Amiphostine should be given by injection, not IV -- accordng to Medimmune which manufactures the drug (and where my husband Barry's daughter worked, she got us a Medimmune book on administering the drug which contains lots of info.) IV adminstration was leading to a lot of severe blood pressure crashes.

My husband took amiphostine throughout his treatment, only skipping chemotherapy days because of risk of excessive nausea and a few other days because he felt "off" -- the drug (also known as Ethyol) can cause nausea and a drop in blood pressure, the latter not so much of an issue since it has started to be given by injection. Barry got total 500 mg, two injections of 250 in 0.9% saline, after each injection the site was treated with cortisone cream as anothjer side effect is a rash. (If the rash becomes generalized, the treatments should be stopped.) The injections are given 1/2 hour before the radiation. Before that you should drink 24-32 oz. of water starting 90 minutes before the injection to avoid BP drop, but we found later that 20 oz is probably enough (this becomes hard to do as your mouth gets more sore). You also have to take an anti-nausea drug 90 minutes or so before and what Barry had to take was Zofran -- expensive but, a lesser drug like Compazine did not work for him. He also took Anzemet a few times, it worked even better than Zofran.

The nurse took his BP before the injection and said she would not give it if his BP was below 100 (which it never was but on occasion close to that!) -- she then re-checked 15 minutes afterwards and also checked for rash or other reaction. She made sure the radiation machine was on time so that the amiphostine was given within the 30-45 minutes window where most effective.

Having said all that, at Hopkins most people are not able to take the drug all the way through -- apparently they get residual queasiness or a rash, or even severe vomiting. Most give up half-way. It is not an easy drug to take, Barry thought it the worst part of the treatment (other than the sore throat) and the worst part of the Ethyol was trying to drink all that water and not get sick , especially as time goes on (you can also drink other clear liquids or even eat Jello).

Our RO, who is an expert on amiphostine, says it adds about 10-15% improvement in salivary function so if you find you cannot tolerate it, it is not the end of the world. More benefit to salivary function (according to him) is derived from the treatment plan itself and whether you get IMRT or not.

In case you are wondering, Barry has very good salivary function 3 weeks' out from treatment so I guess the pain was worth the gain!

On your other question, Barry simply held his tongue in place himself (he had a base of tongue tumor and two nodes); they didn't put anything in his mouth -- but if you are choking you need to tell your techs as hopefully they have aother solution.

Good luck,
Gail