[MOL] Part 4/Chemo Toxicity/ Hot Flashes,High Calcium/Neuropathy/Bladder [00962] Medicine On Line

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[MOL] Part 4/Chemo Toxicity/ Hot Flashes,High Calcium/Neuropathy/Bladder

VIII.  Hot Flashes (Menopause-like Symptoms, Flushing)
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Hot flashes can be a troubling symptom in women who have undergone antiestrogen therapy (tamoxifen) or in men who have been given androgen deprivation therapies (Lupron or Goserelin or orchiectomy). Drugs that may be effective for hot flashes are listed below:

Drug name Usual dose Side effects Cost
Megestrol Acetate (MegaceŽ) 20 mg orally twice daily Weight gain, vaginal bleeding, chills $$. Beneficial effects may require 2 to 3 weeks of treatment
Venlafaxine (EffexorŽ) 12.5 mg orally twice daily In this low dose regimen after 4 weeks, sweating (38%), fatigue (8%), dry mouth 19%), trouble sleeping (8%). $$$. About 60% of patients respond after 4 weeks of therapy.
Metoclopramide (ReglanŽ) 20 mg orally three times daily. Sedation, jitteriness, diarrhea. $$. Less well studied than Megace or Effexor.
Vitamin E 800 units orally daily Blurred vision, dizziness, flu, nausea, headache are signs overdose $. Less well studied.

IX.  High Calcium Level (Hypercalcemia)
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Occasionally, cancer can spread to the bones and cause an increased calcium release in the blood stream. Most patients can eliminate the overflow of calcium, but 10 to 20% of cancer patients cannot and will experience a calcium level greater than 10.5mg/dL, also known as hypercalcemia (high calcium level). Some cancer, such as breast cancer, can cause higher incidence of hypercalcemia. A high calcium level is a serious situation and can cause tiredness, confusion, decreased appetite, increase urination, bone pain, cardiac problems and convulsions. Your doctor may prescribe some drugs (biphosphonates) to stabilize the bones and prevent hypercalcemia. Pamidronate (Aredia) is the preferred drug for treating hypercalcemia. Other measures include a lot of fluid (usually a saline solution) along with a diuretic (Lasix).

Drug name Usual dose Side effects Cost
Pamidronate (Aredia) 60 to 90 mg IV every month Fever, bone pain $$
Etidronate (Didronel) Depending on calcium levels Fever, bone pain $$

X.  Neuropathy from Chemotherapy
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Chemotherapy can have adverse effects on the nervous system. Vincristine can cause autonomic deficiency, causing constipation. Cisplatin, paclitaxel (Taxol) and vincristine can cause numbness, tingling and pain in extremities. They can also cause difficulty in fine motor skills and, in severe cases, impair walking abilities. These side effects normally disappear after chemotherapy, but may take several months to do so. Some drugs can be given to alleviate the symptoms, such as pyridoxine, gabapentin, but results are variable amongst patients

XI.  Bladder or Urinary toxicity from Chemotherapy
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Two chemotherapy drugs are associated with toxic side effects to the bladder and ureter. Both cyclophosphamide and ifosfamide can irritate the bladder and ureter leading to a condition called cystitis, which can occur in up to 10% of patients receiving intermittent or chronic low dose cyclophosphamide and 40% receiving cyclophoshamide in a high dose bone marrow transplant program. Cystitis is manifested as urinary burning or bleeding after several cycles of chemotherapy. Prevention of cystitis is achieved through frequent voiding and vigorous hydration. A patient receiving either of these drugs will be instructed on a method to prevent cystitis from being a problem. Adequate fluids, either taken orally or intravenously, dilute the urine such that the offending metabolites of these drugs will not damage the lining of the bladder or ureters. For ifosfamide a uroprotectant drug called MESNA will be given concurrently along with good hydration. The regimens to protect from cystitis are shown below. Treatment of hemorrhagic cystitis may require bladder irrigation with saline or formalin.

Drug name Therapy to prevent cystitis Uroprotectant Comments
Cyclophosphamide 8 glasses (8 ounces) over the 24 hours after administration of the drug. Mesna not required MESNA may be used when very high doses of cyclophosphamide are used as in Bone Marrow Transplant programs
Ifosfamide 8 glasses (8 ounces) over the 24 hours after administration of the drug. Mesna is required. MESNA 20% of the Ifosfamide dose given IV just prior to ifosfamide and then 4 and 8 hours given IV or orally. OR MESNA 90% mixed with Ifosfamide given continuously IV Mesna should be continued for 12-24 hours after the completion of ifosfamide therapy
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