Aminoglutethimide (ah-mee-no-gloo-TEH-tha-mide) Trade name: Cytadren Chemocare.com uses generic names in all descriptions of drugs.

Cytadren is the trade name for aminoglutethimide. In some cases, health care professionals may use the trade name. Drug type: Aminoglutethimide is a hormone therapy. It fights cancer as an "adrenal steroid inhibitor." (For more detail, see "How this drug works" section below). What this drug is used for: To treat breast cancer in postmenopausal women Metastatic prostate cancer Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. How this drug is given: This drug is taken orally, in pill form. Drinking a glass of water and eating food is recommended when taking this medicine. About half of patients who take this medications will need to take a steroid medication to replace necessary steroids (made by the body) that are reduced by aminoglutethimide. The amount of aminoglutethimide you receive depends on many factors. Your doctor will determine your exact dosage and schedule. Side effects: Important things to remember about the side effects of aminoglutethimide: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset, duration and severity. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The following side effects are common (occurring in greater than 30%) for patients taking aminoglutethimide: Drowsiness, fatigue Skin rash (usually seen during the first week of treatment then goes away) (see skin reactions) Mild nausea These are less common side effects (occurring in 10-29%) for patients receiving aminoglutethimide: Clumsiness, decreased coordination (ataxia) (see balance and mobility) Dizziness Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider: The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Nausea and/or vomiting (vomiting more than 4-5 times in a 24 hour period). Symptoms of adrenal insufficiency (low production of needed steroids produced by the adrenal glands) are: Fatigue, poor appetite, nausea, vomiting, diarrhea, weight loss, weakness, and dizziness. Be sure your health care provider is aware if you are experiencing these symptoms. If adrenal insufficiency occurs replacement steroids may be needed. Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting aminoglutethimide treatment, make sure you tell your doctor about any other medications you are taking (including over-thecounter drugs, vitamins, or herbal remedies). Approximately one half of the patients who take aminoglutethimide need to be on a replacement steroid medication due to adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Anyone who has had an allergic reaction to any component of this drug should not receive it again. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (aminoglutethimide may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.) For both men and women: Do not conceive a child (get pregnant) while taking aminoglutethimide. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication Self-care tips: Take with food to reduce nausea. You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing:

During the course of treatment, your response to this medicine will be carefully monitored. Your blood may be tested at intervals determined by your doctor to check your thyroid function, and adrenal gland function. How this drug works: Aminoglutethimide is a type of hormone therapy. Hormones are chemical substances that are produced by glands in the body, which enter the bloodstream and cause effects in other tissues. (For example, the hormone testosterone made in the testicles is responsible for male characteristics such as deepening voice and increased body hair.) The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells. Hormone therapies work by stopping the production of a certain hormone, blocking hormone receptors, or substituting chemically similar agents for the active hormone, which cannot be used by the tumor cell. The different types of hormone therapies are categorized by their function and/or the type of hormone that is effected. Aminoglutethimide is an adrenal steroid inhibitor, which means it interferes with the hormones produced by the adrenal gland. The adrenal glands are located on top of the kidneys. The outer portion of the adrenal gland (the adrenal cortex) produces hormones called corticosteroids. When these corticosteroids are blocked from being made, they are not able to signal the body to produce other hormones such as estrogen, androgens, glucocorticoids, and mineralocorticoids. The resulting decrease of estrogens and androgens interferes with the stimulation of cancer growth in tumors that are influenced by these hormones. Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice. Megestrol Acetate Megestrol (me-JES-trole) Trade name: Megace Other name: Megestrol Acetate Drug type: Megestrol is a hormone therapy. This medication is classified as a "progesterone." (For more detail, see "How this drug works" section below). What this drug is used for: Treatment of breast, and endometrial cancers. Use as a supportive medication to treat severe loss of appetite (anorexia), muscle wasting (cachexia) and significant weight loss (> 10% of

baseline body weight) associated with cancer and/or AIDS. Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. How this drug is given: Megesterol is given by mouth in tablet form, or as a liquid suspension. The amount of megesterol that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition you have. Your doctor will determine your dose and schedule. Side effects: Important things to remember about the side effects of megestrol: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The following side effects are common (occurring in greater than 30%) for patients taking megestrol: Note: there are no common side effects of megesterol. These are less common side effects (occurring in 10-29%) for patients receiving megestrol: Weight gain Edema (swelling, usually in the feet or hands) Breakthrough menstrual bleeding, spotting Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Difficulty breathing Chest pain Sudden severe headache The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Swelling, redness and pain in one leg or arm and not the other Swelling of the face, lips or mouth Abdominal pain Vaginal itching, irritation or discharge Always inform your health care provider if you experience any unusual symptoms.

Precautions: Before starting megestrol treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-thecounter, vitamins, herbal remedies, etc.). Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (megestrol may cause fetal harm when given to a pregnant woman. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking megestrol, the medication must be stopped immediately and the woman given appropriate counseling). For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking megestrol. Barrier methods of contraception, such as condoms, are recommended. Do not breast feed while taking this medication. Self-care tips: Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. Use caution when driving or engaging in tasks that require alertness until response to the drug is known. Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your doctor while you are taking megestrol, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How this drug works: Megestrol is a type of hormone therapy. Hormones are chemical substances that are produced by glands in the body, which enter the bloodstream and cause effects in other tissues. (For example, the hormone testosterone made in the testicles is responsible for male characteristics such as deepening voice and increased body hair). The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells. Hormone therapies work by; stopping

the production of a certain hormone, blocking hormone receptors, or substituting chemically similar agents for the active hormone, which cannot be used by the tumor cell. The different types of hormone therapies are categorized by their function and/or the type of hormone that is effected. Megestrol is a progestin (a man-made form of the hormone progesterone). It has properties that interfere with the normal estrogen cycle. This interferes with the stimulation of cell growth in estrogen dependent tumor cells. There is also thought to be some direct effect on the lining of the uterine wall (endometrium). A side effect of megestrol has been weight gain. The exact mechanism of this effect is unclear, however the effects lead to an increase in body fat. Taking advantage of this side effect, megestrol has been studied and used to treat severe appetite loss (anorexia), muscle wasting (cachexia) and weight loss associated with cancer and AIDS. Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice. Leukine LeukineTM Generic name: Sargramostim Other names: GM-CSF, GranulocyteMacrophage Colony Stimulating Factor Drug type: Leukine is a biologic response modifier. Leukine is classified as a colony stimulating factor. (For more detail, see "How this drug works" section below). What Leukine is used for: Used to accelerate the recovery of white blood cells following chemotherapy. Used following induction chemotherapy in Acute Myelogenous Leukemia (AML). After bone marrow transplantation. Before and/or after peripheral blood stem cell transplantation. Sargramostim is a support medication. It does not treat cancer. Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. How Leukine is given: As an injection under the skin (subcutaneous, SubQ). As an infusion into the vein (intravenous, IV). How it is given depends on why you are receiving this drug. The amount of sargramostim that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor

