more about Procrit click the link below:
http://www.procrit.com
Eprex
Eprex (Epoetin Alfa) sold under this brand name by Ortho Biotech in Canada. For
more information click the link below
Eprex home page
Or go to the Ortho
Biotech home page
Ortho Biotech home page
Epogen
Epogen (Epoetin Alfa) is another version brand of red blood cell booster
sold by Amgen in the United States. To read more about Epogen click the link below:
Epogen home page
Aranesp
Aranesp (darbepoetin alfa) is the long lasting version of Epoetin Alfa. Instead
of daily injections you need only weekly injections. Note that both Epoetin Alfa and
Aranesp are aimed at patients with dialysis induced anaemia. While they can be
used for chemotherapy induced anaemia they are not suitable for all patients in
this situation. Your doctor will advise you if you are a candidate for either of
them. To read more about Aranesp click the link below:
http://www.aranesp.com/
Miscellaneous support drugs
Furosemide (Lasix)
Lasix is commonly used during Stem Cell Transplant when the patient is
undergoing hyperhydration.
Hyperhydration
simply means the patient is receiving massive amounts of hydration to protect
the vital organs like the kidneys, bladder and liver from the toxic effects of
the high dose chemotherapy used for SCT. If these drugs are allowed to remain in
the kidneys, bladder or liver too long, permanent damage may occur so the
patient is pumped full of water to keep them flushed and clean.
However pumping this much water into a patient also leads to bloating or edema.
This build up of water can not only make the patient very bloated, but it can lead to high blood pressure and other health problems. Therefore if this fluid retention becomes a problem then a diuretic is administered to rid the body of this excess fluid. Each medical centre may have a different "danger" level, but approximately 1.5 litres is the point at which they will consider Lasix administration. This means that when you have consumed (by IV or mouth) 1.5 litres more fluid than you have excreted by urination, then they will administer Lasix. Most patients undergoing an SCT are required to measure their liquid input and output throughout their hospital stay.
When administered intravenously Lasix works very quickly, as soon as 5 minutes. The patient will find themselves urinating large quantities about every 15-30 minutes, however the effect wears off in about 2 hours.
One side effect of Lasix is that in addition to depleting the amount of fluid in your body, it also upsets the natural electrolyte balance of your blood. In particular potassium levels may be lowered dangerously so often a potassium supplement must be given.
To read more about Furosemide click the link below
http://www.rxlist.com/cgi/generic/furos.htm
To read about how
diuretics work, in particular with respect to blood pressure click on this link.
E-drug digest - how diuretics work
Mesna
Mesna is a drug used primarily to protect from hemorrhagic
cystitis during high doses of Ifosphamide or Cyclophosphamide.
"Hemorrhagic cystitis" means bleeding of the urinary bladder. High
dose Cyclophosphamide or Ifosphamide are most likely to be administered during
an SCT. However depending on the protocol either of these drugs could be
administered in high doses, necessitating the use of Mesna or Hyperhydration. As
noted above, hyperhydration is also an effective option for preventing major
organ damage when using high doses of some chemotherapeutic drugs.
To read more about Mesna click either of the links below.
http://www.rxlist.com/cgi/generic2/mesna.htm
BC Cancer Agency Drug information about Mesna
Leucovorin
Leucovorin is a medication that acts the same way in the body as
folic acid. Leucovorin is used to reduce the folic-acid-lowering side effects of
methotrexate because it is not affected by methotrexate in the same way as folic
acid is. It is also used to treat a condition known as megaloblastic anemia,
which is an anemia that can be caused by sprue (a condition resulting from
reduced absorption of nutrients from the stomach into the bloodstream) and that
can occur during pregnancy and infancy. Leucovorin is also used in combination
with fluorouracil to treat cancer of the colon.
Read more about Leukovorin here:
http://www.rxlist.com/cgi/generic2/leucovorin.htm
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