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Post details: R-Hyper CVAD

07/24/05

Permalink 11:09:19 pm, Categories: Treatments, 1769 words   English (US)

R-Hyper CVAD

I'll be taking R-Hyper CVAD, which will be administered in the hospital for 4-5 days, every 3 weeks, for 6-8 cycles.

R-Hyper CVAD (R-HCVAD/-Mtx AraC)

Cycle A Breaks down for me as:
1) Mesna IV all the time (incl 5 hours after Cytoxin) - for bladder protection
2) Decadron (Dexamethasone??) 40mg (IV) - daily - cortiosteroid
3) Cytoxin (Cyclophosphamide) (IV) at 10pm(started at night)/10am for 3 hours, for 6 cycles (s/b Mon-Tues, Tues-Wed, Wed-Thurs) - Chemo drug
4) Sodium Chloride with Potassium whenever the Cytoxin isn't running, They turn it off when it is - for hydration/electrolytes.
5) Rituxin on Day 4, after the Cytoxin.
6) Vincristine (??) s/b on Thursday (12 hours after last Cytoxin) - Chemo drug.
7) Adriamycine (??) s/b on Thursday (12 hours after last Cytoxin) - Cheomo drug.

Antibiotics - given daily
1) Diflucan (Oral) - Anti Fungal
2) Cipro (Oral) - Antibiotic
3) Acyclovir - Anti Viral
4) Allupurinol - Gout Prevention (when the cancer cells break down quickly, it can lead to gout if you don't assist the system)

Other
1) Kytril (Oral) - Anti nausea - given once daily during Chemo in the hospital

At Home
1) Neupogen - 1 shot daily (increase WBC count) Days 1-10 following chemo (through the nadir - low point)
2) Diflucan (Oral) - Anti Fungal
3) Cipro (Oral) - Antibiotic
4) Acyclovir - Anti Viral
5) Take temp 4x daily - anything over 100.5 - go to the hospital for neutropenic fever (take tylenol)

Cycle B for me is:
* Methotrexate Tues 8/16 @ 8am over 2 hours - CHEMO
* Methotrexate Tues 8/16 @ 10am over 24 hours - CHEMO
* Methylprednisolone Tues 8/16 – Thurs 8/18 – Steroid
* Cytarabine (Ara-C) Wed 8/17 – Thurs 8/18 every 12 hours for 4 doses – CHEMO
* Eye Drops to prevent Pink Eye - a side effect f Ara-C - every 6 hours.
* Leucovorin Thurs 8/18 (orally) – moderates the Methotrexate levels, which need to be low to let me be released.

The standard info that I've gotten off the web for R-Hyper CVAD is:
R-Hyper CVAD (A cycle)

• Rituximab
o Rituximab at 375 mg/m2 on day 1 of each cycle
• Hyperfractoinated Cyclophosphamide (Same as CHOP, except Hyper.. part is diff)
o Cyclophosphamide (3 days) at 300 mg/m2 IV over 3 hours every 12 hours for 6 doses on days 1, 2, and 3 (Mesna may be given as an uroprotectant at the same total dose as cyclophosphamide but given by continuous infusion starting with cyclophosphamide and ending 5 h after the last dose.)
• Vincristine (same as CHOP)
o Vincristine at 2 mg IV on days 4 and 11
• Adriamycine (Hydroxydaunomycin/Doxorubicine - same as CHOP)
o Adriamycine at 40 mg/m2 IV on day 4
• Dexamethasone (diff than CHOP)
o Dexamethasone at 40 mg/d PO/IV on days 1-4 and 11-14
o Methotrexate at 12 mg IT on day 2
o Cytarabine at 70 mg IT on day 7

R-yper CVAD (B cycle)
• (HD MTX Ara-C - given for second and fourth cycles.
o Methotrexate (also called High dose Methotrexate)
o Methotrexate at 1000 mg/m2 IV over 24 hours on day 1
o Cytarabine (also called Ara-C) at 3 mg/m2 IV over 2 hours every 12 hours for 4 doses on days 2 and 3
o Rituximab at 375 mg/m2 on day 1 of each cycle
o Leucovorin at 25 mg/m2 IV, 24 hours after the completion of the methotrexate infusion, every 6 hours for 6 doses (1.5 days)
o Sodium bicarbonate at 600 mg PO (starting day before methotrexate) 3 times day for 4 days

Drug overviews:

NAME: methotrexateBRAND NAMES: Rheumatrex, Trexall
DRUG CLASS AND MECHANISM: Methotrexate is classified as an antimetabolite drug, which means it is capable of blocking the metabolism of cells. As a result of this effect, it has been found helpful in treating certain diseases associated with abnormally rapid cell growth, such as cancer of the breast and psoriasis. Recently, methotrexate has been shown to be effective in inducing miscarriage, for example in patients with ectopic pregnancy. This effect of methotrexate is attributed to its action of killing the rapidly growing cells of the placenta. It has also been found very helpful in treating rheumatoid arthritis, although its mechanism of action in this illness is not known. It seems to work, in part by altering aspects of immune function which may play a role in causing rheumatoid arthritis.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Injectable: 25mg/ml; Tablet: 2.5mg (Rheumatrex), and 5, 7.5, 10 and 15 mg (Trexall).

STORAGE: Store between 59 and 77degrees F in a sealed container, avoid light.