will determine your dose and schedule. Side effects of Leukine: Important things to remember about the side effects of sargramostim: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. Sargramostim is a support medication. The following list includes side effects attributed to sargramostim. Other side effects experienced were attributed to the chemotherapy and/or the disease. The following side effects are common (occurring in greater than 30%) for patients taking Leukine: With the first dose of sargramostim a person may experience low blood pressure, fast heart rate, flushing, lightheadedness or feeling faint. This is referred to as "first-dose effect," and tends not to happen with future doses. Diarrhea. Local reactions at the injection site. (swelling, redness and tenderness) Weakness and fatigue These side effects are less common side effects (occurring in about 1029%) of patients receiving Leukine: Mild flu-like syndrome (fever, headache, generalized aches and pains, weakness and fatigue). Swelling in your hands and feet. A rare (< 1%) but significant side effect is problem with blood clots. Blood clots rarely can lead to pulmonary embolus or stroke - potentially lifethreatening conditions. Another serious, but very uncommon side effect of sargramostim is "capillary leak syndrome" or "vascular leak syndrome." Capillary leak syndrome is a potentially serious disease in which fluids within the vascular system (veins and capillaries) leaks into the tissue outside the bloodstream. This results in low blood pressure and poor blood flow to the internal organs. Capillary leak syndrome is characterized by the presence of 2 or more of the following 3 symptoms; low blood pressure, swelling, and low levels of protein in the blood. Your doctor will monitor these things carefully while you are taking sargramostim. You should notify your doctor immediately if you notice dizziness (especially when changing position), sudden swelling or rapid weight gain, little or no urine output (for 8-12 hours), shortness of breath, difficulty breathing, irregular heart beats, or chest pain.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Seek emergency help immediately and notify your health care provider, it you experience the following symptoms: Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction). Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C) or higher, chills (possible signs of infection) Dizziness (especially when changing position), sudden swelling or rapid weight gain, little or no urine output (for 8-12 hours), shortness of breath, difficulty breathing, irregular heart beats, or chest pain. The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Diarrhea (4-6 episodes in a 24-hour period) Extreme fatigue (unable to carry on self-care activities) Swelling, redness and/or pain in one leg or arm and not the other Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting sargramostim treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking sargramostim. Sargramostim must be given at least 24 hours after the last dose of chemotherapy and 12 hours after radiation therapy. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking sargramostim. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication.

Self-care tips: Injection tips: Allow sargramostim to come to room temperature before injecting. Rotate injection sites. Do not rub the skin before or after injections. Apply ice to the site for 1 minute immediately prior to injecting. Inject slowly. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. If you are taking sargramostim for low white blood cells following chemotherapy, you may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider. Wash your hands often. For flu-like symptoms, keep warm with blankets and drink plenty of liquids. Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your health care professional while you are taking sargramostim, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How Leukine works: Colony-Stimulating Factors: In the body's bone marrow (the soft, sponge-like material found inside bones) blood cells are produced. There are three major types of blood cells; white blood cells, which fight infection; red blood cells, which carry oxygen to and remove waste products from organs and tissues; and platelets, which enable the blood to clot. Cancer treatments such as chemotherapy and radiation therapy can effect these cells which put a person at risk for developing infections, anemia and bleeding problems. Colony-stimulating factors are substances that stimulate the production of blood cells and promote their ability to function. They do not directly affect tumors but through their role in stimulating blood cells they can be helpful as support of the persons immune system during cancer treatment. Sargramostim is a growth factor that stimulates the production, maturation and activation of three types of white

blood cells (WBC): neutrophils, macrophages and dendritic cells. Each of these three cells has a distinct purpose and function within the immune system. Neutrophils are the most abundant WBC and are the first to responde to the site of an infection. Their purpose is to capture and digest foreign invaders such as bacteria. Macrophages also capture and digest foreign invaders but are longer acting and recognize more invaders than neutrophils. Dendritic cells make up less than 1% of WBC's but are extremely important. They continuously scan their environment and alert other cells when they find something foreign such as an infection. For patients receiving chemotherapy, sargramostim can accelerate the recovery of these white blood cells that can then enhance recovery. Sargamostim is also used to stimulate the early stem cells prior to harvesting for peripheral stem cell transplant, and stimulate recovery of bone marrow cells after bone marrow trasplantation. Octreotide acetate Octreotide (ok-TREE-oh-tide) Trade names: Sandostatin, Sandostatin LAR Other names: Octreotide acetate Drug type: Octreotide is hormone drug that is used to treat some types of cancer. This medication is classified as an somatostatin analog. (For more detail, see "How this drug works" section below). What this drug is used for: This medicine is given to control symptoms such as diarrhea or flushing in patients with tumors such as carcinoid, pancreatic islet cell tumors, gastrinoma, or vasoactive intestinal peptide-secreting tumors (VIPomas). It is also used to treat acromegaly, when the body produces too much growth hormone, and the hands, feet, face or head grow too large. Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. How this drug is given: Octreotide has two formulations. For purposes of clarity, trade names will be used for discussion. Sandostatinis a short acting version and Sandostatin LARis a long acting version. Sandostatin is given by subcutaneous injection (S.C. - the layer of tissue between the skin and the muscle). It may be necessary to take the shot several times a day. The injection sites should be rotated regularly. This medication may also be given intravenously. Sandostatin LAR is given by intramuscular injection (IM - into the muscle) under a doctor's supervision. This medication is generally given once every 4 weeks. The preferred site for injection is the hip, because it is

painful given into the arm. Sandostatin LAR should NOT be given by S.C. or IV routes. If short acting Sandostatin is to be replaced by long-acting Sandostatin LAR, short acting Sandostatin should be continued for at least two weeks to maintain therapeutic doses in patients with carcinoid tumors or VIPomas. Short acting Sandostatin may also be used to control breakthrough syptoms in carcinoid. The amount of octreotide that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule. Side effects: Important things to remember about the side effects of octreotide: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The side effects of octreotide and their severity depend on how much of the drug is given and which preparation (Sandostatin or Sandostatin LAR) is given. In other words, high doses may produce more severe side effects. The following side effects are common (occurring in greater than 30%) for patients taking Octreotide: Gallstones (common with long term use but rarely symptomatic enough to require intervention). Nausea Pain at the injection site (especially with Sandostatin LAR) These side effects are less common side effects (occurring in about 1029%) of patients receiving octreotide: Abdominal Pain Flatulence (gas) Constipation Vomiting Diarrhea (may be due to the disease rather than the medication) Upper respiratory infection (see lung problems) Fatigue Flu-like syndrome Dizziness Headache If you have diabetes, your blood sugar levels may be affected. Discuss this with your healthcare provider, how you will monitor your blood sugar readings at home. You may experience a slower heartbeat Not all side effects are listed above. Some that are rare (occurring in less

than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Nausea (interferes with ability to eat and unrelieved with prescribed medication) Vomiting (vomiting more than 4-5 times in a 24 hour period) Diarrhea (4-6 episodes in a 24-hour period) Constipation unrelieved by laxative use Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting octreotide treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-thecounter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category B (there is no evidence of risk in humans based on negative animal studies. Use in pregnancy only if clearly needed). For both men and women: Do not conceive a child (get pregnant) while taking octreotide. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication. Self-care tips: This medicine is given to treat severe diarrhea. However, you may become constipated. If you do not move your bowels after 2 days, notify your healthcare provider. You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known. For flu-like symptoms, keep warm with blankets and drink plenty of liquids. There are medications that can help reduce the discomfort caused by chills. Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.

Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: Your health care provider will want to do blood tests to see how well you are responding to octreotide. Keep all appointments for tests, and office visits. Your doctor may also monitor other types of blood work, to see if the medication is affecting other parts of your body. How this drug works: Octreotide is similar to a natural chemical called somatostatin. Somatostatin is produced in the body by the hypothalamus. One of its functions is to "switch off" the secretion of growth hormone by the pituitary gland. Somatostatin also decreases splanchnic blood flow and inhibits the release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin and pancreatic polypeptide. These actions are what helps to control the symptoms of flushing and diarrhea in carcinoid tumors and Vasoactive Intestinal Peptide (VIP) secreting adenomas. Somatostatin is chemically unstable and broken down by the body within minutes of its release. Octreotide, in contrast, is very stable and, therefore, much longer acting. It is for this reason that octreotide is preferred for medicinal use. Cortisone Generic Name: Hydrocortisone Trade Names: AlaCort , Hydrocortone Phosphate, Solu-Cortef , Hydrocort Acetate , Lanacort Other Names: Hydrocortisone Sodium Succinate, Hydrocortisone Sodium Phosphate Drug Type: Cortisone has many uses in the treatment of cancer and is used most often as a supportive care medication. Cortisone is classified as a glucocorticosteroid. (For more detail, see "How Cortisone Works" section below). What Cortisone Is Used For: Cortisone is used as an antiinflammatory medication. Hydrocortisone relieves inflammation in various parts of the body. Cortisone is used to treat or prevent allergic reactions. Cortisone is used as treatment of certain kinds of autoimmune diseases,

skin conditions, asthma and other lung conditions. Cortisone is used as treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma. Cortisone is used to treat nausea and vomiting associated with some chemotherapy drugs. Cortisone is used to stimulate appetite in cancer patients with severe appetite problems. The lotion (topical) is used in treatment of allergic skin reactions, and relieves symptoms of itching, redness, and swelling. Cortisone is also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Cortisone is used asIf a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. How Cortisone Is Given: Cortisone may be given to you in many forms. In a pill form, it is available in 5 mg, 10 mg, and 20 mg tablets. If you are on a daily dose of hydrocortisone, and you miss a dose, take the dose as soon as you remember. You may be instructed to repeat the missed dose, and continue the medication. Take pills with food or after meals. Cortisone may also be given by injection into the muscle (intramuscular,IM) or into the vein (intravenously, IV), by a healthcare provider. Hydrocortisone eye ointment, or eye drops, is given to treat or prevent many inflammatory eye conditions. You may be given hydrocortisone as a lotion or a cream (topical) to treat skin disorders. The amount of hydrocortisone you will receive depends on many factors, including your height and weight, your general health or other health problems, and the reason you are receiving Cortisone. Your doctor will determine your exact dosage and schedule. Cortisone Side Effects: Important things to remember about the side effects of hydrocortisone include: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. The following side effects are common (occurring in greater than 30%) for patients taking hydrocortisone: Increased appetite Irritability Difficulty sleeping (insomnia)

Swelling in your ankles and feet (fluid retention) Nausea (take Cortisone with food) Heartburn Muscle weakness Impaired wound healing Increased blood sugar levels. (Persons with Diabetes may need to have blood sugar levels monitored more closely and possible adjustments to diabetes medications). The following are less common side effects (occurring in 10 to 29%) for patients receiving hydrocortisone: Headaches Dizziness Mood swings Cataracts and bone thinning (with long-term use) This list includes common and less common side effects for individuals taking hydrocortisone. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When To Contact Your Doctor or Health Care Provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C), chills (possible signs of infection) If you feel an irregular or fast heart beat, shortness of breath, or chest or jaw pain, seek emergency help and notify your healthcare provider. If you become suddenly confused The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following: Extreme fatigue (unable to carry on self-care activities) Any unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Nausea (interferes with ability to eat and unrelieved with prescribed medications) Vomiting (vomiting more than 4-5 times in a 24-hour period) Dizziness or lightheadedness, feeling faint Persistent headache Severe hot flashes or mood swings Inability to sleep (insomnia) Severe skeletal (bone) pain Difficult or painful urination; increased urination, or severe thirst Changes in vision, blurred vision, eye pain, enlarged pupils, discharge Any new rashes or changes in your skin Swelling of the feet or ankles. Sudden weight gain (greater than 3 pounds a week) Swelling, redness and/or pain in one leg or arm and not the other Always inform your health care provider if you experience any unusual symptoms.

Cortisone Precautions: Before starting hydrocortisone treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking hydrocortisone. If you have been on hydrocortisone pills daily, for a long period of time, serious side effects may occur if you discontinue the medication abruptly. Do not stop taking Cortisone unless directed by your healthcare provider. Do not change the dose of hydrocortisone on your own. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking hydrocortisone. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking Cortisone. Cortisone Self Care Tips: If you are on Cortisone for a long period of time, you may be more susceptible to infection. Wash your hands well, and report any symptoms of infection to your healthcare provider if noted. If you are given eye drops or eye ointment: You may be more sensitive to the light. Wearing sunglasses may help. It is normal to notice a little blurriness for a short time after the drops or ointment are placed in your eyes. Notify your healthcare provider with any changes in vision, blurriness, or eye pain. If you are given eye drops or eye ointment: Ask your healthcare provider if you may wear contact lenses. Contact lenses may absorb the medication. Wash your hands well before putting eye drops, to decrease the chance of a bacterial infection in your eyes. If you are hydrocortisone as a lotion (topical) to treat skin disorders: Do not apply to open areas of skin, or if you have open or weeping sores. Topical hydrocortisone should not be used for a long time. Discuss this with your healthcare provider. Certain brands of hydrocortisone can be applied to the rectal area to treat hemorrhoids, or local inflammation, either by a suppository of ointment. Make sure that the preparation that you are using was made specifically for the rectal area.

In a pill form: Take Cortisone with food to lessen an upset stomach. Also take Cortisone early on in the day (before 12:00 noon, if possible), so you will be able to sleep better at night. If you have diabetes, Cortisone may increase your blood sugar levels. Notify your healthcare provider that you are diabetic. You may need close monitoring.Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. In general, drinking alcoholic beverages should be avoided. You should also limit caffeine intake (colas, tea, coffee and chocolate, especially). These beverages may irritate your stomach. If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and Testing While Taking Cortisone: You will be checked regularly by your health care professional while you are taking hydrocortisone, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How Cortisone Works: Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids influence the functioning of most of the body's systems (heart, immune, muscles and bones, endocrine and nervous system). They exert a wide array of effects including effects on the metabolism of carbohydrates, protein and fats. They help to maintain balance of fluids and electrolytes. Hydrocortisone is classified as a corticosteroid (more precisely a glucocorticosteroid), and has many uses in the treatment of cancer. One way that it works is to decrease inflammation (swelling). It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids). Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors. For example, by decreasing swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other

