Adriamycin (doxorubicin)

Adriamycin belongs to a group of drugs called anthracycline antibiotics. It attacks cells in the body that rapidly divide but cannot tell the difference between cancer cells and healthy cells. Therefore, certain side effects occur. Adriamycin is orange-red in color and is given through a running IV. It is used to treat certain types of cancer, but is most commonly used for patients who have Breast cancer, Lymphoma, Multiple Myeloma, and certain bone cancers.

Side Effects

Although most of the side effects caused by Adriamycin can be managed by your doctor, it is important to be aware of the most common side effects that can occur. The degree of side effects usually depends on the amount of Adriamycin given in a single dose and how often the drug is given. The most common side effects are:

• Low white blood counts
• Low red blood counts - anemia
• Low platelet count
• Nausea
• Mouth sores
• Diarrhea
• Alopecia - temporary loss of hair
• Heart problems
• Damage to the surrounding tissue if drug leaks out of the vein
• Red urine following administration of the drug

Duration of Treatment

The duration of treatment depends on the type of cancer that is being treated. There is a lifetime maximum dose that a person can receive. Usually, Adriamycin is given once every 3-4 weeks and occasionally it is given over a 4-5 day continuous infusion.

It is important to know that some side effects may continue to occur after you stop taking the drug and you should talk to your doctor or the oncology nurse if you have any questions.

Alimta (Pemetrexed)

Alimta is used to treat certain types of cancer. It is a chemotherapy drug that is used alone or in combination with other medications to slow or stop cancer cell growth. Some of the cancers treated with Alimta are:

• Lung cancer
• Mesothelioma

To lower you chance of side effects, it is very important that you take folic acid vitamins and receive vitamin B12 shots before and during treatment. Make sure your vitamin contains 350 to 1000 micrograms (0.35 to 1 milligram)of folic acid.

To reduce your chance of having a skin reaction while using Alimta, your doctor will prescribe a corticosterioid medicine to take for a short period around the time of each treatment.

If this medication touches your skin, wash the skin immediately and completely with soap and water.

Side Effects

• Nausea
• Vomiting
• Loss of appetite
• Constipation
• Diarrhea
• Mouth sores
• Headache
• Body aches/pains
• Dizziness
• Fatigue

Duration of Treatment

This medication is given by injection into a vein (IV) by a healthcare professional, usually over 10 minutes, once every 3 weeks. The dosage is based on your medical condition, body size, and response to therapy.

Aloxi (Palonosetron hydrochloride

Palonosetron hydrochloride belongs to a general class of drugs called serotonin antagonists. It is used to control or prevent nausea and vomiting.

Side Effects

• Headache
• Constipation

Duration of Treatment

Palonosetron hydrochloride is given as an intravenously in a vein over 5 minutes, 30 minutes before your chemotherapy.

The dose is a standard dose, and it is only given once every 7 days.

Amifostine (Ethyol)

This medication is used to reduce the risk of kidney problems caused by the use of cisplatin or to reduce side effects of radiation therapy, such as dry mouth.

Side Effects

• Flushed/warm or chills/cool sensations
• Dizziness
• Drowsiness
• Hiccups
• Sneezing
• Nausea/vomiting

If you notice other side effects not listed above, contact your doctor or pharmacist.

Duration of Treatment

This medication is injected into a vein or subcutaneously before cancer treatment. Medication to prevent nausea and vomiting may be given along with this drug.

Anzamet (dolasetron mesylate)

Dolasetron mesylate belongs to a general class of drugs called serotonin antagonists. It is an antinausea medicine.

Dolasetron mesylate blocks the serotonin pathway by which chemotherapy stimulates the vomiting center in the brain.

Precautions

Do not use if you are pregant or breastfeeding.

Side Effects

Less common side effects:

• Headache

Duration of Treatment

Dolasetron mesylate is given as a tablet by mouth or intravenously into the vein over 1 to 15 minutes. It is given 30 minutes before chemotherapy or surgery. The dose can be a standard dose or based on your weight.

Aranesp (Darbepoetin alfa)

Darbepoetin alfa belongs to a general class of man-made substances called biological response modifiers. It is used to prevent or treat anemia (low red blood cell count) after chemotherapy.Darbepoetin alfa is similar to a hormone in your body called erythropoietin that makes the body's bone marrow produce more red blood cells.

Precautions

This drug can cause an allergic reaction. You will be watched closely for signs and symptoms of a reaction when you first start receiving this drug. Symptoms can include rash, hives, flushing, and difficulty breathing. Symptoms of anemia (fatigue, low energy level, headaches) will go away once the red blood cell count goes back to a higher level.

You should not take darbepoetin alfa if you have uncontrolled hypertension (high blood pressure).

Your doctor will check your iron level in the blood. You may need to take iron pills to help your body make more red blood cells.

Call your doctor or nurse right away if you get a rash, hives, or difficulty breathing. Report swelling of your feet or legs, bad pain in your legs, and/or fever if it occurs.

Side Effects

• Call your doctor right away if you get a rash, hives, or difficulty breathing.
• Report swelling of your feet or legs, bad pain in your legs, and/or fever if it occurs.

Duration of Treatment

Darbepoetin alfa is given as an injection under the skin every 1 to 2 weeks.

Aredia (pamidronate disodium)

Pamidronate disodium belongs to a specific class of calcium-lowering agents called biphosphonates used to treat hypercalcemia (high calcium level in the blood). Pamidronate disodium stops bone breakdown, so calcium is not released from the bones into the blood. It is also used to treat bone metastases from breast and other types of cancer.

Precautions

• You will have blood tests to check your kidney function before receiving this drug. Sometimes this drug can hurt the kidneys if given too fast.
• Tell your doctor if you have a heart, liver, or kidney problem, if you have calcium or vitamin D deficiency, or if you have dental problems

Side Effects

• Fever lasting for a short time 24 to 48 hours after infusion
• Tiredness and flu-like symptoms
• Pain at place of injection
• Irritation of vein used for giving the drug

Duration of Treatment

Pamidronate disodium is given by infusion intravenously in the vein over 90 minutes to four hours.

Arimidex (Anastrozole)

Anastrozole belongs to a general group of drugs called aromatase inhibitors. It is used to treat cancer in postmenopausal women. Anastrozole selectively prevents the body from making estrogen. Other hormones are not affected.

Side Effects

Very rarely, this drug may cause blood clots to form. Call your doctor or nurse right away if you develop pain in your lower leg (calf), redness or swelling of your arm or leg, shortness of breath, or chest pain.

• Headache
• Nausea
• Mild diarrhea
• Increased or decreased appetite
• Sweating
• Hot flashes
• Vaginal dryness
• Weakness
• Decreased energy level
• Blood clots with redness or mild swelling of arms, legs and ankles, pain in leg calves, shortness of breath, difficulty breathing

Duration of Treatment

Anastrozole is a pill taken once a day, about the same time each day.

Aromasin (exemestane)

Exemestane belongs to a general group of drugs called aromatase inhibitors. It is used to treat breast cancer in postmenopausal women. Exemestane prevents the body from making estrogen. Other hormones are not affected.

Side Effects

It is important to keep taking the drug even though you are feeling well. You may feel depressed or have difficulty sleeping while taking this medicine. Talk to your doctor or nurse about ways to manage these side effects to make you feel better.

• Fatigue
• Hot flashes
• Pain at tumor site
• Nausea
• Depression
• Difficulty sleeping
• Increased appetite
• Weight gain
• Pain
• Increased sweating

Duration of Treatment

Exemestane is given as a pill once a day after eating a meal.

Ativan (lorazepam)

Lorazepam belongs to a general class of antianxiety drugs called benzodiazepines. Lorazepam binds to certain receptors in the brain and spinal cord to bring about reduced anxiety, cause muscle relaxation, and prevent seizures. Lorazepam may also be used to prevent nausea and vomiting following chemotherapy. Lorazepam causes amnesia (difficulty remembering an event).

Precautions

Tell your doctor if you are taking any of the following drugs as they may have serious interactions with lorazepam: oral contraceptives, isoniazid (INH), ketoconazole, cimetidine, digoxin, levodopa, or a tricyclic antidepressant drug.

You should not take this drug if you have acute angle closure glaucoma.

Take lorazepam only as directed by your doctor. It may cause psychological dependence (addiction) and physical dependence (body goes into withdrawal if drug is suddenly stopped). When taken as directed by your doctor or nurse, this will not be a problem.

Abruptly stopping the drug can cause anxiety, dizziness, nausea and vomiting, and tiredness. The drug should be gradually stopped.

When you start taking the drug, you may feel drowsy, dizzy, confused, weak, or have a headache. This should go away after a few days of taking the drug. If not, talk to your doctor; your dose may need to be reduced.

The drug should not be given to women who are pregnant or breastfeeding.

Since lorazepam affects the central nervous system (CNS), it is important not to take other drugs or substances that are known CNS depressants such as alcohol, sedatives, and hypnotics.

Duration of Treatment

Lorazepam can be taken as a pill by mouth or under the tongue, intravenously or as an injection under the skin or in a muscle.

