Amifostine can be a nasty drug to take, and a lot depends on following the Medimmune (drug manufacturer) guidelines *to the letter*. Many people manage to take it for some of their treatment, a few all the way through. My husband took it all the way through but was one of the few at Hopkins who did. As it was they never gave it to him on chemo days. And he said it was the worst part of the treatment. But...it worked!

The Medimmune guidelines --

1) 90 minutes before injection, take antinausea medication. We found that *only* one of the serious antinausea meds worked, which is to say -- Zofran, Kytril, Anzemet. The commonly prescribed Compazine did *nothing* for my husband, although for some people it apparently has worked.

2) Drink at least 16 oz. and better, 24 oz. of fluid starting 90 minutes before injection and finishing about 10 minutes or so before. This gets pretty hard as the mouth becomes more sore, also all that liquid in and of itself can cause queasiness. Folks on a PEG might actually manage better.

3) Nurse will take blood pressure (BP) and other vitals before administering the injections. And note, amifostine *by injection* now -- (they phased out IV delivery due to serious side effects in too many people, including severe BP drop and even a few cases of anaphylactic shock.) If BP is too low, I think the cut-off is 100, the injection isn't given.

4) Nurse also has examine sites of previous day's injections to look for local or (worse) generalized rash. The latter may mean an allergic reaction to the drug and thus it may have to be stopped.

5) After injection, there is a 30-45 minute "window" to receive the radiation. Need really good coordination between radiation techs and the radiation oncology nurse -- our nurse would walk down and make sure everything as on track re the machine, and the tech would walk up about 15 minutes later to confirm exactly when injection given and thus, when Barry had to go in for treatment.

The reason (at Hopkins at least) that many patients had to stop the Ethyol is because they developed a lingering nausea and/or the generalized rash. Our dental ocologist has done some studies with this drug for mucositis and he felt that taking it every other day gave about as good results both for salivary preservation and mouth sores. So this is an option to consider.

But be sure to get the good serotonin anti-emetic drugs as noted above -- my husband said they were expensive but worth every penny! Otherwise he feels he would not have been able to tolerate amifostine and probably would not now have such good saliva (and he also had less severe mucositis).

Gail