Deciding a Folate Product with Methotrexate:
Autoimmune Diseases
Methotrexate given weekly
Folic acid 1-5mg daily
Leucovorin not used unless unresponsive to folic acid
Deciding a Folate Product with Methotrexate:
Oncologic Diseases
Methotrexate doses are higher
Leucovorin required for doses >/=500 mg/m^2
Folic acid is not effective
Chemoman:
Neurotoxicity
Carmustine
Chemoman:
Cisplatin
Ototoxicity
High Emetogenicity
Nephrotoxicity
Chemoman:
Mucositis
Methotrexate
Fluorouracil
Capecitabine
Chemoman:
Pulmonary Toxicity
Bleomycin
Busulfan
Carmustine
Chemoman:
Doxorubicin and other Anthracyclines
Cardiotoxicity
Chemoman:
Ifosfamide and Cyclophosphamide
Hemorrhagic cystitis
Chemoman:
Irinotecan
Diarrhea
Chemoman:
Platinum based compounds, Vinca Alkaloids, Taxanes
Peripheral neuropathy
Chemoman:
Bone Marrow Suppression
Most EXCEPT Bleomycin, Pegaspargase, Vincristine
Cisplatin Nephrotoxicity Prevention
Amifostine
Limit dose per cycle to </=100mg/m^2
Methotrexate Mucositis Prevention
Leucovorin
Bleomycin Pulmonary Toxicity Prevention
Limit lifetime dose to 400 units
Doxorubicin Cardiotoxicity Prevention
Dexrazoxane
Limit lifetime dose to 450-550 mg/m^2
Hemorrhagic Cystitis Prevention
Mesna
Irinotecan Diarrhea Prevention
Atropine
Oxaliplatin Peripheral Neuropathy Prevention
Avoid cold exposure
Vincristine Peripheral Neuropathy Prevention
Limit single doses to 2mg
Myelosuppression Summary:
White Blood Cells
Neutropenia, fever, infection
Prevention: G-CSF in high risk
Treatment: Antibiotics if febrile
Myelosuppression Summary:
Platelets
Thrombocytopenia, bleeding
Treatment: platelet transfusion
Myelosuppression Summary:
Red Blood Cells
Anemia, weakness, fatigue
Treatment: RBC transfusion if symptomatic, ESA in select patients