symptoms caused by the pressing tumor. Another way Cortisone works is by altering the body's normal immune system responses. Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia. In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma. Corticosteroids may work by causing programmed cell death (apoptosis) of certain cells, which may help to fight your disease. Corticosteroids are also used in the short-term treatment of nausea caused by chemotherapy. How it does this is not fully understood. They also have been used to stimulate appetite for patients with severe appetite problems. Corticosteroids are used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Hydrocortisone Sodium Phosphate Generic: Hydrocortisone Other Trade Names: AlaCort , Hydrocortone Phosphate, SoluCortef , Lanacort, Hydrocort Acetate Other Names: Cortisone, Hydrocortisone Sodium Succinate Drug type: Hydrocortisone Sodium Phosphate has many uses in the treatment of cancer. Used most often as a supportive care medication. It is classified as a glucocorticosteroid. (For more detail, see "How this drug works" section below). What this drug is used for: As an anti-inflammatory medication. Hydrocortisone Sodium Phosphate relieves inflammation in various parts of the body. To treat or prevent allergic reactions. As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions. As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma. To treat nausea and vomiting associated with some chemotherapy drugs. Used to stimulate appetite in cancer patients with severe appetite problems. The lotion (topical) is used in treatment of allergic skin reactions, and relieves symptoms of itching, redness, and swelling. Also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Note: If a drug has been approved for one use, physicians sometimes elect to

use this same drug for other problems if they believe it might be helpful. How this drug is given: This medication may be given to you in many forms. In a pill form, it is available in 5 mg, 10 mg, and 20 mg tablets. If you are on a daily dose of Hydrocortisone Sodium Phosphate, and you miss a dose, take the dose as soon as you remember. You may be instructed to repeat the missed dose, and continue the medication. Take pills with food or after meals. This medication may also be given by injection into the muscle (intramuscular,IM) or into the vein (intravenously, IV), by a healthcare provider. Hydrocortisone Sodium Phosphate eye ointment, or eye drops, is given to treat or prevent many inflammatory eye conditions. You may be given Hydrocortisone Sodium Phosphate as a lotion or a cream (topical) to treat skin disorders. The amount of Hydrocortisone Sodium Phosphate you will receive depends on many factors, including your height and weight, your general health or other health problems, and the reason you are receiving this drug. Your doctor will determine your exact dosage and schedule. Side effects: Important things to remember about the side effects of Hydrocortisone Sodium Phosphate include: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. The following side effects are common (occurring in greater than 30%) for patients taking Hydrocortisone Sodium Phosphate: Increased appetite Irritability Difficulty sleeping (insomnia) Swelling in your ankles and feet (fluid retention) Nausea, take with food Heartburn Muscle weakness Impaired wound healing Increased blood sugar levels. (Persons with Diabetes may need to have blood sugar levels monitored more closely and possible adjustments to diabetes medications). The following are less common side effects (occurring in 10 to 29%) for patients receiving Hydrocortisone Sodium Phosphate: Headaches Dizziness Mood swings Cataracts and bone thinning (with long-term use) This list includes common and less common side effects for individuals

taking Hydrocortisone Sodium Phosphate. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C), chills (possible signs of infection) If you feel an irregular or fast heart beat, shortness of breath, or chest or jaw pain, seek emergency help and notify your healthcare provider. If you become suddenly confused The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following: Extreme fatigue (unable to carry on self-care activities) Any unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Nausea (interferes with ability to eat and unrelieved with prescribed medications) Vomiting (vomiting more than 4-5 times in a 24-hour period) Dizziness or lightheadedness, feeling faint Persistent headache Severe hot flashes or mood swings Inability to sleep (insomnia) Severe skeletal (bone) pain Difficult or painful urination; increased urination, or severe thirst Changes in vision, blurred vision, eye pain, enlarged pupils, discharge Any new rashes or changes in your skin Swelling of the feet or ankles. Sudden weight gain (greater than 3 pounds a week) Swelling, redness and/or pain in one leg or arm and not the other Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting Hydrocortisone Sodium Phosphate treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking Hydrocortisone Sodium Phosphate. If you have been on Hydrocortisone Sodium Phosphate pills daily, for a long period of time, serious side effects may occur if you discontinue the medication abruptly. Do not stop taking this medication unless directed

by your healthcare provider. Do not change the dose of Hydrocortisone Sodium Phosphate on your own. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking Hydrocortisone Sodium Phosphate. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication. Self Care Tips: If you are on this medication for a long period of time, you may be more susceptible to infection. Wash your hands well, and report any symptoms of infection to your healthcare provider if noted. If you are given eye drops or eye ointment: You may be more sensitive to the light. Wearing sunglasses may help. It is normal to notice a little blurriness for a short time after the drops or ointment are placed in your eyes. Notify your healthcare provider with any changes in vision, blurriness, or eye pain. If you are given eye drops or eye ointment: Ask your healthcare provider if you may wear contact lenses. Contact lenses may absorb the medication. Wash your hands well before putting eye drops, to decrease the chance of a bacterial infection in your eyes. If you are hydrocortisone as a lotion (topical) to treat skin disorders: Do not apply to open areas of skin, or if you have open or weeping sores. Topical hydrocortisone should not be used for a long time. Discuss this with your healthcare provider. Certain brands of hydrocortisone can be applied to the rectal area to treat hemorrhoids, or local inflammation, either by a suppository of ointment. Make sure that the preparation that you are using was made specifically for the rectal area. In a pill form: Take this medication with food to lessen an upset stomach. Also take this medication early on in the day (before 12:00 noon, if possible), so you will be able to sleep better at night. If you have diabetes, this medication may increase your blood sugar levels. Notify your healthcare provider that you are diabetic. You may need close monitoring.Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.

In general, drinking alcoholic beverages should be avoided. You should also limit caffeine intake (colas, tea, coffee and chocolate, especially). These beverages may irritate your stomach. If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your health care professional while you are taking Hydrocortisone Sodium Phosphate, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How this drug works: Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids influence the functioning of most of the body's systems (heart, immune, muscles and bones, endocrine and nervous system). They exert a wide array of effects including effects on the metabolism of carbohydrates, protein and fats. They help to maintain balance of fluids and electrolytes. Hydrocortisone is classified as a corticosteroid (more precisely a glucocorticosteroid), and has many uses in the treatment of cancer. One way that it works is to decrease inflammation (swelling). It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids). Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors. For example, by decreasing swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other symptoms caused by the pressing tumor. Another way this drug works is by altering the body's normal immune system responses. Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia. In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma. Corticosteroids may work by causing

programmed cell death (apoptosis) of certain cells, which may help to fight your disease. Corticosteroids are also used in the short-term treatment of nausea caused by chemotherapy. How it does this is not fully understood. They also have been used to stimulate appetite for patients with severe appetite problems. Corticosteroids are used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Hydrocortisone Trade Names: AlaCort , Hydrocortone Phosphate, SoluCortef , Hydrocort Acetate , Lanacort Other Names: Cortisone, Hydrocortisone Sodium Succinate, Hydrocortisone Sodium Phosphate Drug Type: Hydrocortisone has many uses in the treatment of cancer. Hydrocortisone is used most often as a supportive care medication. Hydrocortisone is classified as a glucocorticosteroid. (For more detail, see "How Hydrocortisone Works" section below). What Hydrocortisone Is Used For: As an anti-inflammatory medication. Hydrocortisone relieves inflammation in various parts of the body. To treat or prevent allergic reactions. As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions. As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma. To treat nausea and vomiting associated with some chemotherapy drugs. Used to stimulate appetite in cancer patients with severe appetite problems. The lotion (topical) is used in treatment of allergic skin reactions, and relieves symptoms of itching, redness, and swelling. Also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. How Hydrocortisone Is Given: Hydrocortisone may be given to you in many forms. In a pill form, it is available in 5 mg, 10 mg, and 20 mg tablets. If you are on a daily dose of Hydrocortisone, and you miss a dose, take the dose as soon as you remember. You may be instructed to repeat the missed dose, and continue the medication. Take pills with food or after meals. Hydrocortisone may also be given by injection into the muscle (intramuscular,IM) or into the vein