Avastin (Bevacizumab)

Bevacizumab is an antiangiogenesis drug, used in molecular targeted therapy to stop tumors from making new blood vessels. Bevacizumab is a monoclonal antibody that works by attaching to and stopping vascular endothelial growth factor (VEGF) from starting the growth of new blood vessels. Without new blood vessels, the tumor cannot grow. Bevacizumab is approved for use against metastatic colorectal cancer, and is being studied for the treatment of many different cancers.

Side Effects

Call your doctor or nurse right away if you develop a nosebleed that doesn't stop with pressure in 10-15 minutes or if you develop severe pain in your abdomen, along with nausea, constipation or other symptoms

• High blood pressure
• Mouth soures
• Diarrhea
• Fatigue
• Weakness
• Nose bleed
• Headache
• Bleeding in the intestines
• Protein in the urine
• Constipation
• Heart Failure
• Pain
• Low white blood cell count

Duration of Treatment

Bevacizumab is given by an infusion intravenously into a vein with a tapering time frame. The drug is infused over 90 minutes the first time and, if tolerated well, over 60 minutes the second time. If you have no problems, the drug is given over 30 minutes for each treatment thereafter. If you have fever or chills, you will receive medicine before the dose to prevent this from happening again.The dose may be held if you have problems with your blood pressure. It may be stopped if you have severe bleeding, stomach pain, opening of a wound, or kidney problems. Bevacizumab is given in combination with 5-fluorouracil based chemotherapy.

Bleomycin (Blenoxane)

Bleomycin belongs to the general group of chemotherapy drugs known as antibiotics. It is used to treat several types of cancer including testicular cancer and lymphoma.

Precautions

After receiving this drug, it is important not to receive pure oxygen-for example, during surgery.

There is a very small chance that patients with lymphoma will have an allergic reaction when receiving bleomycin. Your doctor may give you a test dose of the medicine before you receive the full dose.

Most patients will have a fever the night after getting the drug. This is caused by the drug, and you will probably get medicine before your next dose to prevent the fever.

Bleomycin can cause lung toxicity. You probably will have a lung test (pulmonary function test) before you get the drug, and this may be repeated several times during treatment. After you have begun receiving the drug, tell your doctor or nurse right away if you notice shortness of breath or difficulty breathing, especially in the cold.

Side Effects

• Fever and chills
• Nausea
• Loss of appetite
• Hair loss
• Sores in the mouth or on lips
• Skin changes, such as darkened, thickened areas of skin or nails, rash, or dry skin peeling at the fingertips

Duration of Treatment

Bleomycin is given by an infusion intravenously into a vein, either over 10 minutes or as a continuous infusion for 24 hours.An initial test dose is given for the first 2 doses. Infusions can be are given weekly or twice weekly initially, or for 4-5 days as continuous IV infusion. It can also be given as a shot into the muscle or under the skin, called a test dose before infusion. The drug will be given after you have a special breathing test, and the test may be repeated a few times during treatment.

Camptosar (Irinotecan)

Irinotecan belongs to a general group of chemotherapy drugs known as topoisomerase inhibitors. It is used to treat colon and rectal cancers.

Precautions

While you are being treated with irinotecan, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.

Irinotecan may lower your blood counts (white blood cells, red blood cells, platelets).

Irinotecan can decrease your white blood cell count, especially 21 days after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, or coughing, and bringing up sputum. Irinotecan can decrease your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Irinotecan can cause severe diarrhea. It is very important to understand how to give yourself medicine to stop the diarrhea. Make sure you get the medicine right away, so that you will have it at home to stop the diarrhea immediately.

Side Effects

• Nausea
• Vomiting
• Decreased white blood cell count
• Sweating, abdominal cramping, or diarrhea during infusion
• Diarrhea
• Tiredness
• Anemia

Duration of Treatment

Irinotecan is given by an infusion intravenously into a vein over 90 minutes weekly for 4 weeks and then 2 off.

Carboplatin

Carboplatin is a platinum chemotherapy drug that belongs to a general group of drugs known as alkylating agents. It is used to treat ovarian, lungs, and other cancers.

Precautions

• While you are being treated with carboplatin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay.
• Try to avoid contact with people who have recently taken the oral polio vaccine. Check with your doctor about this.
• Carboplatin can lower your blood counts (white blood cells, red blood cells, platelets).
• Carboplatin can cause a decrease in your white blood cell count, especially 2 weeks after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing and bringing up sputum.
• Carboplatin can lower your platelet count. This can increase your risk of bleeding, in particular if you also take aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Decreased white blood count
• Decreased platelet count
• Brittle hair
• Kidney function can be altered at high doses
• Fetal abnormalities if pregnant or becoming pregnant while taking this drug

Duration of Treatment

Carboplatin is given as an infusion intravenously into the vein over 15 to 60 minutes. It can also be given as an infusion intravenously into a vein over 24 hours or directly into the peritoneal cavity in advanced ovarian cancer.

Cisplatin

Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It is used to treat testicular and ovarian cancers that have spread. It is also used to treat several other cancers, such as lung cancer. Cisplatin stops the growth of cancer cells, causing the cell to die.

Precautions

• While you are being treated with cisplatin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Cisplatin can cause kidney damage. This is prevented by checking your kidney function before you receive the drug, giving you extra intravenous fluids, and asking you to drink extra fluid after the drug is given. This extra fluid helps to flush the medicine out of your system and protects your kidneys.
• Cisplatin also causes your red blood cell count to decrease over a few months' time. Cisplatin can lower the platelet count, which can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Kidney damage
• Decreased blood levels of magnesium, potassium, and calcium
• Nausea
• Vomiting
• Taste changes including metallic taste of food
• Sensation of pins and needles in hands and/or feet caused by irritation of nerves
• Fetal changes if becoming pregnant during treatment

Duration of Treatment

Cisplatin is given by an infusion intravenously into the vein over at least 1 hour every 3 to 4 weeks or daily for 5 days every 3 to 4 weeks. Hydration of fluids will be given before and after Cisplatin is infused to help flush the medicine out quickly through the kidneys. A drug called Mannitol will be given with the Cisplatin infusion; this will also help flush the medicine out quickly through the kidneys. Before and after the medicine you should drink 2 to 3 quarts of fluid a day (an 8 oz. glass of water or fluid every hour while awake) to protect your kidneys.

Compazine (Prochlorperazine

Prochlorperazine belongs to a general class of drugs called phenothiazines. It is an antinausea medicine. Prochlorperazine is useful in preventing nausea and vomiting resulting from chemotherapy. It blocks messages to the part of the brain responsible for nausea and vomiting.

Precautions

• Prochlorperazine may make you feel very sleepy. Do not drive or operate heavy machinery when you are drowsy.
• Prochlorperazine may cause extrapyramidal side effects. These include restlessness, tongue protrusion, and involuntary movements. These side effects are immediately stopped when you are given diphenhydramine.
• Be careful when getting up, changing position, or walking.

Side Effects

• Dry mouth
• Constipation
• Sedation
• Sleepiness

Duration of Treatment

Prochlorperazine is given by mouth as a pill, long-acting capsule, liquid, rectal suppository, or an injection in a vein over 5 to 15 minutes or in a muscle. If you are taking antacids, take the prochlorperazine at least 2 hours before or after the antacid.

Cytarabine (Ara-C)

Cytarabine belongs to the general group of drugs known as antimetabolites. It is used to treat acute leukemias.Cytarabine prevents cells from making genetic material and thereby interferes with cancer cells forming daughters cells.

Precautions

• While you are being treated with cytarabine, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Cytarabine may be given in many dosage strengths. It can lower your blood counts (white blood cells, red blood cells, platelets).
• Cytarabine can decrease your white blood cell count, especially 7 to 9 days after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum.
• Cytarabine can decrease your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Decreased white blood cell count with increased risk of infection
• Decreased platelet count with increased risk of bleeding
• Nausea
• Vomiting
• Tiredness (fatigue)
• Sores in mouth or on lips

Duration of Treatment

Cytarabine or cytosine arabinoside is given infusion intravenously in a vein over 20 minutes to 4 hours, or as a continuous infusion intravenously over 24 hours. It can also be given as a shot under the skin or into the spinal canal.

Cytoxan (cyclophosphamide)

Cytoxan belongs to a group of drugs called alkyklating agents. It is one of the oldest chemotherapies and is used to treat many different types of cancer. Some of the most common cancers treated with Cytoxan are:

• Breast Cancer
• Ovarian cancer
• Lymphoma
• Bladder cancer
• Multiple myeloma
• Leukemia

Side Effects

• Irritation and bleeding of the bladder
• Nausea and vomiting
• Mouth sores
• Alopecia - temporary loss of hair
• Low white blood count
• Low platelet count
• Anemia

It is very important to drink at least 2-3 quarts of fluid for 48 hours following the infusion of Cytoxan. This prevents the damage that can be done to the lining of the bladder by Cytoxan.

Duration of Treatment

Cytoxan is usually administered intravenously over 15-30 minutes depending on the dose being given. In some cases, it is given orally over a 2-3 week period.

Cytoxan is usually given in combination with other chemotherapy drugs. It is given once every 2-4 weeks, depending on the disease being treated. It is usually given a total of 6 times. Your doctor will schedule lab tests to be done in between treatments to monitor blood counts.

It is important to communicate with your doctor and oncology nurse about any side effects you may be having.

