The major thing with the amifostine is to follow Medimmune instructions to the letter:

This means:

1) Gievn by injection sub-cutaneously, not by IV -- many fewer dangerous side effects such as blood pressure drop (but not zero side effects, I know one person who had severe BP drop after one injection).

2) drink at least 20 oz. fluid (jello also counts) starting 90 minutes before injection. 24 oz. is better.

3) take *serious* anti-emetic (Zofran, Anzemet, or Kytril) 90 minutes before injection.

4) the nurse should check BP, skin at previous day's injection site and probably also temperature before administering the shots. 500 mg amifostine is typically delivered in two injections, 250 mg each dissolved in saline. Hydrocortisone cream can be rubbed into the injection site immediately afterwards to reduce chance of localized rash. Medimmune also suggests an oral anti-histamine but our radiation nurse had never found that to add any benefit.

5) After injection you must wait 30 minutes but ideally no more than 45 minutes for radiation -- thus there needs to be good coordination between radiation team and your onc. nurse. In our case the nurse would check with the radiation therapist to see how their schedule was holding up (and if the machine was up!) and the radiation therapist would also check as to exact time of injection, and get my husband in to treatment within the window.

After radiation, drink water to flush drug from body but have to be careful -- too much water can itself cause nausea.

One tip -- do not have the amifostine on chemotherapy days -- the missed shots will not affect outcome significantly if at all and it will greatly reduce chance of severe nausea.

My husband took amifostine essentially all the way through, missing chemo days and two-three times when he was feeling ill towards the end of treatment (infection). It was NOT easy and he felt it was almost the hardest part towards the end, trying to get down all that water. BUT he tells people it was worth every queasy moment as he has very good salivary production now (about 75-80%, one year out) even in the right parotid which got a lot of radiation and which one of his ROs told him would be "nonfunctioning" after treatment, based on his radiation plan.

Gail