Side Effects and Drug Interactions

PCV is not, however, an innocuous therapy, and for a disease in which cure is desired by all but not expected except by the patient, less toxic therapies are necessary. Lomustine (CCNU) is a potent marrow toxin with a delayed nadir. Effects on marrow worsened with repeat dosing. One must avoid cumulative doses of more than 1100 mg/m2 because of possible pulmonary fibrosis and secondary leukemias.91 Procarbazine is a mild monoamine oxidase inhibitor. There are potential interactions with medications and tyramine-containing foods.94 Vin-cristine causes a neuropathy, with numbness in the extremities and constipation. This effect may be compounded in patients with preexisting neuropathies.94

In addition, the concomitant use of antiepileptic drugs (AEDs) and chemotherapy may increase clearance of the chemotherapy and therefore decrease response, especially with the taxanes irinotecan65,79and 9-aminocamptothecan.42 Conversely, chemotherapy can cause fluctuations in the serum concentrations of phenytoin, allowing for breakthrough seizure activity and mandating frequent serum monitoring.38,44 Ele vated serum phenytoin levels and clinical toxicity have been reported during treatment with fluorouracil.39 Heightened hema-tologic toxicity has been reported in patients treated with cis-platin-nitrosourea-based chemotherapy and valproic acid.8 Studies are now commonly stratified as to the use of cytochrome p450-inducing AEDs. Patients taking these enzyme-inducing agents (phenytoin, carbamazepine, etc.) are typically entered into companion dose-finding phase I studies of new agents, whereas patients on no AED or non-enzyme inducing AEDs (gabapentin, valproic acid, etc.) are entered into phase II studies.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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