Dactinomycin (Actinomycin D, Cosmegen, Act-D)

Dactinomycin belongs to the general group of chemotherapy drugs known as antibiotics. It is used to treat testicular, ovarian, and germ cell cancers. Dactinomycin stops the growth of cancer cells, causing the cells to die.

Precautions

• While you are being treated with dactinomycin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Dactinomycin can lower your blood counts (white blood cells, red blood cells, platelets).
• Dactinomycin can cause radiation recall. When a person has had radiation therapy and then receives this drug, the skin or tissue damage from prior radiation therapy can become red and appear damaged again. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

Side Effects

• Vomiting
• Loss of appetite
• Sores in mouth or on lips, esophagus, or rectal area
• Darkening of skin along vein used for giving the drug
• Diarrhea
• Rash
• Hair loss
• Radiation recall skin changes
• Nausea

Duration of Treatment

Dactinomycin is given intravenously into a vein over 15 minutes daily for 2- 5 days. If the drug accidentally leaks out of the vein where it is given, it may damage the tissue and cause scarring. Tell the nurse right away if you notice redness, pain, or swelling at the place of injection.You will get medicine to stop any nausea or vomiting before the dactinomycin and to take afterward.

Daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR)

Daunorubicin belongs to the general group of chemotherapy drugs known as anthracycline antibiotics. It is used to treat acute lymphocytic and myelocytic leukemias. Daunorubicin stops the growth of cancer cells, causing the cells to die.

Precautions

• Daunorubicin can injure the heart muscle when large doses are given. Your doctor will test your heart function before you receive your first treatment, and then during the treatment. This way, any damage can be found early.
• While you are being treated with daunorubicin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Daunorubicin can lower your blood counts (white blood cells, red blood cells, platelets).
• Daunorubicin can cause radiation recall. When a person has had radiation therapy and then receives this drug, the skin or tissue damage from prior radiation therapy can become red and appear damaged again. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

Side Effects

• Nausea/vomiting
• Hair loss
• Darkening of nail beds

Duration of Treatment

Daunorubicin is given intravenously into a vein over about 15 minutes daily for 3 days. If the drug accidentally leaks out of the vein where it is given, it may damage the tissue and cause scarring. Tell the nurse right away if you notice redness, pain, or swelling at the place of injection.You will get medicine to stop any nausea or vomiting before receiving the daunorubicin and to take afterward.

Dexamethasone (Decadron)

Dexamethasone is a glucocorticoid steroid. It is similar to the steroid hormone made by the adrenal glands in the body. Dexamethasone is a strong anti-inflammatory agent. This drug works by preventing white blood cells from completing an inflammatory reaction. This drug can cause lymphocytes, a type of white blood cell, to break apart and die. Thus it is an important drug used in combination with chemotherapy for the treatment of lymphoma, leukemia, and multiple myeloma. The drug is sometimes given to reduce the likelihood that a person will have an allergic reaction to a chemotherapeutic agent, such as paclitaxel. Finally, this medicine is used to prevent nausea and vomiting from chemotherapy, in combination with other drugs.

Side Effects

• Weight gain
• Sodium and fluid retention with swelling of ankles, increased blood pressure, congestive heart failure
• Depression
• Increased blood sugar
• Increased appetite
• Sleep disturbance
• Increased risk of infection
• Bruising of the skin
• Mood changes
• Delayed wound healing

Duration of Treatment

Dexamethasone is given intravenously into the vein or orally. Dexamethasone pills should be taken with food or milk to protect the stomach from irritation. Talk with your doctor if you have stomach irritation or peptic ulcer disease.

Demerol (Meperidine hydrochloride)

Meperidine hydrochloride is a synthetic opioid analgesic, similar to morphine. Meperidine hydrochloride relieves moderate to severe acute pain. It binds to opioid receptors in the brain and central nervous system (CNS), altering the perception of pain as well as the emotional response to pain.

Precautions

• Take the smallest effective dose to prevent development of tolerance (larger doses needed to give the same effect) as well as physical dependence (body goes into withdrawal if drug is suddenly stopped). This is different from addiction, which is psychological dependence (take drug for psychological effect, not for relief of pain). Tell your doctor or nurse if you still are in pain even though you are taking the medicine as directed.
• Since meperidine hydrochloride affects the central nervous system (CNS), it is important not to take other drugs or substances that are known CNS depressants such as alcohol, sedatives, and hypnotics.
• Acetaminophen or aspirin may be combined with meperidine hydrochloride to increase pain relief.
• You should be on a bowel regimen to prevent constipation while you are taking opioid pain relievers. Talk to your nurse or doctor about this.
• Meperidine hydrochloride is used to relieve acute pain, such as postoperative pain. It should not be used to manage chronic pain related to cancer. The pain relief is short acting, and frequent use can cause dangerous side effects.

Side Effects

• Constipation
• Drowsiness
• Sedation
• Nausea and/or vomiting
• Dizziness
• Dry mouth

Duration of Treatment

Meperidine hydrochloride can be given by an injection into a vein, into the muscle, or under the skin. It can also be given as a pill by mouth.

Doxil (Doxorubicin hydrochloride liposome)

Doxorubicin hydrochloride liposome injection belongs to the general group of chemotherapy drugs known as anthracycline antibiotics that are lipid encapsulated. It is used to treat Kaposi's sarcoma and metastatic ovarian cancer. Doxorubicin hydrochloride liposome injection is doxorubicin surrounded by a special covering made of fat (liposome) that allows the drug to go directly to the cancer and not be damaged by the body's immune system. Doxorubicin hydrochloride liposome injection stops the growth of cancer cells, causing them to die.

Precautions

• While you are being treated with doxorubicin hydrochloride liposome injection, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Rarely, doxorubicin hydrochloride liposome injection can cause a reaction when the infusion starts. Tell your nurse if you feel flushed or short of breath, or if you have chest tightness, chills, back pain, headache, or swelling of your face.
• Doxorubicin hydrochloride liposome injection can injure your heart muscle if large total doses are given. Your doctor will test your heart function before you receive your first treatment, and then during the treatment. This way, any damage can be found early. Talk to your doctor about this.
• Doxorubicin hydrochloride liposome injection can cause radiation recall. When a person has had radiation therapy and then receives this drug, the skin or tissue damage from prior radiation therapy can become red and appear damaged again. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

Side Effects

• Decreased white blood cell count with increased risk of infection
• Decreased platelet count with increased risk of bleeding
• Swelling, Redness and/or swell of hands and/or soles of feet

Duration of Treatment

Doxorubicin hydrochloride liposome injection is given infusion in the vein over 1 hour, usually every 3- 4 weeks. Tell your nurse right away if you get chest pain or tightness, back pain, and/or feel flushed.

DTIC (Dacarbazine)

Dacarbazine is a chemotherapy drug that acts like an alkylating agent. It is used to treat Hodgkin's disease and malignant melanoma. Dacarbazine stops the growth of cancer cells, causing the cells to die.

Precautions

• While you are being treated with dacarbazine, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Dacarbazine can lower your blood counts (white blood cells, red blood cells, platelets).
• Dacarbazine can make you very sensitive to sunlight or bright ultraviolet light. You can get a very bad sunburn. Wear sunglasses, sunscreen, and protective clothes when out in strong sunlight. Always wear sunscreen when out in the sun.

Side Effects

• Nausea and/or vomiting
• Loss of appetite
• Irritation at the injection site
• Flu-like illness up to 7 days after treatment (tiredness, headache, muscle aches, fever, stuffy nose)
• Hair loss

Duration of Treatment

Dacarbazine is given as an infusion intravenously into a vein over 20 minutes or longer for 5-10 days which may be repeated at 3-4-week cycles or a single infusion intravenously on day 1 and day 15 of every cycle. Tell the nurse if you feel pain, burning, or discomfort in the vein when it is given. You will get medicine to stop any nausea or vomiting before the acarbazine and to take afterward. This medicine may be given in addition to other anticancer medicines.

Duragesic (Fentanyl)

Fentanyl transdermal system is an opioid analgesic. Fentanyl transdermal system relieves moderate to severe pain. Fentanyl binds to opioid receptors in the brain and central nervous system, altering the perception of pain as well as the emotional response to pain. Fentanyl transdermal system is a patch. The patch is placed on the skin, and the drug is absorbed through the skin.

Precautions

• If you have never taken opioid pain relievers before, your doctor will start you at the lowest dose. Keep a record of the pain relievers you are taking so that you can show it to your doctor or nurse. This will help in determining the best dosage for you.
• Since fentanyl transdermal system affects the central nervous system (CNS), it is important not to take other drugs or substances that are known CNS depressants such as alcohol, sedatives, and hypnotics.
• You should be on a bowel regimen to prevent constipation while you are taking opioid pain relievers. Talk to your nurse or doctor about this.
• Acetaminophen or aspirin may be combined with fentanyl transdermal system to increase the pain relief action.

Side Effects

• Sleepiness
• Constipation
• Dizziness
• Nausea

Duration of Treatment

Fentanyl transdermal system is a patch that has the medicine inside it. When you first start the patch, you will not feel its effect for 17 to 20 hours, so you need to take other pain medicine until the patch starts working. The patch is put firmly on the skin. First, find a good place on your body to put the patch; it should be clean, flat, and without any skin injury, bumps, etc. Avoid skin that is irritated or has been radiated. Press the patch firmly to the skin, and keep the palm of your hand pressed on the patch for at least 30 to 60 seconds. Write the date and time on the white sticker that comes with the patch. When you shower, you can cover the patch with plastic wrap lightly taped over it, or you may not have to use anything. The patch should be left on for 3 days.

