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Managing the Side Effects of Cancer and Cancer Treatment

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Medicines may help to either prevent or reduce side effects of treatment, or to manage certain side effects once they occur. Since you can develop these symptoms from the treatment and/or from the cancer itself, it is essential that you discuss them with your doctor when you notice them, and ask him or her if any of these medicines are appropriate for you.

Drugs to Help Manage Nausea and Vomiting

Anti-nauseants, also called anti-emetics, are given to help treat nausea and vomiting, which may be caused by chemotherapy , radiation therapy , surgery , or other aspects of cancer and its treatment.
Anti-nauseants given by prescription include the following:
  • Dexamethasone (Decadron)
  • Dronabinol (Marinol)
  • Granisetron (Kytril)
  • Lorazepam (Ativan)
  • Metoclopramide (Octamide, Metoclopramide Intensol, Reglan)
  • Ondansetron (Zofran)
  • Prochlorperazine (Compazine)
Common side effects for dexamethasone include:
  • Upset stomach, vomiting
  • Headache
  • Dizziness
  • Insomnia
  • Restlessness
  • Depression
  • Anxiety
  • Acne
  • Increased hair growth
  • Easy bruising
  • Irregular or absent menstrual periods
Common side effects for dolasetron include:
  • Diarrhea
  • Headache
  • Abdominal or stomach pain
Common side effects for dronabinol include:
Common side effects for granisetron include:
  • Abdominal pain
  • Constipation
  • Diarrhea
  • Headache
  • Unusual tiredness or weakness
Common side effects for lorazepam include:
  • Clumsiness or unsteadiness
  • Dizziness or lightheadedness
  • Drowsiness
  • Slurred speech 
Prochlorperazine can be taken by mouth, injection, or a suppository. Ondansetron and granisetron can be taken orally or as injections. Metoclopramide is usually given by injection.
Common side effects for prochlorperazine include:
  • Blurred vision, change in color vision, or difficulty seeing at night
  • Fainting
  • Loss of balance
  • Restlessness or need to keep moving
  • Shuffling walk
  • Stiffness of arms or legs
  • Trembling and shaking of hands and fingers
Common side effects for metoclopramide include:
  • Diarrhea (with high doses)
  • Drowsiness
  • Restlessness
Common side effects for ondansetron include:
  • Constipation
  • Diarrhea
  • Fever
  • Headache

Drugs to Decrease Pain

To help manage pain, your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs). You may also be prescribed corticosteroids or opioid analgesics.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs are used to relieve pain and inflammation. You may experience pain and inflammation for a variety of reasons, such as:
  • Pain from cancer that has spread to your bones
  • Edema (fluid build up in cells) caused by tumors or treatment
NSAIDs include the following:
  • COX 2 antagonists ( Celebrex )
  • Ibuprofen
  • Naproxen
Common side effects of NSAIDs include:
  • Stomach cramps, pain, or discomfort
  • Dizziness, drowsiness, or lightheadedness
  • Headache
  • Heartburn, indigestion, nausea, or vomiting
Corticosteroids
Like NSAIDS, corticosteroids help to minimize inflammation and to relieve pain due to inflammation.
Corticosteroids include the following:
  • Dexamethasone (Cortastat, Decadrol, Decadron, Dexamethasone Intensol, Dexasone, Hexadrol, Mymethasone, Primethasone)
  • Prednisone (Cordrol, Deltasone, Liquid Pred, Meticorten, Orasone, Prednicot, Prednisone Intensol)
Common side effects of corticosteroids include:
  • Increased appetite
  • Indigestion
  • Nervousness or restlessness
Opioid Analgesics
Opioid analgesics act on the central nervous system to relieve pain. These drugs can be very effective; however, they must be used with care because of the side effects. Addiction is rare in patients who use these medicines appropriately for pain control. If you are going to take one of these drugs for a long period of time, your doctor will closely monitor you.
Opioid analgesics include the following:
  • Fentanyl transdermal patch (Duragesic)
  • Hydrocodone (Dilaudid, Hydrostat)
  • Methadone (Dolophine, Methadose)
  • Morphine (Astramorph PF, Duramorph, Kadian, MS Contin, Rescudose, Roxanol)
  • Oxycodone (Roxicodone, OxyContin)
Acetaminophen is often combined with an opioid analgesic to provide better pain relief than either medicine used alone. And in some cases, lower doses of each medicine are necessary to achieve pain relief. Examples of such drugs include the following:
  • Acetaminophen with hydrocodone ( Vicodin )
  • Acetaminophen with oxycodone ( Percocet )
The most common side effects of opioid analgesics include:
  • Dizziness, light-headedness, or feeling faint
  • Drowsiness
  • Nausea or vomiting
  • Constipation—A study found that the medicine methylnaltrexone (Relistor) can rapidly relieve this side effect.

Drugs to Support Your Blood Cells

During cancer treatment, blood cells can be destroyed along with cancer cells. Medicines given to treat this problem are called blood stem cell support drugs and include the following:
  • Darbepoetin alpha (Aranesp)
  • Epoetin /EPO/Erythropoietin (Epogen, Procrit)
  • Filgrastim /G-CSF (Neupogen)
  • Oprelvekin (Neumega)
  • Pegfilgrastim (Neulasta)
Filgrastim helps your bone marrow make new white blood cells, which help your body fight infection. Therefore, filgrastim helps to reduce your risk of infection.
Epoetin helps your bone marrow to make new red blood cells. Low red blood cell levels can lead to anemia ; therefore, epoetin helps reduce your risk for this condition. The medicine is quite effective, but it has a two-week delay between the injection and when your red blood cell count really starts to come back. It is not used as a “quick fix” for a low red blood cell count; a blood transfusion is usually performed if you need to recover your red blood cell count more quickly.
Oprelvekin is a platelet growth factor. Platelets help your blood clot, so very low counts can lead to serious bleeding. If your platelet counts fall (usually below 10,000), you may be given transfusions.
Blood stem cell support drugs are given by injection in your doctor's office.
Common side effects for darbepoetin alpha include:
  • Changes in blood pressure
  • Muscle aches
  • Headaches
  • Diarrhea
Common side effects for filgrastim include:
  • Headache
  • Pain in arms or legs
  • Pain in joints or muscles
  • Pain in lower back or pelvis
  • Skin rash or itching
Common side effects forepoetin include:
  • Cough, sneezing, or sore throat
  • Fever
  • Swelling of face, fingers, ankles, feet, or lower legs
  • Weight gain
Common side effects for pegfilgrastim include:
  • Bone pain
  • Flu-like symptoms
  • Nausea/vomiting
  • Shortness of breath

References

Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. Philadelphia, PA: WB Saunders Co; 2002: 738-741.

Conn HF, Rakel RE. Conn’s Current Therapy. Philadelphia, PA: WB Saunders Co; 2002: 527-529.

Sleisenger MH, Fordtran JS, Scharschmidt B. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Philadelphia, PA: WB Saunders Co; 1998: 733-749.

6/25/2008 DynaMed Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332-2343.

11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm . Published November 19, 2010. Accessed November 30, 2010.

1/4/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. Anzemet (dolasetron mesylate): drug safety communication—reports of abnormal heart rhythms. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm237341.htm . Updated December 17, 2010. Accessed January 4, 2011.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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