I know nausea is supposed to be a definite side effect of Amaphostine as well as blood pressure drop. The RO says sometimes the nausea isn't as persistent when given in injection as opposed to IV - what is others experiences? I've got perscriptions for 8 mg Zofran + Compazine. Is there anything stronger? Just trying to be prepared.
Bonnie

My husband had profound nausea with amiphostine. Compazine didn't touch it, but the Zofran ODT did help (the "orally disintegrating tablets" really work fast). He was able to get through 3 weeks of the amiphostine tx, not the full 6 and much of what we read said many patients can't tolerate the full course. But some people tolerate it well and I hope you're one of them!

Good for you for having the zofran ready. If I recall, an oncology nurse friend told me there *are* newer antiemetics than Zofran (more commonly prescribed for chemotherapy)- but they're incredibly expensive - might have trouble with insurance coverage. We didn't try them.

Good luck!

Bonnie,
My father received the injection every day and he took a compazine pill about 1 hour before every injection. He also drank about 3 bottles of water prior to every injection. I believed that really helped toward the end, the water was difficult to get down. He was able to take the shot every day except for the last three when he developed a rash in the area of the injection which they considered an allergic reaction and stopped the shots. We were fortunate as I know many on this forum had trouble. His dentist says he has more saliva than would be expected eventhough my father says he is really dry. He also started taking the prescription pill Evoxac after treatment is over so don't really know what has helped. He had very aggressive radiation in a very large area since he was unknown primary so the saliva gland area was hit hard. I wrote down a "to do" list for lack of a better word of the items he had to do every day prior to treatment and after treatment. We kept them posted on the frig. He was very happy to tear them down when we were finished.
Good luck to you and your daughter - you can do it!
Kim

Hi Bonnie,

My husband is receiving amifostine and so far has gotten it for two weeks (10 doses) with no problems whatsoever!

Here's his routine: Checks in at MO 2-1/2 hours before his RO appointment. They take his blood pressure and start IV saline going at a rate of 500 ml/hour. After about an hour of fluids he receives 100 mg of anzamet (anti-nausea medication) and then dexamethasone (steroid). The dex has been tapered slowly over the course of the 10 weeks. He started at 20, then 10, 8, 6, 6, 6, 4, 4, 2, 2. This week he will probably stay at 2 all week since he isn't having any side effects. He then receives the rest of the liter of IV fluids over the second hour. About one hour before he is to go to radiation he receives 0.5 mg of Ativan (lorazepam) to help with anxiety in the radiation mask. They keep pumping in saline during all this time. 15 minutes before his radiation appointment they push the amifostine (200 mg/m2) into the IV over 30 seconds. (the recommenation from the drug company is to give it over 3 minutes but they have found less nausea if the drug is given more quickly). They have Mike lie back while they give the amifostine. They check his BP after 5 minutes, which usually drops about 10 points both diastolic and systolic, but nothing serious. Then he walks over to RO and gets zapped.

This has worked wonderfully well for him so far (knock on wood) and he hasn't had any bad problems with nausea, low BP, rash or anything from the Ethyol. Note that this is a very time-consuming process. We are at the MO office for 2-3 hours then RO for 30 minutes every weekday. But it is working! The other downside is that he had to have a port-a-cath placed in his chest, though he didn't have any problems with this and actually likes having it because he doesn't have to get stuck for blood draws, IV fluids, or anything like that.

Whichever method the doctors choose (IV or injection), I would ask about the anti-nausea drugs anzamet and also aloxi. The aloxi lasts a long time so is useful to take on Fridays when you have the weekend ahead of you.

Good luck!!

Tricia

Hi Bonnie,

Zofran is one of the strong anti-nausea medications so you're okay with that. There are a variety of these medications and newer isn't necessarily better. Jack was able to do the entire course of Ethyol injections with the zofran ODT twice a day, and LOTS of water. Compazine is not very strong but good for breakthrough nausea if he gets any so that's handy to have on board. Jack was also told to take claritan to prevent localized site allergic reactions. The Ativan he took so he could tolerate the mask but that also helps nausea - in combination with everything else.

Being proactive with the strong anti-nausea medication rather than waiting for nausea to start seems to make a big difference. Fluids are critical to prevent the BP drop, among other things. It's a lot of work but our RO says he's seeing good results with it.

Regards JoAnne

Zofran is about $40-$50 a pill--can't imagine meds that are way more expensive than THAT!

Thanks all! I'm filling the rx for Zofran 8mg today & also the compazine. We have a rad appt tomorrow am to check measurements etc & then I think we're starting Wed. Will mention the anzamet & aloxi as she had compazine in the hospital & it didn't work for her. The rx they gave us says to take the Zofran 2 hrs before treatment and compazine every 6 hrs. As she has the PEG I will be diligent to push the water before & after.
Bonnie

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

Just came from last rad planning session - rad starts Thurs. Onc nurse's instructions are 32 oz water 2 hrs before injection (she has a PEG so this shouldn't be a problem), 8 mg Zofran 2 hrs before plus an Allegra pill. Compazine every 6 hrs plus another 32 oz water in the hrs following. Cortisone cream on injection site.
Gail: Thanks for the notation re the timing between injection & actual treatment, I'll question them on that. That's excellent news re your husband's salivaries; this is a major concern of Teri's.
Bonnie
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Caregiver to daughter (age 41, non-smoker/drinker, aerobic instructor), SCC base of tongue, Stage III (T1N1M0), Dx 9/27/06, partial glossectomy + modified radical ND 10/16/06, Tx 30 IMRT start 11/9/06

Treatment 1 went well with very minimal nausea. Treatment #2 on Friday was a totally different story. Teri took the Zofran + Compazine at 8am before treatment plus had 32 oz water. Approx 1 hr after treatment terrible nausea set in. She spent the entire day sitting in bed with a bowl in front of her on the verge of vomiting. I gave her more Zofran at 2pm & finally called the doctor at 4pm. They have called in Kytril for her for her treatment on Monday. She did sleep most of the night & the nausea is pretty much gone today but it was a really rough second day. Needless to say she's nervous that this terrible nausea is going to be with her each treatment day for the next 7 weeks! Am keeping my fingers crossed that the Kytril will work better!
Bonnie