Treatment for Chemotherapy Side Effects - Gastrointestinal Tract
- Aprepitant may be given by mouth to reduce nausea and vomiting by blocking certain neurotransmitters in the brain. This drug is one component of a three-drug therapy that includes a 5-HT3 antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone). It may cause constipation, diarrhea, fatigue, and headache.
- Zofran may be given either intravenously or by mouth (IV or orally) to control acute episodes of nausea and emesis occurring within 24 - 48 hours of chemotherapy administration. This drug is not as effective in controlling delayed nausea and emesis.
- Kytril is given either intravenously or by mouth (IV or orally) to help control acute episodes of nausea and emesis occurring within 24 - 48 hours of chemotherapy administration. It is not effective in controlling delayed nausea and emesis.
- Compazine is given either intravenously or by mouth (IV or orally) to help control delayed episodes of nausea and emesis occurring more than 48 hours after chemotherapy administration.
- Reglan is a medication that is usually administered in pill form. It is used to help reduce nausea and emesis by moving food through the stomach faster.
- Decadron is a steroid that has multiple actions and uses. It can be used alone, or in combination with Zofran or Kytril, to help control acute episodes of chemotherapy-induced nausea or vomiting. It also can be used alone to improve appetite and to improve the patient's general feeling of well-being. This drug can cause weight gain if used for prolonged periods of time.
- Megace is given orally, in either pill or liquid (most common) form. The medication is a progestational agent, which increases appetite and causes weight gain due to increased caloric intake. This drug may be used as second or third line therapy in patients who have breast cancer that has progressed on Tamoxifen.
- Marinol is a prescription medication that mimics the increased appetite side effect of marijuana, without the associated high.
- Lomotil is a prescription medication that is used to decrease transition time in the colon, allowing more water to be reabsorbed and decreasing the incidence of diarrhea.
- Immodium is an over-the-counter) medication that decreases colon transition time, reducing the frequency of diarrhea.
- Milk of Magnesia (MOM) is an over-the-counter medication that helps draw water into the large intestine, softening the stool for easier elimination. This medication may cause abdominal cramps.
- Magnesium citrate is an over-the-counter medication that draws water into the large intestine, softening the stool for easier elimination. As with Milk of Magnesia, this medication may cause abdominal cramps.
- Senokot is an over-the-counter medication that increases the bulk of the stool and can lead to more predictable elimination patterns.
- Benadryl/Nystatin/Viscous lidocaine solution is a prescription solution of three medications that helps to relieve the pain, inflammation and potential fungal infections associated with moderate to severe mucositis and esophagitis (inflammation and sores of the mouth and esophagus).
- Bax solution is a prescription medication that helps to relieve the pain and potential fungal infections associated with moderate to severe mucositis.
- Diflucan is a prescription antifungal medication used to treat fungal infections of the mouth and throat. Diflucan can be given either intravenously or by mouth (IV or orally).
In August 2008, the FDA approved the granisetron transdermal system (Sancuso) to prevent nausea and vomiting in patients who are receiving nausea-inducing chemotherapy for as many as 5 consecutive days. Sancuso is a 5-HT3 receptor antagonist that is administered in a single patch applied to the skin of the upper arm. The patch may be applied up to 48 hours before chemotherapy, should be removed no less than 24 hours after completion of chemotherapy, and can be worn for as many as 7 days.
Side effects include minor skin irritation at the application site and constipation. If a severe reaction occurs, the patch must be removed. Patients should avoid sun exposure to the site of application while wearing the patch and for 10 days following removal.
Rolapitant (Varubi) was approved by the FDA in September 2015 to prevent delayed-phase chemotherapy-induced nausea and vomitingnausea and/or vomiting that occurs 24120 hours after the start of the chemo treatment. These delayed symptoms, which can occur with highly- and moderately-emetogenic (vomit-inducing) drugs like cisplatin, anthracycline and cyclophosphamide, and others, can be serious and lead to weight loss, dehydration, and hospitalization.
In clinical trials, Varubi reduced vomiting and decreased the need for rescue medication for nausea and vomiting. The drug is contraindicated in patients who are taking thioridazine (used to treat the symptoms of schizophrenia). Side effects include decreased appetite, hiccups, dizziness, and low white blood cell count.