Epirubicin (Hydrochloride)

Epirubicin hydrochloride belongs to the general group of chemotherapy drugs known as anthracycline antibiotics. It is used together with other drugs to treat breast cancer after surgery to prevent any breast cancer cells from coming back. Epirubicin hydrochloride stops the growth of cancer cells, causing the cells to die.

Precautions

• While you are being treated with epirubicin hydrochloride, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine or who have infections.
• Epirubicin hydrochloride can lower your blood counts (white blood cells, red blood cells, platelets).
• Epirubicin hydrochloride can cause radiation recall. When a person has had radiation therapy and then receives this drug, the skin or tissue damage from prior radiation therapy can become red and appear damaged again. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

Side Effects

• Nause and/or vomiting (can be severe)
• Stopping of menstrual periods
• Tiredness(fatigue)
• Mouth sores
• Diarrhea
• Hair loss

Duration of Treatment

Epirubicin hydrochloride is given as an infusion intravenously into a vein over about 15 minutes, every 3-4 weeks or in divided equal doses on day 1 and day 8 of each cycle. Tell the nurse right away if you feel pain, burning, or discomfort in the vein when it is given.

Erbitux (Cetuximab)

Cetuximab is used alone or with other anti-cancer drugs to treat colorectal cancer that has spread to other parts of the body. This medication is also used to treat head and neck cancer. Cetuximab works by slowing cancer cell growth. This action occurs when this drug binds to a specific protein (epidermal growth factor receptor-EGFR) on the cancer cells. Cetuximab is a man-made protein (monoclonal antibody).

Side Effects

• Constipation
• Nausea and vomiting
• Diarrhea
• Headache
• Stomach ache
• Back ache
• Fevers/chills
• Trouble sleeping (insomnia)
• Weight loss
• Fatigue
• Drowsiness
• Eye redness/itching

Duration of Treatment

Cetuximab is given by vein (intravenously-IV) usually once a week by a healthcare professional. Another drug (e.g., diphenhydramine) may be given before you receive cetuximab to lessen the chance of certain side effects. The first dose (loading dose) is larger and is given over 2 hours. All other doses (maintenance doses) are smaller and are given over 1 hour if tolerated. The dosage is based on your medical condition and response to therapy. A healthcare professional should watch you for at least 1 hour after your infusion is finished to make sure you do not have an infusion reaction. If you experience a severe infusion reaction, your infusion will be stopped and your doctor may decide to stop further treatments.

Etoposide

Etoposide belongs to the general class of chemotherapy drugs known as plant alkaloids. It is used to treat small cell lung and testicular cancers.

Precautions

• While you are being treated with etoposide, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Etoposide can lower your blood counts (white blood cells, red blood cells, platelets).

Side Effects

• Nausea and/or vomiting (can be severe)
• Loss of appetite
• Changes in taste including metallic taste of foods
• Hair loss
• Fetal damage if pregancy occurs while taking this drug

Duration of Treatment

Etoposide can be given as an infusion intravenously into a vein over 30 to 60 minutes, or at higher doses over 1 to 4 hours every 14-21 days or daily up to 5 days with adjusted doses. Etoposide can also be given by mouth as a capsule once a day, or in divided doses daily for 5 days.Take antinausea medicine 1 hour before the dose of etoposide. Take the capsule with a glass of water.

Evista (Raloxifene hydrochloride)

Raloxifene hydrochloride is a hormone or hormone blocker (antagonist) that belongs to a group of drugs called selective estrogen receptor modulators (SERMs). Raloxifene hydrochloride is being studied in women who are at high risk for development of breast cancer to see if it prevents cells from becoming cancerous. However, it is used to prevent osteoporosis because in cells like bone cells, it acts like estrogen to prevent bone loss (osteoporosis) in menopausal women. It also helps to lower the fat in the blood (low density lipids). Raloxifene hydrochloride blocks estrogen from binding to certain cells, such as those in the breast. Some cancer cells depend on estrogen for their growth.

Precautions

• Drug or blood clotting levels may need to be checked more frequently if you are also taking Coumadin, a blood-thinning medicine.
• Raloxifene hydrochloride can increase your risk for developing blood clots. If you travel or fly frequently, it is important to get up and walk around frequently so you are not in the same position for a long time. Call your nurse or doctor if you develop shortness of breath, chest pain, pain in your calf (leg) muscles, or redness or swelling of your legs; you may have a blood clot and should be seen by a doctor right away.
• If you are pregnant or may be pregnant, you should not take this drug.

Side Effects

• Hot flashes
• Trouble sleeping

Duration of Treatment

Raloxifene is a pill given once a day at about the same time each day, without regard to food.

Faslodex (Fulvestrant)

Fulvestrant belongs to a new group of drugs called estrogen receptor down regulators. It is used to treat postmenopausal women with advanced breast cancer that no longer responds to antiestrogens like tamoxifen. Breast cancer cells often have estrogen receptors on their cell surface. Estrogen stimulates cells with estrogen receptors to divide without regard to the body's needs. This is called estrogen receptor positive breast cancer. Fulvestrant binds to the estrogen receptor in the cell so that estrogen cannot bind to it and destroys the receptor. This "down regulates," or decreases, the expression of the estrogen receptor in the cell so that the cell acts like a normal cell.

Precautions

• Fulvestrant should not be taken by pregnant or premenopausal women.
• Fulvestrant should not be taken by women who have bleeding problems or who are on drugs like Coumadin to stop blood clots.

Side Effects

• Nausea
• Feeling listless or tired

Duration of Treatment

Fulvestrant is given by injection into the muscle of your buttock, once a month. It can be a single shot, or can be divided into 2 shots.

Femara (Letrozole)

Letrozole belongs to the general group of drugs called aromatase inhibitors. It is used to treat breast cancer in postmenopausal women. It can also be used to reduce the risk of cancer recurrence after five years of tamoxifen. Letrozole prevents the body from making estrogen. Cancer cells that need estrogen are stopped from growing. Other hormones are not affected.

Side Effects

• Pain in bone and muscle

Duration of Treatment

Letrozole is a pill taken by mouth once a day. Take with water, with or without food.

Fludarabine (Fludara)

Fludarabine phosphate belongs to the general group of chemotherapy drugs known as antimetabolites. It is used to treat chronic lymphocytic leukemia and certain acute leukemias Fludarabine phosphate prevents cells from making genetic material required for the growth of cancer cells

Precautions

• While you are being treated with fludarabine, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Fludarabine can lower your blood counts (white blood cells, red blood cells, platelets).

Side Effects

• Tiredness (fatigue)
• Nausea
• Vomiting

Duration of Treatment

Fludarabine phosphate is usually given as an injection in a vein over 30 minutes once a day for 5 days.

Gemzar (Gemcitabine)

Gemcitabine belongs to a general group of chemotherapy drugs known as antimetabolites. It is used to treat pancreatic cancer, breast cancer (along with paclitaxel), and lung cancer (along with cisplatin), and may be used for other cancers as well. Gemcitabine prevents cells from making DNA and RNA by interfering with the synthesis of nucleic acids. This stops the growth of cancer cells, causing the cells to die.

Precautions

• While you are being treated with gemcitabine, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Gemcitabine can lower your blood counts (white blood cells, red blood cells, platelets).

Side Effects

• Nausea and/or vomiting
• Increased liver function blood tests
• Tiredness (fatigue)

Duration of Treatment

Gemcitabine is given as an infusion intravenously into a vein over 30 minutes weekly.For pancreatic cancer, gemcitabine is given once a week for up to 7 weeks to start. Then it is given once a week for 3 weeks, and 1 week without treatment. This is repeated every 4 weeks.When given for breast cancer, it usually is given once a week for 2 weeks, then 1 week off. When given for lung cancer or other cancers, it usually is given weekly for 3 weeks, then 1 week off.

Gleevec (Imatinib mesylate)

Imatinib mesylate is a protein-tyrosine kinase inhibitor used in molecular targeted therapy to treat patients with chronic myeloid leukemia (CML). It has been approved by the FDA to treat gastrointestinal stromal tumors (GIST). Imatinib mesylate inhibits (blocks) the Bcr-Abl protein tyrosine kinase, which is made by the abnormal Philadelphia chromosome in chronic myeloid leukemia. The protein tyrosine kinase carries messages to the cell telling it to divide and grow. By blocking this message, imatinib mesylate prevents the cancer cells from making more cells and causes them to die (apoptosis). Imatinib mesylate also blocks the receptor tyrosine kinase for c-kit, which carries the message for the cancer cells in GIST telling them to divide, causing the cells to stop dividing and to die. The drug is used to treat patients with chronic myeloid leukemia (CML) and GIST when the tumor cannot be removed.

Side Effects

• Nausea
• Vomiting
• Swelling around the eyes or feet (edema)
• Muscle cramps
• Diarrhea
• Muscle aches and pains
• Skin rash
• Tiredness(fatigue)
• Headache
• Joint and bone pain
• Abdominal pain

Duration of Treatment

Imatinib mesylate is a capsule taken by mouth once a day with a full glass of water. If your doctor increases your dose, you may need to split the dose and take it once in the morning and once later in the day.