PRESCRIBED FOR: Methotrexate is used for cancer treatment generally in higher doses than for other uses, and is often administered intravenously or intramuscularly. Methotrexate is used to treat psoriasis, an inflammatory skin disease, as well as the arthritis that occurs in 10 percent of these patients (psoriatic arthritis). It is also used to treat active rheumatoid arthritis in adults and children. It is also used to treat other rheumatic diseases, including polymyositis and systemic lupus erythematosus. Methotrexate has been used to induce miscarriage in patients with ectopic pregnancy.

DOSING: May be taken with or without food. For rheumatoid arthritis and psoriasis, the dose of methotrexate is given WEEKLY, whether by injection or orally. For psoriasis, the weekly dose is often divided into three doses given at 12 hour intervals each week. This has been shown to be more effective, as it relates to the natural growth cycling of the skin.

DRUG INTERACTIONS: Because methotrexate can cause serious liver disease, patients with alcoholism or liver disease should not receive it. Patients should curtail alcohol consumption while taking methotrexate. Methotrexate can suppress the body's immunity. Therefore, any symptoms of infection should be reported to the doctor. Patients with underlying immune deficiency diseases should not receive methotrexate. A dry, non-productive cough can be a result of a rare lung toxicity. Methotrexate can impair fertility, decrease sperm count and cause menstrual dysfunction. Safety and effectiveness has not been established in children.

PREGNANCY: Methotrexate should not be used in pregnancy, as it can be toxic to the embryo and can cause fetal defects and spontaneous abortion (miscarriage). It should be discontinued prior to conception if used in either partner. Male patients should stop taking methotrexate at least 3 months prior to a planned conception and females should discontinue use for at least one ovulatory cycle before conception.

SIDE EFFECTS: Methotrexate can be well tolerated, but also can cause severe toxicity which is usually related to the dose taken. The most frequent reactions include mouth sores, stomach upset, and low white blood counts. Methotrexate can cause severe toxicity of the liver and bone marrow, which require regular monitoring with blood testing. It can cause headache and drowsiness, which may resolve if the dose is lowered. Methotrexate can cause itching, skin rash, dizziness, and hair loss. A dry, non-productive cough can be a result of a rare lung toxicity.

GENERIC NAME: CYTARABINE - INJECTION (sye-TAIR-uh-bean)BRAND NAME(S): Cytosar-U, Tarabine PFS
Warning | Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage | Medical Alert

WARNING: This medication will be given where you can be closely monitored by your doctor because serious (rarely fatal) blood disorders (e.g., anemia, bone marrow suppression) have been caused by this medication. Liver problems may also develop. Notify your doctor immediately if you develop fever, unusual fatigue, nausea, vomiting, diarrhea, persistent sore throat, easy bruising or bleeding, abdominal or stomach pain, dark urine, yellowing eyes or skin, or mouth sores.

USES: Cytarabine is one of a large group of drugs known as "antineoplastics"; these drugs are also known as cancer drugs, chemotherapy, or "chemo". They are used in the treatment of various cancers to slow or stop the growth of cancer cells. A combination of different types of cancer drugs will often be used to achieve better results and minimize side effects.

HOW TO USE: This is a potent medication. Use it exactly as prescribed. Unless your doctor instructs you otherwise, drink plenty of fluids while using this medication. This helps your kidneys to remove the drug from your body and avoid some of the side effects. Do not stop using this medication, even if you feel nauseated or experience vomiting.

SIDE EFFECTS: Nausea, vomiting, loss of appetite, headache, itching, freckling, diarrhea, dizziness are common side effects. Using the drug on an empty stomach may help to relieve vomiting. Changes in diet such as eating several small meals or limited activity may help lessen some of these effects. In some cases, drug therapy may be necessary to prevent or relieve nausea and vomiting. Temporary hair loss is another common side effect. Normal hair growth should return after treatment has ended. Contact your doctor without delay if you experience any of the following symptoms: fever, chills, painful or difficult urination, chest pain, heartburn, difficulty swallowing, easy bruising or bleeding, black or tarry stools, blood in urine or stools, pinpoint red spots on the skin, joint/back/side pain, swollen feet or lower legs, sores in the mouth or on the lips, yellowing of the eyes or skin, dark urine, shortness of breath, bone or muscle pain, severe stomach pain. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor your medical history, especially of: kidney or liver problems, gout, infections, allergies (especially drug allergies). Contraceptive (birth control) measures are recommended for use in men and women while using this medication. A preservative (benzyl alcohol) which may be found in this product or in the liquid used to mix this product (diluent) can infrequently cause serious problems (sometimes death), if given in large amounts (more than 100 mg/kg daily) to an infant during the first months of life (neonatal period). The risk is also greater with low birth weight infants. Symptoms include sudden gasping, low blood pressure, or a very slow heartbeat. Report these symptoms to the doctor immediately should they occur. If possible, a preservative-free product should be used when treating neonates. Cytarabine is not recommended for use during pregnancy. Consult your doctor for details. It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription drugs you may use, especially of: medicines used for gout. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.

NOTES: This medication can lower your body's ability to fight an infection. Notify your doctor if you develop any signs of an infection such as fever, sore throat, rash or chills. Avoid touching your eyes or inside your nose without first washing your hands. Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports in order to lower the chance of getting cut, bruised or injured. Do not have immunizations/vaccinations without consent of your doctor, and avoid contact with people who have recently received oral polio vaccine. Regular doctor visits are important. Frequent blood tests will be done to monitor therapy.

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