(intravenously, IV), by a healthcare provider. Hydrocortisone eye ointment, or eye drops, is given to treat or prevent many inflammatory eye conditions. You may be given Hydrocortisone as a lotion or a cream (topical) to treat skin disorders. The amount of Hydrocortisone you will receive depends on many factors, including your height and weight, your general health or other health problems, and the reason you are receiving this drug. Your doctor will determine your exact dosage and schedule. Hydrocortisone Side Effects: Important things to remember about Hydrocortisone side effects: Most people do not experience all of the Hydrocortisone side effects listed. Hydrocortisone side effects are often predictable in terms of their onset and duration. Hydrocortisone side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent Hydrocortisone side effects. The following Hydrocortisone side effects are common (occurring in greater than 30%) for patients taking Hydrocortisone: Increased appetite Irritability Difficulty sleeping (insomnia) Swelling in your ankles and feet (fluid retention) Nausea (take with food) Heartburn Muscle weakness Impaired wound healing Increased blood sugar levels (persons with diabetes may need to have blood sugar levels monitored more closely and possible adjustments to diabetes medications) The following are less common Hydrocortisone side effects (occurring in 10 to 29%) for patients receiving Hydrocortisone: Headaches Dizziness Mood swings Cataracts and bone thinning (with long-term use) This list includes common and less common Hydrocortisone side effects. Hydrocortisone side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When To Contact Your Doctor or Health Care Provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C), chills (possible signs of infection)

If you feel an irregular or fast heart beat, shortness of breath, or chest or jaw pain, seek emergency help and notify your healthcare provider. If you become suddenly confused The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following: Extreme fatigue (unable to carry on self-care activities) Any unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Nausea (interferes with ability to eat and unrelieved with prescribed medications) Vomiting (vomiting more than 4-5 times in a 24-hour period) Dizziness or lightheadedness, feeling faint Persistent headache Severe hot flashes or mood swings Inability to sleep (insomnia) Severe skeletal (bone) pain Difficult or painful urination; increased urination, or severe thirst Changes in vision, blurred vision, eye pain, enlarged pupils, discharge Any new rashes or changes in your skin Swelling of the feet or ankles. Sudden weight gain (greater than 3 pounds a week) Swelling, redness and/or pain in one leg or arm and not the other Always inform your health care provider if you experience any unusual symptoms. Hydrocortisone Precautions: Before starting Hydrocortisone treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking Hydrocortisone. If you have been on Hydrocortisone pills daily, for a long period of time, serious side effects may occur if you discontinue Hydrocortisone abruptly. Do not stop taking Hydrocortisone unless directed by your healthcare provider. Do not change the dose of Hydrocortisone on your own. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking Hydrocortisone. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.

Do not breast feed while taking Hydrocortisone. Hydrocortisone Self Care Tips: If you are on Hydrocortisone for a long period of time, you may be more susceptible to infection. Wash your hands well, and report any symptoms of infection to your healthcare provider if noted. If you are given eye drops or eye ointment: You may be more sensitive to the light. Wearing sunglasses may help. It is normal to notice a little blurriness for a short time after the drops or ointment are placed in your eyes. Notify your healthcare provider with any changes in vision, blurriness, or eye pain. If you are given eye drops or eye ointment: Ask your healthcare provider if you may wear contact lenses. Contact lenses may absorb Hydrocortisone. Wash your hands well before putting eye drops, to decrease the chance of a bacterial infection in your eyes. If you are Hydrocortisone as a lotion (topical) to treat skin disorders: Do not apply to open areas of skin, or if you have open or weeping sores. Topical Hydrocortisone should not be used for a long time. Discuss this with your healthcare provider. Certain brands of Hydrocortisone can be applied to the rectal area to treat hemorrhoids, or local inflammation, either by a suppository of ointment. Make sure that the preparation that you are using was made specifically for the rectal area. In a pill form: Take Hydrocortisone with food to lessen an upset stomach. Also take Hydrocortisone early on in the day (before 12:00 noon, if possible), so you will be able to sleep better at night. If you have diabetes, Hydrocortisone may increase your blood sugar levels. Notify your healthcare provider that you are diabetic. You may need close monitoring.Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. In general, drinking alcoholic beverages should be avoided. You should also limit caffeine intake (colas, tea, coffee and chocolate, especially). These beverages may irritate your stomach. If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and Testing While Taking Hydrocortisone: You will be checked regularly by your health care professional while you are

taking Hydrocortisone, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How Hydrocortisone Works: Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids influence the functioning of most of the body's systems (heart, immune, muscles and bones, endocrine and nervous system). They exert a wide array of effects including effects on the metabolism of carbohydrates, protein and fats. They help to maintain balance of fluids and electrolytes. Hydrocortisone is classified as a corticosteroid (more precisely a glucocorticosteroid), and has many uses in the treatment of cancer. One way that it works is to decrease inflammation (swelling). It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids). Taking advantage of the anti-inflammatory properties of Hydrocortisone, corticosteroids are used to decrease the swelling around tumors. For example, by decreasing swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other symptoms caused by the pressing tumor. Another way this drug works is by altering the body's normal immune system responses. Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia. In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma. Corticosteroids may work by causing programmed cell death (apoptosis) of certain cells, which may help to fight your disease. Corticosteroids are also used in the short-term treatment of nausea caused by chemotherapy. How it does this is not fully understood. They also have been used to stimulate appetite for patients with severe appetite problems. Corticosteroids are used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Note: We strongly encourage you to talk with your health care professional about your specific medical condition

and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice. Methotrexate Sodium Methotrexate (meth-oh-TREKS-ayt) Trade names: Rheumatrex, TrexallTM Other names: Amethopterin, Methotrexate Sodium, MTX Drug type: Methotrexate is an anticancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "antimetabolite." (For more detail, see "How this drug works" section below). What this drug is used for: Used in the treatment of breast, head and neck, lung, stomach, and esophagus cancers. Acute lymphoblastic leukemia (ALL), sarcomas, non-Hodgkin's lymphoma (NHL), gestational trophoblastic cancer, and mycosis fungoides (cutaneous T-cell lymphoma). Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. How this drug is given: As an infusion into the vein (intravenous, IV). As an injection into the muscle (intramuscular, IM). Another method it is given is by intraventricular or intrathecal infusion. This method is used when drugs need to reach the cerebrospinal fluid (CSF) the fluid that is surrounding the brain and spinal cord, the drug is infused directly into the spinal fluid. There is also a pill form of methotrexate. The amount of methotrexate and how it is given depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose, schedule and how it is given. Side effects: Important things to remember about the side effects of methotrexate: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The side effects of methotrexate and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects. In some cases leucovorin infusion (see leucovorin) may be given 24 hours