Herceptin (Trastuzumab)

Herceptin is a monoclonal antibody which belongs to the general class of man-made substances called biologic response modifiers. It is used to treat breast cancer. Trastuzumab (monoclonal antibody) is a protein that fits like a lock and key with a protein on certain breast cancer cells. The protein (antigen) on the breast cancer cells is the Epidermal Growth Factor Receptor, called HER-2. Once it attaches to the cells, it brings other immune cells to help kill the cancer cells. It is usually given with chemotherapy.

Precautions

• Trastuzumab often can cause an allergic reaction with fever and chills. Tell your nurse or doctor if these side effects occur.

Side Effects

• Fevers
• Chills

Duration of Treatment

Herceptin is given by intravenous infusion over 90 minutes at first, then in later treatments, over 30 minutes.

Hydrea (Hydroxyurea)

Hydroxyurea belongs to a general group of chemotherapy drugs called antimetabolites. It is used to treat chronic myeloid leukemia and blood disorders including polycythemia vera and sickle cell anemia. Hydroxyurea prevents cells from making DNA and RNA by interfering with the synthesis of nucleic acids, thus stopping the growth of cancer cells.

Precautions

• While you are being treated with hydroxyurea, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Hydroxyurea can lower your blood counts (white blood cells, red blood cells, platelets).
• Hydroxyurea can cause a dramatic decrease in your white blood cell count, especially 24 to 48 hours after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum.
• Hydroxyurea can cause a decrease in the platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding of gums when you brush your teeth, or black, tarry stools.

Side Effects

• Decreased white blood cell count with increased risk of infection

Duration of Treatment

Hydroxyurea is taken by mouth as a capsule or pill daily, this medication is increased every 6-8 weeks as tolerated. Take the medicine with a full glass of water. If the medicine makes you feel sick to your stomach, take an antinausea pill 1 hour before the hydroxyurea.

Idamycin (Idarubicin)

Idarubicin belongs to a general group of chemotherapy drugs known as anthracycline antibiotics. It is used to treat nonlymphocytic leukemia in combination with other drugs. Idarubicin prevents cells from making DNA and/or RNA, thus altering cell growth.

Precautions

• While you are being treated with idarubicin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Idarubicin can lower your blood counts (white blood cells, red blood cells, platelets).
• Idarubicin can decrease your white blood cell count, especially 10 to 20 days after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum. Idarubicin can decrease the platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.
• Idarubicin can injure the heart muscle when large doses are given. Your doctor will test your heart function before you receive your first treatment, and then during the treatment. This way, any damage can be found early. Talk to your doctor about this.

Side Effects

• Nausea and/or vomiting
• Decreased appetite
• Sores in mouth or on lips
• Hair loss
• Skin rash

Duration of Treatment

Idarubicin is given as an intravenously into the vein over about 15 minutes daily for 3 days with cytarabine. Tell the nurse if you feel pain, burning, or discomfort in the vein when it is given.

Kytril (Granisetron hydrochloride

Granisetron hydrochloride belongs to a general class of drugs called serotonin antagonists. It is an antinausea medicine. Granisetron hydrochloride blocks two pathways of serotonin release to prevent chemotherapy-related nausea and vomiting. It binds to the serotonin receptors in the gastrointestinal tract (lining of the stomach), thus preventing the stimulation of the vomiting center and chemoreceptor trigger zone in the brain. In addition, it responds to high levels of serotonin released from chemotherapy injury to the cells lining the stomach.

Side Effects

• Headache
• Constipation
• Diarrhea
• Tiredness(fatigue)
• Sleepiness

Duration of Treatment

Granisetron hydrochloride is given as an intravenously into a vein over 5 minutes, or as a pill 1 hour before chemotherapy.

Leucovorin

Leucovorin calcium is a vitamin. It is a water soluble vitamin in the folate group (folinic acid). Leucovorin calcium can do two things. First, it helps drugs such as 5-fluorouracil work better than the 5-fluorouracil can alone (potentiates). This makes the 5-fluorouracil kill cancer cells more effectively. Second, it can rescue normal cells from the action of methotrexate. This allows cells lining the mouth and gastrointestinal tract, and the cells in the bone marrow to be less affected by the methotrexate. It is an antidote when used this way, and MUST be taken exactly as directed. Otherwise, the body will have severe side effects from the methotrexate.

Precautions

• Tell your doctor if you are taking seizure medicines. If you receive high doses of leucovorin calcium, this may decrease the anti-seizure action of your medicine.
• Tell your doctor if you are taking folic acid or multi-vitamins that contain folic acid.

Side Effects

• Allergic reaction with flushing of face and itching
• Nausea/Vomiting

Duration of Treatment

Leucovorin calcium is given intravenously with other medications or orally. If taking the tablets, the dose must be given exactly on time as directed by your nurse or doctor.

Leukeran (Chlorambucil)

Chlorambucil belongs to the general group of chemotherapy drugs known as alkylating agents. It is used to treat chronic lymphocytic leukemia. Chlorambucil stops the growth of cancer cells, causing the cells to die.

Precautions

• While you are being treated with chlorambucil, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Chlorambucil can lower your blood counts (white blood cells, red blood cells, and platelets). Your doctor will check your blood counts before and after each treatment to see its effect on your blood counts. Your doctor or nurse will give you specific instructions if your blood counts are low.
• Chlorambucil can lower your white blood cell count, especially 3 weeks after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum.
• Chlorambucil can lower your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Stopping of menstrual periods
• Reduced sperm production
• Fetal changes if becoming pregnant

Duration of Treatment

Chlorambucil is a pill that is given by mouth once a day for a short or long time depending upon the type of cancer being treated. Try to take the pill at about the same time every day. You may need to take an anti-nausea pill 1 hour before taking the medicine if you get sick to your stomach. Remember to drink lots of water during the day to keep your kidneys flushed out.

Leukine (Sargramostin)

Sargramostim is a protein cytokine that belongs to the general class of synthetic substances called biologic response modifiers. It is used to control and stimulate the growth of white blood cells and is used to help prevent infection due to low white blood cells following chemotherapy. Sargramostim tells the body's bone marrow to make more special immune cells (monocytes and macrophages). It also stimulates the immune system to work better to fight infection.

Precautions

• Sargramostim often causes a flu-like syndrome with fever, chills, tiredness, headache, and muscle aches. Talk to your nurse or doctor about ways to lessen these side effects.

Side Effects

• Flu-like symptoms such as fever, chills, tiredness, and muscle aches
• Bone pain

Duration of Treatment

Sargramostim is given as an injection under the skin or in a vein over 2 hours.

Lomustine (CCNU, CeeNU)

Lomustine belongs to the general group of chemotherapy drugs known as alkylating agents. It is used to treat several types of cancer including brain cancer and Hodgkin's disease. Lomustine stops the growth of cancer cells, which causes them to die.

Precautions

• While you are being treated with lomustine, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine. Check with your doctor about this.
• Lomustine can decrease your white blood cell count, especially 4 to 5 weeks after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum.
• Lomustine can decrease your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Nausea and/or vomiting
• Fetal changes if pregnant

Duration of Treatment

Lomustine is a pill taken by mouth on an empty stomach at bedtime. Take an antinausea medicine 1 hour before. The pill is usually taken once every 6 weeks.

Lupron (Leuprolie acetate)

Leuprolide acetate belongs to the general class of drugs known as hormones or hormone antagonists. It is used to treat advanced prostate cancer. It is also used to treat uterine fibroids and endometriosis.

Leuprolide acetate is a hormone similar to the hormone LHRH (luteinizing hormone-releasing hormone) that regulates the production of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) produced by the pituitary gland. It reduces the production of FSH and LH. The decrease in LH causes the reduction in testosterone. This prevents cancer cells that depend on testosterone from growing.

Precautions

• Leuprolide acetate can cause a "flare" reaction after you start taking the drug.
• You will feel increased pain in bone and/or the tumor site, and men may have difficulty urinating.

Side Effects

• Hot flashes
• Headache
• Dizziness
• enstrual periods will stop
• "Flare" reaction with initial dose

Duration of Treatment

Leuprolide acetate is given as an injection into a muscle or under the skin. It can be given monthly or every 3 months, 4 months, or 6 months, depending on how stable the cancer is.

Megace (megestrol acetate)

Megestrol acetate belongs to the general group of drugs known as hormones or hormone antagonists. It is used to treat several types of cancer, including advanced breast cancer and endometrial cancer. It is often used in higher doses to help increase appetite. It is unclear how the drug, which is a progesterone (female hormone), stops cancer cells from growing, but the drug appears to compete for hormone receptor sites on the cell.

Side Effects

• Fluid retention
• Weight gain

Duration of Treatment

Megestrol acetate is a pill or liquid taken by mouth. The pill is usually taken 4 times a day. The liquid is taken either daily or twice a day.

Melphalan (Alkeran, L-Phenylalanine Mustard)

Melphalan hydrochloride belongs to the general group of chemotherapy drugs known as alkylating agents. It is used to treat multiple myeloma and ovarian cancer. Melphalan hydrochloride stops the growth of cancer cells, causing them to die.

