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August 26, 2003

Anti-emetic • Anti-Nausea Drugs

In the most recent issue of Cure magazine, in the article "Weighing in: Preventing Cancer Weight Loss," (http://www.curetoday.com/currentissue/features/weight%20loss/index.html). There is a discussion about antiemetics (anti-nausea) medication.

As I looked at the list, I had taken several listed, Zofran and Anzement. In my current protocol, I get Zofran before chemo and after chemo I take phenergan. Interestingly, phenergan wasn't on the list.

So after a discussion with my trusted chemo pharmacist Liz, she indicated that phenergan was an "older" drug. This sent me to the web to search out the details.

There is a class of anti-emetics:

Serotonin Receptor Antagonist. It is thought that chemotherapy related nausea is the result of signals from the central nervous system to the gut and brain as a result of a chemical signal known as serotonin that is released after exposure to certain chemotherapy agents. Serotonin binds with the 5-HT3 receptors, resulting in the nausea and vomiting. The following drugs are 5-HT3 receptor antagonist:

Zofran
Kytril
Anzemet
Aloki

A new class of antiemetics approved by the FDA in March of 2003, substance P inhibitors, which are a regulatory protein that binds to the neurokinin (NK) receptors found in the gut and the nervous system to interfere with the binding of substance P to NK receptors, which is thought to play a central role in the development of chemotherapy-induced nausea. Current Emend is available.

The two previous classes of anti-emetic drugs are the new ones. There is also phenothiazines group, phenothiazines are antipsychotic agents and are used for other disorders. The phenothiazines used for chemotheraphy-induced nausea are:

promethazine (Phenergan)
prochlorperazine (Compazine)

There is also the class of metoclopramide which contains Reglan.

In addition, dexamethasone (Decadron) when give in 8mg or greater doses becomes an antiemetic. Dexamethasone is a glucocorticoid steroid that is a strong anti-inflammatory which prevents white blood cells from completing and inflammatory reaction.

Sorry for the micro-biology, but, hopefully some this is help when you are prescribed an anti-emetic for chemotheraphy-induced nausea.

04:01 PM in Chemo Chronicles | Permalink | Comments (0)

Cycle 28 • Day 2

Feeling pretty good after today. The fevers and ill-feeling of Sunday and Monday seem to have gone away. Of course 20mg of dexamethasone could be a factor.

Today was the last "long-infusion" of the cisplatinum. Beginning tomorrow, the infusing time drops to 1.0-1.5 hours -- that will be great.

02:54 PM in Chemo Chronicles | Permalink | Comments (0)

August 25, 2003

Cycle 28 • Day 1

After what started off as a bad morning, ended up being a good day.

We had been in Bella Vista most of last week, flying home yesterday (Sunday). On the flight home, I just was feeling good and by the time we got home, I was running a fever.

When I awoke this morning, again, a fever -- not a good way to start a chemo week. But, after a discuss with Dr. Parikh, we decided to go ahead. This afternoon, I'm feeling much better.

03:48 PM in Chemo Chronicles | Permalink | Comments (0)

August 04, 2003

Cycle 27 • Day 7

After a surprisingly good week, Sunday took a turn for the worse. Energy levels very low, nausea and fatigue all setting in.

Spent the day trying to relax and deal with somewhat of a set-back, at least in my eyes. I do have to remember that its been awhile since I had a full five day cycle and especially after the Taxotere one-day cycles -- it hit home rather hard.

The week of actual chemo had been very smooth, so it was a bit surprising to have such a bad day. Today, Monday is better. Energy levels are better. Fatigue is better and so far, nausea has not been a factor. We did start Neupogen on Saturday, with the expectation that my white count would be coming down Monday, Tuesday or Wednesday of this week.

11:25 AM in Chemo Chronicles | Permalink | Comments (0)

August 01, 2003

Cycle 27 • Day 5

Today is the last day of the new protocol. In general, I'm feeling very good.

I originally wasn't excited about returning to a five day protocol -- I liked having the really low day on Friday and starting to recovery for the weekend.

Thus far, this protocol seems to have the "bad days" on Tuesday and Wednesday, I would assume because of the heavy medication day on Monday.

I also think the difference in pre-nausea medication administration makes a big difference.

The "low days" seem much less severe with this protocol, in addition without the Taxal, the usual ankle and foot ache is gone -- which just makes the "low days" even lower.

The other changes with this protocol is the nadir changes to Monday, Tuesday, or Wednesday of next week, rather than nearly a week later.

This all sounds good, but, the real test will be the CT scan in about 5 weeks to see just how effective this has been.

So, that's it for today.

08:24 AM in Chemo Chronicles | Permalink | Comments (0)