after methotrexate to lessen the side effects of methotrexate. The following side effects are common (occurring in greater than 30%) for patients taking methotrexate: Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding. Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts. Onset: 7 days Nadir: 10 days Recovery: 21 days Mouth sores. (usually occur 3-7 days after treatment) Nausea and vomiting. (uncommon with low dose) Poor appetite These side effects are less common side effects (occurring in about 1029%) of patients receiving methotrexate: Kidney toxicity (see kidney problems) particularly with high-doses. In severe cases can lead to kidney failure. Care is taken to make sure patient is well hydrated with IV fluids before infusion of high-dose methotrexate. Skin rash, reddening of the skin (with high doses). Diarrhea Hair loss Eye irritation (conjunctivitis) (see eye problems). Increases in blood tests measuring liver function, often seen with high dose treatment. These return to normal within about 10 days. (see liver problems). Darkening of the skin where previous radiation treatment has been given. (radiation recall - see skin reactions). Loss of fertility. Meaning, your ability to conceive or father a child may be affected by methotrexate. Discuss this issue with your health care provider. Side effects specific to intrathecal administration of methotrexate (the drug is infused directly into the cerebrospinal fluid (CSF) the fluid that is surrounding the brain and spinal cord): Acute chemical arachnoiditis: a syndrome that can be seen immediately after the infusion of methotrexate intrathecally. It is an inflammation of the membrane surrounding the brain and spinal column. Symptoms are: severe headache, stiff neck, seizures, vomiting, and fever. Central neurotoxicity: Less-common, seen with intrathecal or very high IV dose methotrexate. Symptoms are; difficulty with speech, paralysis of the arms and legs, seizures, or coma. This may develop within 6 days of treatment and resolves within 48-72 hours. Not all side effects are listed above. Some that are rare (occurring in less

than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C) or higher, chills (possible signs of infection). The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Extreme fatigue (unable to carry on self-care activities) Mouth sores (painful redness, swelling or ulcers) Nausea (interferes with ability to eat and unrelieved with prescribed medication) Vomiting (vomiting more than 4-5 times in a 24 hour period) Diarrhea (4-6 episodes in a 24-hour period) No urine output in a 12 hour period Yellowing of the skin or eyes Swelling of the feet or ankles. Sudden weight gain. Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination. Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness. Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting methotrexate treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not take non-steroidal antiinflammatory drugs (NSAIDS) such as ibuprophen or naproxen unless your doctor specifically permits this. Bone marrow suppression, intestinal irritation and severe anemia have occurred with combined usage of non-steroidal anti-inflammatory drugs (NSAIDS) and methotrexate. Folic acid supplements should be avoided while on methotrexate. Folic acid may counteract the anti-cancer effects of methotrexate. If you are on warfarin (Coumadin) as a blood-thinner, adjustments may need to be made to your dose based on blood work. Do not receive any kind of immunization or vaccination without your doctor's approval while taking methotrexate.

Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (methotrexate may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking methotrexate. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication. Self-care tips: Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider. Wash your hands often. To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water. Use an electric razor and a soft toothbrush to minimize bleeding. Avoid contact sports or activities that could cause injury. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your health care professional while you are taking methotrexate, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. Blood levels of this drug may be monitored in patients receiving highdose methotrexate. How this drug works: Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they

come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis). Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle nonspecific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles. Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body. Methotrexate belongs to the class of chemotherapy drugs called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cellcycle specific. They attack cells at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere. Folic acid antagonist: Methotrexate. Pyrimidine antagonist: 5-Fluorouracil, Foxuridine, Cytarabine, Capecitabine, and Gemcitabine. Purine antagonist: 6-Mercaptopurine and 6-Thioguanine. Adenosine deaminase inhibitor: Cladribine, Fludarabine and Pentostatin. Methotrexate exerts its chemotherapeutic effect by being

able to counteract and compete with folic acid in cancer cells resulting in folic acid deficiency in the cells and causing their death. This action also effects normal cells which can cause significant side effects in the body, such as: low white, red and platelet blood cell counts, hair loss, mouth sores, difficulty swallowing, diarrhea, liver, lung, nerve and kidney damage. These complications and side effects of high-dose methotrexate can be either prevented or decreased by using leucovorin, which provides a source of folic acid for the body's cells. Leucovorin is normally started 24 hours after high-dose methotrexate is given. This delay gives the methotrexate a chance to exert its anti cancer effects. Interferon Alfa-2b (PEG Conjugate) Generic Name: PEG Interferon Trade Name: PEG-INTRON Drug type: PEG Interferon alfa-2b is a "biologic response modifier." This medication is classified as a "cytokine." (For more detail, see "How this drug works" section below). What this drug is used for: This medication is used to treat chronic hepatitis C. This medication is also being investigated for use in various cancers. Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. How this drug is given: This medication is given by injection under the skin (subcutaneous, SubQ). It is given as a once a week injection. You may be taught to give yourself the injection if you are willing and able to learn. The amount of this medication you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dosage and schedule. Side effects: Important things to remember about the side effects of PEG Interferon alfa2b: You will not get all of the side effects mentioned below. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after therapy is complete. Side effects are quite manageable, and there are many options to minimize or prevent them. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The following side effects are common (occurring in greater than 30%) for patients taking PEG Interferon alfa-2b: Flu-like symptoms (headache, muscle aches, tiredness and fever) usually

lessen after the first few weeks of treatment. Fatigue Injection site reactions (bruising, itching, irritation). Poor appetite Nausea The following are less common side effects (occurring in 10-29%) for patients receiving PEG Interferon alfa2b: Depression Anxiety/ irritability Insomnia (see sleep problems) Joint and bone pain (see pain) Temporary hair thinning. Your hair will grow back after you stop taking this medication. Diarrhea Abdominal pain Itching Dizziness Weight loss Dry skin Trouble concentrating (see central neurotoxicity). This list includes common and less common side effects for individuals taking PEG Interferon alfa-2b. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Shortness of breath, chest pain, rapid heart beat Depressed or have any thoughts of hurting yourself or others The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following: Unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Diarrhea (4-6 episodes in a 24-hour period) Nausea that interferes with eating and is not relieved by prescribed medications Vomiting (vomiting more than 4-5 times in a 24-hour period) Persistent abdominal pain Feeling "faint" or dizzy Unusual fatigue Anxiety, changes in thinking or mood, confusion, difficulty concentrating or trouble sleeping Changes in eyesight Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting PEG Interferon alfa-2b treatment, make sure you tell your doctor about any other medications you are taking (including over-thecounter, vitamins, or herbal remedies).

Do not take aspirin or products containing aspirin unless your doctor permits this. PEG Interferon alfa-2b may cause patients to develop mood or behavioral problems. Make sure to tell your doctor if you are being treated for a mental illness or had treatment in the past for any mental illness, including depression and suicidal behavior. You should also tell your doctor if you have ever been addicted to drugs or alcohol. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking PEG Interferon alfa-2b. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication. Self Care Tips: Take injections at bedtime. You may be able to sleep through "flu-like" symptoms. Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake. For flu-like symptoms, keep warm with blankets and drink plenty of liquids. There are medications that can help reduce the discomfort caused by chills. Acetaminophen or ibuprophen may help relieve discomfort from fever, headache, generalized aches and pains. However, be sure to talk with your doctor before taking it. You may be at risk of infection so try to avoid crowds or people with colds or not feeling well, and report fever or any other signs of infection immediately to your healthcare provider. Wash your hands often. Avoid sun exposure. Wear SPF 15 (or higher) sun block and protective clothing. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to this drug is known. Conserve energy, try to get plenty of rest. Patients receiving this medication should have regular eye exams, especially if you have a history of diabetes or high blood pressure. Report any changes in vision immediately.