Precautions

• Melphalan hydrochloride can decrease your white blood cell count, especially 16 to 21 days after the drug is given. This can increase your risk of getting an infection. Report fever of 100.°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum.
• Melphalan hydrochloride can decrease your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines without the approval of your physician. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.
• While you are being treated with melphalan hydrochloride, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine. Check with your doctor about this.
• Because of the way this drug acts on the body, there is a chance that it can cause other side effects that may not occur until months or years after the drug is used. This drug can very rarely cause a second cancer such as leukemia.

Side Effects

• Nausea (at higher doses)
• Vomiting (at higher doses)
• Fetal changes if pregnancy occurs while taking this drug

Duration of Treatment

Melphalan hydrochloride is a pill taken by mouth. It can also be given in high doses as an injection in a vein (investigational). Take the pill on an empty stomach, usually once a day for 5 days, every 6 weeks. You will be given antinausea medicine before taking the high-dose melphalan.

Methotrexate (Amethopterin, Folex, Mexate)

Methotrexate belongs to a general group of chemotherapy drugs known as antimetabolites. It is used to treat choriocarcinoma, leukemia in the spinal fluid, osteogenic sarcoma, breast cancer, and head and neck cancers. Methotrexate prevents cells from making DNA and RNA by interfering with the synthesis of nucleic acids, thus stopping the growth of cancer cells.

Precautions

• While you are being treated with methotrexate, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Methotrexate can decrease your white blood cell count, especially 7 to 9 days after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, or coughing, and bringing up sputum.
• Methotrexate can decrease your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.
• While receiving high-dose methotrexate, you will receive extra intravenous fluid with a medicine called sodium bicarbonate to flush the medicine through your kidneys. After the treatment, it is important to drink extra liquids and take the bicarbonate tablets as directed by your nurse or doctor.

Side Effects

• Nausea and/or vomiting(high doses)
• Sores in mouth
• Diarrhea
• Increased risk of sunburn
• Skin changes in areas previously treated with radiation
• Loss of appetite

Duration of Treatment

Methotrexate is given as a pill by mouth, as an injection intravenously into a vein for up to 20 minutes, or as an injection into a muscle. The pills are usually taken as a single dose at bedtime. If the pills cause stomach upset, take an antacid or antinausea pill 1 hour before taking the methotrexate.Methotrexate can also be injected into the spinal cord to kill any cancer cells there. If methotrexate is given in medium or high doses, leucovorin calcium is given 24 hours later, then every 6 hours for up to 8 oses to "rescue" normal cells.

Mitomycin C

Mitomycin belongs to a general group of chemotherapy drugs known as antibiotics but acts as an alkylating agent. It is used to treat gastric and anal cancers. Mitomycin blocks DNA synthesis in the cell, which results in cell death.

Precautions

• While you are being treated with mitomycin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Mitomycin can decrease your white blood cell count, especially 4 to 6 weeks after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, coughing, and bringing up sputum.
• Mitomycin can cause a decrease in the platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Nausea and/or vomiting (can be severe)
• Loss of appetite
• Tiredness(fatigue)
• Hair loss

Duration of Treatment

Mitomycin is given intravenously into the vein over 20 minutes once every 6-8 weeks. If the drug accidentally leaks out of the vein where it is given, it may damage the tissue and cause scarring. Tell the nurse right away if you notice redness, pain, or swelling at the place of injection.This medicine may be given in addition to other chemotherapy medicines.

Morphine(MS Contin)

Morphine is an opioid analgesic used to relieve moderate to severe pain.

Precautions

• Take the smallest effective dose to prevent development of tolerance (larger doses needed to give the same effect) as well as physical dependence (body goes into withdrawal if drug is suddenly stopped). This is different from addiction, which is psychological dependence (take drug for psychological effect, not for relief of pain). Tell your doctor or nurse if you are still in pain even though you are taking the medicine as directed.
• Acetaminophen or aspirin may be combined with morphine to increase the pain relief action.
• You should be on a bowel regimen to prevent constipation while you are taking opioid pain relievers. Talk to your nurse or doctor about this.
• Since morphine affects the central nervous system (CNS), it is important not to take other drugs or substances that are known CNS depressants such as alcohol, sedatives, and hypnotics.

Side Effects

• Constipation
• Drowsiness
• Sedation
• Nausea
• Dizziness
• Dry Mouth

Duration of Treatment

Morphine comes in a number of preparations. It is usually taken as a pill by mouth. It comes in a short-acting form (3 to 4 hours) or a long-acting form (12 to 24 hours). Take the pill or liquid with a full glass of water, with or without food. Make sure to shake the liquid before pouring the dose. Try to drink an 8 oz glass of water or fluid every hour to help prevent constipation. It can also be given by an injection in a vein or the spinal cord, in a pump connected to a vein, as a liquid, or as a rectl suppository.

Mylotarg (Gemtuzumab ozogamicin)

Gemtuzumab ozogamicin is a monoclonal antibody attached to chemotherapy. It belongs to the class called chemoimmunotherapy agents, meaning that it is both a chemotherapy and an immunotherapy agent. It is used to treat some leukemias. Gemtuzumab ozogamicin is like a "smart bomb." The monoclonal antibody part of gemtuzumab ozogamicin is directed against a certain receptor (CD33) located on leukemic cells. This receptor is found on the leukemia white blood cells in 80% of people with acute myelocytic leukemia (AML). The antibody attaches to the CD33 receptor and is taken into the cell, along with the chemotherapy. This kills the leukemic cell.

Precautions

• Gemtuzumab ozogamicin can lower your white blood cell count. This can increase your risk of getting an infection. Report fever, of 100.5°F or higher, or signs of infection such as pain in passing your urine or a cough that produces sputum.
• Gemtuzumab ozogamicin can lower your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.
• Rarely, you can have a severe allergic reaction to the monoclonal antibody. Your nurse or doctor will watch you very closely during the treatment.

Side Effects

• Nausea and/or vomiting
• Syndrome of chills, fever, nausea, vomiting, headache, low blood pressure or high blood pressure, breathing difficulty, and high blood sugar within 24 hours of treatment
• Tiredness (fatigue)
• Mouth sores
• Temporary increase in level of liver function enzymes in the blood
• Diarrhea
• Constipation
• Rash
• Swelling of the hands or feet

Duration of Treatment

Gemtuzumab ozogamicin is given by an injection in a vein over 2 hours, every 14 days for 2 cycles. You will get medicine before taking gemtuzumab ozogamicin to lessen the chance you will have an allergic reaction. The dose depends on your size.

Navelbine (vinorelbine tartrate)

Vinorelbine tartrate belongs to the general group of chemotherapy drugs known as plant (vinca) alkaloids. It is used to treat lung cancer and breast cancers.

Precautions

• Vinorelbine tartrate can lower your blood counts (white blood cells, red blood cells, platelets).
• Vinorelbine tartrate can decrease your white blood cell count, especially 7 days after the drug is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection such as pain in passing your urine, or coughing and bringing up sputum.
• Vinorelbine tartrate can decrease your platelet count. This can increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools
• While you are being treated with vinorelbine tartrate, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.

Side Effects

• Numbness and tingling in hands and/or feet due to peripheral nerve irritation
• Increased blood values of liver function tests
• Redness and tenderness at the place of injection
• Darkening of vein used to give the drug

Duration of Treatment

Vinorelbine tartrate is given intravenously into the vein over 5 to 10 minutes weekly. If the drug accidentally leaks out of the vein where it is given, it may damage the tissue and cause scarring. Tell the nurse right away if you notice redness, pain, or swelling at the place of injection.

Neulasta (Pegfilgrastim)

Pegfilgrastim is a protein cytokine that belongs to the general class of synthetic drugs called biologic response modifiers. It is used to increase the neutrophils (white blood cells) in the blood after chemotherapy. Pegfilgrastim is similar to a cytokine, a substance made by the body's immune system. It stimulates the body's bone marrow to make more neutrophils, a type of white blood cell involved in fighting infections. It also makes them work better. Pegfilgrastim is a version of another drug, filgrastim, but has been changed so that it stays in the body longer.

Precautions

• You may feel pain in your bones, but it can be easily controlled. Talk to your nurse or doctor about ways to lessen this side effect.
• Very rarely, patients receiving the parent drug filgrastim have an allergic reaction. Since pegfilgrastim contains the drug filgrastim, side effects in both drugs will be similar. Signs and symptoms to report right away are rash, itching, red blotches, difficulty breathing, or swollen face or lips.
• Very rarely, patients receiving pegfilgrastim have had an increase in the size of their spleen. In some cases, the spleen has ruptured and a few people have died. If you get pain in your left upper abdomen or tip of the shoulder, tell your doctor right away.
• Very rarely, patients receiving pegfilgrastim who have very low neutrophil counts (few infection-fighting cells) and blood infection (sepsis) also have severe breathing problems.

Side Effects

• Bone pain

Duration of Treatment

Pegfilgrastim is given as a shot under the skin once a day after chemotherapy in each chemotherapy cycle.

Neumega (Oprelvekin)

Oprelvekin belongs to a general class of substances called biologic response modifiers. It is used to increase the number of platelets in the body, especially in patients receiving chemotherapy. Oprelvekin is a synthetic version of a substance made by the body called IL-II (interleukin II), which is a growth factor. It tells the body's bone marrow to make more platelet cells so that bleeding does not occur after chemotherapy.

