Support drugs

A discussion of some of the drugs used to manage toxicity and side effects

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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

Another excellent resource for checking your drugs is DrugWatch. Drugwatch.com is a comprehensive Web site featuring extensive information about medications, Drug Interactions, and drug side effects. This site also provides information on new drug alerts as well as information on medical devices 

 

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

 

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

 

Mozobil (previously AMD3100)

Mozobil, (generic name Plerixafor) has been approved in North America and Europe. It has been shown excellent results mobilizing stem cells from patients who failed to mobilize enough with Neupogen. It is often combined with Neupogen to ensure adequate stem cell harvest. Read more about it from:

Mozobil website

 

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 is another Erythropoiesis-Stimulating Agent. Their website Empower the Patient is an excellent resource for understanding anaemia and fatigue related to cancer and chemotherapy, and what you can do about it including the user of ESAs.

Empower the Patient website

 

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

 

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:

Leucovorin Information

http://www.rxlist.com/cgi/generic2/leucovorin.htm

 

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