If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your health care professional while you are taking PEG Interferon alfa-2b, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. Your thyroid gland may also be affected by this medication. Your healthcare provider may order a blood test periodically to assess your thyroid function. How this drug works: PEG Interferon alfa-2b is interferon alfa-2b with a substance called polyethylene glycol (PEG) attached to it. The attachment process is called pegylation, and is used to allow active substances (the interferon alfa-2b) to stay in the body longer before they are broken down and eliminated. Interferon alfa-2b belongs to the category of therapies called biologic response modifiers (BRM), also called immunotherapy. This is a type of treatment that mobilizes the body's immune system to fight cancer. The therapy mainly consists of stimulating the immune system to help it do its job more effectively. Interferon alfa-2b is part of a family of proteins called cytokines. Cytokines act primarily by communicating between the various cells of the body's immune system. Interferon alfa-2b interacts with receptors on the surface of cells. There are several ways that interferon alfa-2b fights cancer; directly by interfering with the cancer cells ability to divide, and indirectly by modifying the bodies response to the cancer cells. Zoladex Generic Name: Goserelin Drug Type: Zoladex is a hormone therapy. It is classified as an "LHRH agonist." (For more detail, see "How Zoladex Works" section below). What Zoladex Is Used For: Prostate cancer Breast cancer Also used to treat endometriosis (noncancerous condition) Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. How Zoladex Is Given: Injection under the skin (subcutaneous, SubQ) As a monthly or every 3 month injection

Your doctor will determine your dose and schedule Side Effects of Zoladex: Important things to remember about the side effects of Zoladex: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The following side effects are common (occurring in greater than 30%) for patients taking Zoladex: Hot flashes (see sexuality) Loss of libido (decreased interest in sex) Impotence (inability to obtain or sustain an erection) These side effects are less common side effects (occurring in about 1029%) of patients receiving Zoladex: Increased bone pain due to disease "flare" during first couple weeks of treatment Headache Vaginal dryness (see sexuality) Swelling of the breasts (gynecomastia) (see sexuality) Depression Sleepiness Skin rash Zoladex may cause short-term (within first 2 weeks of treatment) increases in testosterone serum levels. When this is used for prostate cancer the resulting "tumor flare" can cause temporary increase of bone pain, swelling of the prostate that blocks urine flow or swelling around tumor in the spine causing compression of the spinal cord. If you are noticing increased weakness, numbness or tingling in arms or legs, or difficulty with urination, report these symptoms to your health care provider immediately. Rare but significant side effects may include heart problems such as arrhythmias, congestive heart failure or heart attack (<5%). Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When To Contact Your Doctor or Health Care Provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Urinary retention or inability to urinate Weakness, numbness or tingling in arms or legs The following symptoms require medical attention, but are not an

emergency. Contact your health care provider within 24 hours of noticing any of the following: Extreme fatigue (unable to carry on self-care activities) Swelling of the feet or ankles. Sudden weight gain. Swelling, redness and/or pain in one leg or arm and not the other Changes in mood or memory Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting Zoladex treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-thecounter, vitamins, herbal remedies, etc.). Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (Zoladex may cause fetal harm when given to a pregnant woman. Zoladex must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking Zoladex, the medication must be stopped immediately and the woman given appropriate counseling). For both men and women: Do not conceive a child (get pregnant) while taking Zoladex. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking Zoladex. Zoladex Self Care Tips: If you are experiencing hot flashes, wearing light clothing, staying in a cool environment, and putting cool cloths on your head may reduce symptoms. Consult you health care provider if these worsen, or become intolerable. Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and Testing While Taking Zoladex: You will be checked regularly by your

health care professional while you are taking Zoladex, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) may also be ordered by your doctor. How Zoladex Works: Hormones are chemical substances that are produced by glands in the body, which enter the bloodstream and cause effects in other tissues. For example, the hormone testosterone, made in the testicles and is responsible for male characteristics such as deepening voice and increased body hair. The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells. Hormone therapy can work by stopping the production of a certain hormone, blocking hormone receptors, or substituting chemically similar agents for the active hormone, which cannot be used by the tumor cell. Different types of hormone therapies are categorized by their function and/or the type of hormone that is affected. Zoladex is classified as a leutinizing hormone releasing hormone (LHRH) agonist. LHRH agonists work by telling the pituitary gland located in the brain to stop producing leutinizing hormone, which (in men) stimulates the testicles to release testosterone and (in women) stimulates the ovaries to release estrogen. The drug does not have a direct effect on the cancer, only on the testicles or ovaries. The resulting lack of testosterone (in men) and estrogen (in women) interferes with stimulating cell growth in testosterone or estrogen dependent cancer cells. In treatment of prostate cancer LHRH agonists are often used together with anti-androgen medications. Antiandrogens are substances that block the effects of testosterone. Cancer of the prostate depends on the male hormone testosterone for its growth. If the amount of testosterone is reduced it is possible to slow down or shrink the cancer. Examples of anti-androgens are: bicalutamide, flutamide, nilutamide. VePesid Etoposide (e-TOE-poe-side) Trade names: Toposar, VePesid, Etopophos Other name: VP-16, Etoposide phosphate Drug type: Etoposide is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as a "plant alkaloid" and "topoisomerase II inhibitor." (For more

detail, see "How this drug works" section below). What this drug is used for: Testicular, bladder, prostate, lung, stomach, and uterine, cancers. Hodgkin's and non-Hodgkin's lymphoma, mycosis fungoides, Kaposi's sarcoma, Wilm's tumor, rhabdomyosarcoma, Ewing's sarcoma, neuroblastoma, brain tumors. It also may be given as high-dose therapy in bone marrow transplant setting. Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. How this drug is given: In tablet form by mouth. As an infusion into the vein (intravenous, IV), as a short infusion or as a continuous infusion over 24 hours. Etoposide is considered an irritant. An irritant is a chemical that can cause inflammation of the vein through which it is given. If the medication escapes from the vein it can cause tissue damage. The nurse or doctor who gives this medication must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving etoposide, alert your health care professional immediately. The amount of etoposide that you will receive and the method it is given depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose, schedule and how it will be given. Side effects: Important things to remember about the side effects of etoposide: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The side effects of etoposide and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects. The following side effects are common (occurring in greater than 30%) for patients taking etoposide: Low white blood cell count. (This can increase your risk for infection). Low platelet count (This can increase your risk of bleeding). Nadir: Meaning low point, nadir is the point in time between chemotherapy

