Re: Fatigue & nausea from FCR

[Guest guest]

Dr. ,

The zofran will make you sleepy.I cut mine in half and only took half and didn't get quite as sleepy but maybe your body is tired from all you are going through so just rest!Oh the benedryl causes me to sleep also.So since you are getting zofran by IV,just ask them to use half as much if possible!

Good luck and I will say a prayer for you now!

God Bless,

Deb

www.cllcfriends.com

I can only Imagine !!!!!

Deb

From: Koffman <briankoffman@...>Subject: Fatigue & nausea from FCR Date: Friday, June 27, 2008, 8:47 PM

Dear Dr. Furman and friends,I have received 30 per m2 of Fluderabine and 750 per m2 of Cytoxan for the last 3 days + 1 course of Rituxan 375 per m2.Though my counts remain normal, I am extremely fatigued and nauseous. I have been treated with Bendryl 25-50 IV Push, Lorazapam ,5 Push and Zofran. While these help quell the nausea, all I want to do is sleep. Any advice? Thanks., 57 yr family doc & father of 4, dx 9/05 del 11q w ATM, unmutated, CD38+, W & W, stable except for growing nodes and spleen until ITP 9/06 eventually failed steroids, IVIG , Rituxan and splenectomy now on cyclosporin and finished Rituxan with ITP controlled and CLL in old school CR, planning a RIC MUD HSCT July 1 seehttp://bkoffman. blogspot. com/

[Guest guest]

There have been many postings regarding this. One of the most

significant side effects of Zofran (or ondansetron) is constipation.

This is usually what makes patients feel most uncomfortable. If

zofran does not work by itself the first things worth doing are:

1. increase the dose: Zofran was actually approved at a dose of 32

mg. We now no that 32 mg is unnecessary, but some patients who have

nausea at 4 mg respond nicely to 8, 12, or 16 mg.

2. Try a different serotonin receptor agonist (drug class of

Zofran). There are several other drugs in this category and some

people respond better to one versus the other. The other drugs

include granisetron (Kytril), palonosetron (Aloxi), dolasetron

(Anzemet).

3. Add Emend (apreepitant) which seems to make Zofran type drugs more

effective.

4. Add other agents less likely to cause sedation: reglan, compazine,

haldol, etc.

So there are other options. Just make sure your physician knows so

they can best tailor the anti-nausea medicines to your needs. Also,

and this is my bias, oral Zofran (as well as the others in this

class) probably work better when given by mouth.

I hope this helps.

Rick Furman, MD

>

> Dear Dr. Furman and friends,

> I have received 30 per m2 of Fluderabine and 750 per m2 of Cytoxan

for

> the last 3 days + 1 course of Rituxan 375 per m2.

> Though my counts remain normal, I am extremely fatigued and

nauseous.

> I have been treated with Bendryl 25-50 IV Push, Lorazapam ,5 Push

and

> Zofran. While these help quell the nausea, all I want to do is

sleep.

> Any advice? Thanks.

>

>

> , 57 yr family doc & father of 4, dx 9/05 del 11q w ATM,

> unmutated, CD38+, W & W, stable except for growing nodes and spleen

> until ITP 9/06 eventually failed steroids, IVIG , Rituxan and

> splenectomy now on cyclosporin and finished Rituxan with ITP

> controlled and CLL in old school CR, planning a RIC MUD HSCT July

1

> seehttp://bkoffman.blogspot.com/

>

[Guest guest]

Been praying for you and cheering you on.

dx sll/cll 8/2002--watch and wait--no treatment needed yet

From: Koffman <briankoffman@...>Subject: Fatigue & nausea from FCR Date: Friday, June 27, 2008, 9:47 PM

Dear Dr. Furman and friends,I have received 30 per m2 of Fluderabine and 750 per m2 of Cytoxan for the last 3 days + 1 course of Rituxan 375 per m2.Though my counts remain normal, I am extremely fatigued and nauseous. I have been treated with Bendryl 25-50 IV Push, Lorazapam ,5 Push and Zofran. While these help quell the nausea, all I want to do is sleep. Any advice? Thanks., 57 yr family doc & father of 4, dx 9/05 del 11q w ATM, unmutated, CD38+, W & W, stable except for growing nodes and spleen until ITP 9/06 eventually failed steroids, IVIG , Rituxan and splenectomy now on cyclosporin and finished Rituxan with ITP controlled and CLL in old school CR, planning a RIC MUD HSCT July 1 seehttp://bkoffman. blogspot. com/

[Guest guest]

, what about considering Phenergan suppositories for a short time till you

get your nausea under control, the advantages being that it will be quickly

absorbed and will bypass your sensitive stomach. Yes, you will continue to be

drowsy, but you may not have to take them for long. Gad, a nauseated belly

makes a person feel as if he is one great huge stomach!

Warm wishes,

Jan