Precautions

• Tell your doctor or nurse if you get white patches or soreness in your mouth, or if you have difficulty swallowing. Your doctor will give you medicine to help lessen these side effects.
• Tell your doctor if you are taking a water pill (diuretic). This drug can cause mild swelling of the ankles or fluid in the lungs.
• Women who are pregnant or breastfeeding should not use this drug.

Side Effects

• Mild swelling of ankles
• Runny nose
• Fluid in lungs
• Difficulty breathing when exerting yourself

Duration of Treatment

Oprelvekin is given as a shot under the skin once a day. Oprelvekin is usually started within 24 hours after you receive chemotherapy and continued until your platelet count has eached a certain level. It should not be given at least 2 days before your next treatment and Neumega treatment is up to six sequential courses of Neumega treatment, with each course lasting from 1 to 28 days.

Neupogen (Filgrastin)

Filgrastim is a protein cytokine that belongs to the general class of synthetic drugs called biologic response modifiers. It is used to increase the neutrophils (white blood cells) in the blood after chemotherapy. Filgrastim is similar to a substance made by the body's immune system. It stimulates the body's bone marrow to make more neutrophils, a type of white blood cell involved in fighting infections. It also makes them work better.

Precautions

• Filgrastim is given at least 24 hours after chemotherapy and is continued for up to 2 weeks or until the neutrophils in the blood have reached a certain level.

Side Effects

• Mild-moderate bone pain
• Splenomegaly (enlarge spleen)
• Elevated in other WBCs
• Elevated uric acid, LDH and alkaline phosphate
• Mild lowered platelet count

Duration of Treatment

Filgrastim is given as a shot under the skin or as an injection in a vein. The dose depends on your weight, and the number of doses depends on your white blood cell count (neutrophil count), and can vary from 5 to 10 doses.

Orencia (Abatacept)

Orencia is a medicine that keeps your immune system from attacking healthy tissues in the body. The immune system defends the body against infections caused by bacteria and viruses. A normal immune system leaves healthy body tissue alone. In people with rheumatoid arthritis, the immune system attacks normal tissue causing damage and inflammation, especially in the tissues of your joints. Orencia interferes with an important step in this attack. By decreasing the immune system's attack on normal tissues, Orencia can reduce pain and joint inflammation, and some of the damage to your balance and cartilage. However, Orencia can also lower your body is the ability to fight infection. Orencia treatment can make you more prone to getting infections or make an infection you have worse. It is important to tell your doctor if you think you have any infections.

Precautions

• Serious infections. Patients taking Orencia are at increased risk for developing infections including pneumonia and other infections caused by viruses, bacteria or fungi. Call your doctor immediately if you feel you get sick with an infection during treatment with Orencia.
• Allergic reactions. These reactions are usually mild or moderate and includes hives, swollen face, eyelids, lips, tongue, throat or troubled breathing.
• Malignancies. There have been rare cases of certain kinds of cancer in patients receiving Orencia. The role of Orencia in the development of cancers is not known.

Side Effects

• Headaches
• Upper respiratory tract infections
• Sore throat
• Nausea

Duration of Treatment

Dosage of Orencia is based on patient weight. Patients weighing less than 60 kg should receive doses of 500 mg, those weighing 60-100 kg should receive doses of 750 mg, and those weighing more than 100 kg should receive doses of 1 g. Orencia is given by IV infusion over 30 minutes. The initial 3 doses of Orencia are administered at 0, 2, and 4 weeks; additional doses are given once every 4 weeks thereafter.

Oxaliplatin

Oxaliplatin belongs to the general group of chemotherapy drugs known as alkylating agents. It is used together with 5-fluorouracil and leucovorin to treat colorectal cancer. Oxaliplatin stops the growth of cancer cells, which causes the cells to die.

Precautions

• While you are being treated with oxaliplatin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Avoid cold exposure for 3-5 days after your treatment with oxaliplatin. Use gloves if you need to reach in the freezer. Make sure you dress warmly if it is cold outside, and enter a heated car. Be careful of air conditioners in warm climates.
• Tell your doctor or nurse if you have trouble doing everyday things like buttoning your clothes, preparing food, or cutting food.

Side Effects

• Nausea and/or vomiting
• Numbness and tingling in hands and/or feet due to nerve irritation
• Numbness of lips
• Diarrhea
• Abdominal pain
• Mouth sores
• Difficulty breathing
• Tiredness(fatigue)

Duration of Treatment

Oxaliplatin is given as a shot into the vein and is used with 5-FU and leucovorin.

Phenergan (Promethazine hydrochloride)

Promethazine hydrochloride belongs to a general class of antinausea drugs called antihistamines. Promethazine hydrochloride has sedative, antihistamine, and mild antinausea properties. It has a depressant effect on the central nervous system (CNS), but the specific mechanism is not known.

Precautions

• Promethazine hydrochloride may make you feel very sleepy. Do not drive or operate heavy machinery when you are drowsy.
• Promethazine hydrochloride may cause increased risk of confusion, sedation, and drowsiness in the elderly. This drug should be used cautiously in the elderly. It is important to protect against falls or injury.
• Be careful when getting up, changing position, or walking.

Side Effects

• Drowsiness
• Dry Mouth
• Constipation

Duration of Treatment

Promethazine hydrochloride is given as a pill or liquid by mouth, as a rectal suppository, or as an injection in a vein over 5 minutes or in a muscle.

Prednisone (Decadron)

Precautions

• Before using this drug, tell your doctor your medical history, particularly if you have: liver or kidney disease, heart problems, intestinal problems, ulcers, high blood pressure, an underactive thyroid gland, myasthenia gravis, herpes eye infection, a history of tuberculosis (TB), seizures, blood clots, osteoporosis (brittle bones), eye problems, any allergies.
• Do not have a vaccination, other immunization or any skin test while you are using this drug unless your doctor specifically tells you that you may.
• If you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this medication. It may make your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications, increasing your risk of ulcers.
• Before you take this drug, tell your doctor of any over-the-counter or prescription medications you are taking especially: aspirin, arthritis medication, anticoagulants ("blood thinners"), diuretics ("water pills"), rifampin, phenobarbital, estrogen (e.g., birth control pills), phenytoin, ketoconazole, neostigmine, pyridostigmine, ambenonium, drugs for diabetes. Do not start or stop any medicine without doctor or pharmacist approval.

Side Effects

• Dizziness
• Nausea
• Indigestion
• Increased appetite
• Weight gain
• Weakness
• Sleep disturbances (insomnia)

How to take this Medication

Take with food or immediately after a meal to prevent stomach upset. If you are taking this medication only once a day, it should be taken in the morning before 9 a.m. The liquid (suspension) form must be shaken well before each use. First use of suspension may require shaking for 5 to 7 minutes. After the first use, no more than 30 seconds of shaking should be required to mix all the ingredients well. If you have been taking this medication for a long time, do not suddenly stop taking it without your doctor's approval. Your dose may need to be gradually reduced. You may experience extreme fatigue, weakness, stomach upset or dizziness when the medication is suddenly stopped.

Procrit (Epoetin alfa)

Epoetin alfa belongs to a general class of synthetic substances called biologic response modifiers. This drug is made by recombinant DNA techniques. It is used to prevent or treat anemia (low red blood cell count) after chemotherapy. Epoetin alfa is similar to a hormone in your body that makes the body's bone marrow produce more red blood cells. Thus, this drug can make the body produce more red blood cells.

Precautions

• Symptoms of anemia (tiredness, low energy level, headache) will go away once your red blood count increases.

Side Effects

• Fever
• Tiredness(fatigue)
• Headache
• Hives
• Injection site discomfort
• Nausea and/or vomiting
• Diarrhea

Duration of Treatment

Epoetin alfa is given by a shot under the skin once a week.

Revlimid (Lenalidomide)

This medication is used to treat anemia in patients with a certain condition (myelodysplastic syndrome-MDS). These patients do not have enough properly working red blood cells. They often require blood transfusions to reverse their anemia. Lenalidomide may decrease the need for treatment with blood transfusions. Lenalidomide is a type of drug known as an immunomodulator. It is believed to work by decreasing the immune system's response, thereby lowering the number of working red blood cells that are destroyed naturally by the body.

Precautions

• This drug may make you dizzy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages.
• Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at a greater risk for side effects while using lenalidomide.
• Lenalidomide must not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. Even a single dose of lenalidomide taken during pregnancy can cause severe birth defects. If pregnancy does occur during treatment, this drug must be stopped immediately.
• Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at a greater risk for side effects while using lenalidomide.

Side Effects

• Diarrhea
• Tiredness
• Dizziness
• Dry skin
• Constipation
• Stomach pain
• Vomiting
• Dry mouth
• Altered taste
• Loss of appetite
• Headache
• Sleep disturbances (Insomnia)
• Painful urination

Duration of Treatment

Take this medication by mouth with a full glass of water, usually once daily or as directed by your doctor. Swallow this medication whole. Do not break, chew, or open the capsules. Dosage is based on your medical condition, response to therapy, and laboratory test results. Be sure to follow your doctor's directions carefully. Use this medication regularly in order to get the most benefit from it. Remember to take it at the same time each day. Inform your doctor if your condition persists or worsens.

Rituxan (Rituximab)

Rituximab is a monoclonal antibody that belongs to the general class of synthetic substances called biologic response modifiers. It is used to treat certain lymphomas that have lymphocytes with the CD20 receptor. A monoclonal antibody is a protein that fits like a lock and key with a protein on the cancer cell. Rituximab (antibody) attaches to the CD20 protein (antigen) on certain cancerous lymphocytes (white blood cells). Once it attaches to the cells, it brings other immune cells to help kill the cancer cells.

Precautions

• While you are being treated with rituximab, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine.
• Rituximab can often cause allergic reactions (fever and chills), especially the first treatment. Rarely, decreased blood pressure, swelling of face, and coughing can occur. Tell your nurse or doctor right away if you get a fever or chills, hives, nausea, itching, headache, shortness of breath, or swollen tongue or throat during your treatment. Your nurse will stop the infusion and evaluate you.
• Tell your doctor or nurse right away if you develop shortness of breath or difficulty breathing, have a fever over 100.5°F, have symptoms of infection such as coughing up sputum or burning when urinating, unusual bruising, or bleeding such as nosebleeds, bleeding of gums when you brush your teeth, or black, tarry stools.

Side Effects

• Allergic reaction with the first infustion only

Duration of Treatment

Rituximab is given as an infusion intravenously into the vein weekly for 4-8 weeks over 4 to 6 hours.The first infusion is given very slowly to see if you have a reaction. Later infusions are given a little faster if you tolerated the first one well. You will get other medicine to prevent a reaction if you have any trouble.

Sandostation (Octreotide acetate)

Octreotide acetate acts like somatostatin, a naturally occurring hormone that helps regulate many functions in the body. It is used to treat diarrhea caused by AIDS, chemotherapy, and radiation. It is also used to control some symptoms of carcinoid syndrome (such as flushing, wheezing, and diarrhea) and to treat graft-versus-host disease. Octreotide acetate has many effects. It slows the time the stool passes through the intestines. This allows water to be absorbed from the stool, so the stool becomes more firm. It also blocks the release of serotonin, gastrin, and pancreatic enzymes. Octreotide is usually used for diarrhea when other treatments have not worked and other treatable causes have been excluded.

Precautions

• To help decrease diarrhea, change your diet. Try to eat small, frequent meals that are warm or at room temperature. Avoid foods that cause gas (such as broccoli or beans), fatty foods (such as bacon or cheeses), citrus fruits and juices, and high-lactose foods (such as milk or ice cream). Eat foods high in sodium and potassium (such as soups, sports drinks, and bananas). Eat foods high in soluble fiber (such as rice or bananas). Avoid foods high in insoluble fiber (such as cereal or nuts). Try to drink at least eight oz glasses of water a day. To add calories, dilute with fruit juice.
• Tell your doctor if you are taking cyclosporine, insulin, oral hypoglycemic agents (for diabetes), beta blockers, or calcium channel blockers (heart medicines). Talk with your doctor about possible drug interactions.
• Tell your doctor or nurse if the diarrhea does not go away after 1 to 2 doses, as the dose of the drug may have to be increased

Side Effects

• Nausea
• Bruising at injection site

Duration of Treatment

Octreotide acetate is given as an injection under the skin. A preparation is also available for giving it in the muscle. After the right dose is found, most patients can take the shot once a month or every 3 months. Octreotide acetate can also be given as an intravenously into in a vein 1 to 4 times a day, or as a continuous intravenous infusion for 24 hours.

Tamoxifen (Nolvadex)

Tamoxifen citrate belongs to the general group of drugs known as hormones or hormone antagonists. It is used to prevent breast cancer in high-risk women; decrease the risk of getting invasive breast cancer in women with ductal cancer in situ (DCIS); prevent cancer from coming back after surgery, radiation, and chemotherapy; and to treat advanced breast cancer. Tamoxifen citrate blocks estrogen by binding to estrogen receptors. When this occurs, the cancer cells that depend on estrogen to divide stop growing and die.

Precautions

• Tamoxifen increases the risk of blood clots forming in veins in the legs or lungs. This can lead to pain and swelling in the affected leg, chest pain, or sudden difficulty breathing. The risk of stroke, which could lead to problems with vision, thinking, sensation, or movement, is also increased. Tell your doctor right away if you notice any of these symptoms.
• Tamoxifen may temporarily increase the calcium blood level when you start taking the medicine.
• When you start taking tamoxifen, you may get a "flare" reaction. You will feel a temporary increase in bone and/or tumor pain. Tell your doctor if this does not go away in 1 to 2 weeks.
• Tell your doctor or nurse right away if you have blurred vision, tumor or bone pain lasting more than 1 to 2 weeks, sudden onset of chest pain or trouble breathing, or if you have confusion or dizziness that does not go away.

Side Effects

• Initial, temporary feeling of tiredness

Duration of Treatment

Tamoxifen citrate is a pill usually taken twice a day with an 8 oz glass of water, with or without food.

Tarceva (Erlotinib)

Erlotinib, an inhibitor of human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase, is an antineoplastic agent.

Precautions

• Rare, sometimes fatal, lung toxicity (interstitial pneumonia, interstitial lung disease, obliterative bronchiolitis, pulmonary fibrosis) has occurred; an interruption of therapy should occur with unexplained pulmonary symptoms (shortness of breath, cough, and fever).

Side Effects

• Nausea and/or vomiting
• Loss of appetite
• Diarrhea
• Skin rash
• Dryness
• Weakness

Duration of Treatment

Tarceva is taken by mouth. Follow exactly the instructions by your physician as far as dose and frequency is concerned. Tarceva should be taken at least one hour before or two hours after the ingestion of food.

Taxol (Paclitaxel)

Taxol belongs to a group of drugs known as antimicrotubule agents. It is derived from the bark and needles of the yew tree. It is given through a running IV only. Taxol is used to treat the following cancers:

• Breast
• Ovarian
• Lung
• Head and neck
• Melanoma

Side Effects

Although most side effects can be managed by your oncologist, there are still a few that are important to know about. These include:

• Allergic reaction to the drug
• Low white blood count
• Low platelet count
• Anemia
• Mouth sores
• Joint discomfort
• Nausea
• Hair loss
• Nerve damage
• Fluid retention

Duration of Treatment

Taxol is usually given in combination with other chemotherapy drugs. Depending on the type of cancer being treated, Taxol is given on a weekly basis or on an every three week basis for a total of four to eight cycles.

Temodar (Temozolomide)

Temozolomide belongs to a general group of chemotherapy drugs called alkylating agents. stops the growth of cancer cells, which causes them to die. The drug cannot tell the difference between normal cells and cancer cells, so some normal cells are injured, causing some of the side effects. This drug can cross into the brain, where it can kill hidden cancer cells. It is approved to treat a brain cancer called anaplastic astrocytoma that does not shrink when other treatments have been tried. It is also approved for use along with radiation therapy to treat glioblastoma multiforme (GBM), another type of brain cancer.

Precautions

• Temozolomide can lower your blood counts (white blood cells, red blood cells, platelets).
• Temozolomide can lower your white blood cell count, reaching the lowest point about three to four weeks after the treatment is given. This can increase your risk of getting an infection. Report fever of 100.5°F or higher, or signs of infection, such as pain in passing your urine or a productive cough (bringing up sputum). If you are getting radiation therapy along with Temozolomide, your doctor may give you an antibiotic to help prevent infection.
• Temozolomide can lower your platelet count and increase your risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines without talking to your doctor first. Report unusual bruising, bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Side Effects

• Nausea and/or vomiting
• Diarrhea
• Constipation
• Loss of appetite
• Tiredness (fatigue)

Duration of Treatment

Temozolomide is a capsule that comes in four sizes: 250 mg, 100 mg, 20 mg, and 5 mg. The dose you receive depends on your weight, whether you have received other chemotherapy before, and your blood counts. The capsules should be taken with an 8-oz glass of water on an empty stomach, either one hour before or two hours after eating. Try to take the capsules at the same time each day.If you do forget to take a capsule do not take a double dose. Tell your doctor and keep to a regular dose schedule.Do not crush or dissolve the capsule.

Thalidomide (Thalomid)

Thalidomide appears to interfere with the growth of blood vessels. A group of cancer cells (tumor) must grow new blood vessels when it reaches the size of a pencil tip. Thalidomide interferes with the growth of these new blood vessels, and theoretically stops the cancer from growing larger than the size of a pencil tip. Thalidomide is being studied in combination with other agents, such as chemotherapy or biological therapy.

Precautions

• Thalidomide can make you very sleepy. You should not drive a car or operate heavy machinery until you know how this drug makes you feel.
• Thalidomide may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy.
• Thalidomide can make you feel dizzy when you change from a lying to sitting position, or from sitting to standing position. Try to change position very slowly, and make sure you have a secure surface to hold on to if needed.

Side Effects

• Birth defects in fetus
• Numbness and tingling in hands and/or feet
• Drowsiness
• Dizziness
• Mild constipation

Duration of Treatment

Thalidomide is taken as a capsule with water, at least 1 hour after a meal. If you are only taking thalidomide once a day, take the capsule(s) 1 hour after your evening meal or bedtime. Patients must be enrolled in a clinical tr