cycles in which you experience low blood counts. Onset: 5-7 days Nadir: 7-14 days Recovery: 21-28 days Hair loss Menopause (chemotherapy induced) Loss of fertility. Meaning, your ability to conceive a child may be affected by etoposide. Discuss this issue with your health care provider. Nausea and vomiting (especially at high-doses) Low blood pressure (if the drug is infused too fast) These side effects are less common, meaning they occur in 10-29 percent of patients receiving etoposide: Mouth sores (especially at high doses) Diarrhea (especially at high doses) Poor appetite Radiation recall (see skin reactions) Other side effects: Metallic taste during infusion of drug Inflammation at injection site Peripheral neuropathy (numbness in your fingers and toes) may occur with repeated doses. This is a rare side effect but can be irreversible. Report numbness or tingling of feet or hands to your health care provider. Delayed effects: There is a slight risk of developing a blood cancer such as leukemia years after taking etoposide. Talk to your doctor about this risk. Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C) or higher, chills (possible signs of infection). The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Nausea (interferes with ability to eat and unrelieved with prescribed medication) Vomiting (vomiting more than 4-5 times in a 24 hour period) Diarrhea (4-6 episodes in a 24-hour period) Unusual bleeding or bruising Black or tarry stools, or blood in your stools or urine Extreme fatigue (unable to carry on self-care activities) Mouth sores (painful redness, swelling or ulcers) Swelling, redness and/or pain in one leg or arm and not the other Numbness or tingling in your fingers or toes Yellowing of the skin or eyes

Pain, redness or swelling at the IV site Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting etoposide treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-thecounter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking etoposide. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (etoposide may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking etoposide. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication. Self-care tips: Apply warm compresses if you have any pain, redness or swelling at the IV site, and notify your doctor. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider. Wash your hands often. To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water. Use an electric razor and a soft toothbrush to minimize bleeding. Avoid contact sports or activities that could cause injury. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer

other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your health care professional while you are taking etoposide, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How this drug works: Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis). Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle nonspecific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles. Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body. Etoposide belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants. The vinca alkaloids are made from the periwinkle plant

(catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May apple plant. Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata). Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division. Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine Taxanes: Paclitaxel and Docetaxel Podophyllotoxins: Etoposide and Tenisopide Camptothecan analogs: Irinotecan and Topotecan Topoisomerase inhibitors (such as etoposide) are drugs that interfere with the action of topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the manipulation of the structure of DNA necessary for replication. Topoisomerase I inhibitors: Ironotecan, topotecan Topoisomerase II inhibitors: Amsacrine, etoposide, etoposide phosphate, teniposide Prednisone Prednisone (pred NIS one) Trade names: Deltasone, Liquid Pred, Meticorten, Orasone Chemocare.com uses generic names in all descriptions of drugs. Deltasone is the trade name for prednisone. Liquid pred and meticorten and orasone are other names for prednisone. In some cases, health care professionals may use the trade name deltasone or other names liquid pred or meticorten or orasone when referring to the generic drug name prednisone. Drug type: Prednisone has many uses in the treatment of cancer. It is classified as a glucocorticosteroid. (For more detail, see "How this drug works" section below). What this drug is used for: As an anti-inflammatory medication. Prednisone relieves inflammation in various parts of the body. To treat or prevent allergic reactions. As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions. As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma. To treat nausea and vomiting associated with some chemotherapy drugs. Used to stimulate appetite in cancer patients with severe appetite problems. Also used to replace steroids in conditions of adrenal insufficiency (low

production of needed steroids produced by the adrenal glands). Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. How this drug is given: This medication is given to you in a pill form. If you miss a dose, do not take a double dose the next day. This medicine is to be taken once a day. Take pills with food or after meals. The amount of prednisone you will receive depends on many factors, including, your general health or other health problems, and the reason you are receiving this drug. Your doctor will determine your dosage and schedule. Side effects: Important things to remember about the side effects of prednisone include: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. The following side effects are common (occurring in greater than 30%) for patients taking prednisone: Increased appetite Irritability Difficulty sleeping (insomnia) Swelling in your ankles and feet (fluid retention). Nausea, take with food. Heartburn. Muscle weakness. Impaired wound healing. Increased blood sugar levels. (Persons with Diabetes may need to have blood sugar levels monitored more closely and possible adjustments to diabetes medications). The following are less common side effects (occurring in 10 to 29%) for patients receiving prednisone: Headaches Dizziness Mood swings Cataracts and bone thinning (with long-term use). This list includes common and less common side effects for individuals taking prednisone. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.5 F (38 C), chills (possible signs of infection) If you feel an irregular or fast heart beat, shortness of breath, or chest or

jaw pain, seek emergency help and notify your healthcare provider. If you become suddenly confused The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following: Extreme fatigue (unable to carry on self-care activities) Any unusual bleeding or bruising.Black or tarry stools, or blood in your stools or urine Nausea (interferes with ability to eat and unrelieved with prescribed medications) Vomiting (vomiting more than 4-5 times in a 24-hour period) Dizziness or lightheadedness, feeling faint Persistent headache Severe hot flashes or mood swings Inability to sleep (insomnia) Severe skeletal (bone) pain Difficult or painful urination; increased urination, or severe thirst Changes in vision, blurred vision, eye pain, enlarged pupils, discharge Any new rashes or changes in your skin Swelling of the feet or ankles. Sudden weight gain (greater than 3 pounds a week) Swelling, redness and/or pain in one leg or arm and not the other Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting prednisone treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-thecounter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this. Do not receive any kind of immunization or vaccination without your doctor's approval while taking prednisone. If you have been on prednisone pills daily, for a long period of time, serious side effects may occur if you discontinue the medication abruptly. Do not stop taking this medication unless directed by your healthcare provider. Do not change the dose of prednisolone on your own. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking prednisone. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking this medication. Self Care Tips:

If you are on this medication for a long period of time, you may be more susceptible to infection. Wash your hands well, and report any symptoms of infection to your healthcare provider. Take this medication with food to lessen an upset stomach. Also take this medication early on in the day (before 12:00 noon, if possible), so you will be able to sleep better at night. If you have diabetes, this medication may increase your blood sugar levels. You may need more frequent monitoring. Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition. Avoid sun exposure. Wear SPF 15 (or higher) sun block and protective clothing. To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. In general, drinking alcoholic beverages should be avoided. You should also limit caffeine intake (colas, tea, coffee and chocolate, especially). If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and testing: You will be checked regularly by your health care professional while you are taking prednisone, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How this drug works: Corticosteroids are naturally produced by the adrenal gland in the body. Corticosteroids influence the functioning of most of the body's systems (heart, immune, muscles and bones, endocrine and nervous system). They exert a wide array of effects including effects on the metabolism of carbohydrates, protein and fats. They help to maintain balance of fluids and electrolytes. Prednisone is classified as a corticosteroid (more precisely a glucocorticosteroid), and has many uses in the treatment of cancer. One way that it works is to decrease inflammation (swelling). It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids). Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors. For example, by decreasing

swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other symptoms caused by the pressing tumor. Another way this drug works is by altering the body's normal immune system responses. Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia. In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma. Corticosteroids may work by causing programmed cell death (apoptosis) of certain cells, which may help to fight your disease. Corticosteroids are also used in the short-term treatment of nausea caused by chemotherapy. How it does this is not fully understood. They also have been used to stimulate appetite for patients with severe appetite problems. Corticosteroids are used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands).