Cytotoxic Drugs.

Dangers and side effects

What are serious side effects of cytotoxic drugs?

Cytotoxic drugs cause different side effects in different people.

One of the most serious side effects is the suppression of certain cells:

• White blood cells, which help your body fight infections. When these are suppressed, you may get infections more easily.
• Platelets, which help your blood clot. When these are suppressed, you may bruise and/or bleed more easily.
• Red blood cells, which carry oxygen to your tissues. When these are suppressed, you may have anemia (extreme tiredness and fatigue).

When should a person using cytotoxic drugs contact a doctor?

Contact your doctor right away if you notice these side effects:

• Signs of infection
  • fever, chills, or very sore throat
• Signs of bleeding
  • any unusual bleeding or bruising
  • black, tarry stools, a sign of internal bleeding
  • pinhead-size red spots on lower legs
• Signs of anemia
  • unusual tiredness or weakness
• Lung problems caused by methotrexate
  • cough or severe shortness of breath, with or without a fever
• Bladder problems caused by Cytoxan
  • blood in the urine or painful urination

While these side effects don't happen very often, you should still be aware of them. Some of them are signs of serious problems which should be treated right away.

What are less serious side effects of cytotoxic drugs?

Other side effects may occur with these drugs. If you have any of these side effects, or other problems not listed here, check with your doctor or pharmacist:

• loss of appetite
• nausea or stomach pain
• diarrhea
• sores or ulcers in the mouth
• hair loss
• missed menstrual periods
• rash

What can be done about the side effects of cytotoxic drugs?

The most important thing you can do to treat and help avoid some side effects is to have regular checkups. Here are some other things you can do to handle the following side effects:

Risk of infection

Stay away from adults and children who have contagious illnesses, such as colds, the flu, or chickenpox. Do NOT have any immunizations without checking with your doctor, because they could lead to infection. Report any sign of an infection to your doctor, right away.

Loss of appetite

Plan meals when you're not feeling nauseous. Try eating small, more frequent meals. Ask your doctor if you can take the medicine at bedtime to reduce this side effect.

Mouth sores

Contact your doctor if these develop. Use a soft-bristled toothbrush. Use salt water or peroxide as a mouth wash. Eat soft, non-spicy foods of medium to cold temperature. If the pain doesn't go away, ask your doctor about using a topical pain reliever before meals.

Easy bruising or bleeding

This could be a sign of serious problems, so you should contact your doctor right away.

What should a person with arthritis tell the doctor before using cytotoxic drugs?

Your doctor needs to know about the following conditions in order to decide whether to recommend cytotoxic drugs:

• If you are pregnant or if you plan to have children: cytotoxic drugs may cause birth defects if either parent is taking them during the time of conception, or if taken during pregnancy. These drugs may also cause short- or long-term sterility. After treatment is stopped, women should wait at least one menstrual cycle before trying to get pregnant. Men should wait at least three months before trying to have children.
• If you have allergies to any medications.
• If you are breast-feeding: breast-feeding is generally not recommended while taking these medications.
• If you are taking any other medications, vitamins, mineral supplements or over-the-counter drugs: don't take other medications without your doctor's approval.
• If you have any other medical problems, especially kidney or liver disease.
• If you are often around people who have colds, the flu, or other infections: you may have a higher risk of catching their infection.
• If you have ever been treated with X-rays or cancer medications.
• If you drink alcohol.

What are some of the different types of cytotoxic drugs for people with arthritis?

Each cytotoxic drug is different and has its own special instructions.

Azathioprine (Imuran) is usually given in pill form (2-3 tablets daily) or by injection. The dose may be lowered after the desired response is obtained.

• Do not take with allopurinol (Zyloprim), a drug used to treat gout. The combination of these two drugs may be toxic.
• Take the drug with or after meals, to reduce stomach upset.

Cyclophosphamide (Cytoxan) is usually given in pill form or intravenously, according to a prescribed schedule. It is probably the strongest cytotoxic drug. It may cause additional side effects, such as cystitis (inflammation of the bladder marked by blood in the urine and painful urination), as well as bladder cancer.

• Drink extra fluids every day to help dilute toxic build-up in the bladder. Ask your doctor how much extra fluid to drink.
• Do not take cyclophosphamide at bedtime. It will build up in your urine and will stay in your bladder too long. Some doctors recommend emptying your bladder in the middle of the night at least once, even if it means setting an alarm clock to do so.

Methotrexate (Rheumatrex) is usually given in pill form and sometimes by weekly injections. This drug can cause additional side effects, such as liver scarring (cirrhosis), and a lung problem similar to pneumonia, which causes shortness of breath, cough, and a fever.

• If you accidentally take too much, contact your doctor right away to receive an antidote.
• Do not drink alcohol while taking this drug, because it can make any liver problems worse.
• Contact your doctor before you take any other medicines, especially antibiotics. Some antibiotics can make methotrexate much more toxic.

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