Diarrhea

• May occur days to weeks after the drug is given / after treatment starts
• Drink plenty of clear fluids. Limit hot, spicy, fried foods, foods/drinks with caffeine, orange or prune juice. 
• Try a low-fiber BRAT diet (Bananas, white Rice, Apple sauce, Toast made with white bread).
• Take anti-diarrhea drug(s) if given to you by your doctor.
• Also see Diarrhea pamphlet.*

Mouth sores, sores on lips (with high doses)

• Maintain good mouth hygiene. Regular teethbrushing with a soft toothbrush or Toothette®, and  regular use of mouthwashes, especially after meals and at bedtime. Use alcohol-free mouthwashes.
• Try rinsing mouth with a baking soda mouthwash: Half a teaspoon baking soda in a cup (250mL) of water
• Avoid hot, spicy, acidic, hard or crunchy foods.
• Check with your doctor or nurse as soon as you notice sores in mouth/lips or pain with swallowing. Your doctor may prescribe a prescription mouthwash to relieve mouth sores and prevent infection.
• Also see Mouth Care pamphlet.*

Unusual bleeding or bruising
(black stools, coughing up blood, purple or red dots on skin, bleeding that will not stop)

Fever, chills, infection
(low white blood cells)

• May occur in days to weeks after the dose is given/ after starting treatment.
• Phone your doctor right away or go to the nearest emergency department, if your oral temperature is over 38°C or 100.4°F (unless stated otherwise by your healthcare team). Tell the health care team that you are on chemotherapy.
• Check your temperature, especially if you are feeling unwell with sweats, fever or chills. Take your temperature before using acetaminophen, since it may mask fever.
• Use acetaminophen (Tylenol®) for fever, mild headache, aches or pains. Talk to your doctor before using ibuprofen (Advil®), naproxen (Aleve®) or aspirin, since these may increase bleeding risk. If taking aspirin regularly, talk to your doctor before you stop taking it.
• Wash your hands often. Avoid sick people and crowds.
• Use a soft toothbrush. Be careful not to cut or bruise yourself.
• Check with your doctor before getting any vaccines, any surgeries or dental work.
• Also see Low Platelets and Low White Blood Cells pamphlets.*

Nausea and vomiting

• May occur in hours to days after the dose is given/ after treatment starts.
• Drink clear fluids and avoid large meals. Get fresh air and rest.
• Limit spicy, fried foods or foods with a strong smell.
• Take anti-nausea drug(s) exactly as directed by your doctor. It is easier to prevent nausea than to treat it.
• Contact your doctor if nausea lasts more than 1 day or if any vomiting occurs.
• Also see Nausea & Vomiting pamphlet.*

Rapid killing of cancer cells when you start treatment may lead to build up of cell waste products

• If mild, this may cause gout, with joint pains, but if severe, may cause fevers, kidney failure, confusion and be life-threatening.
• You MUST take the preventive medicines given by your doctor AND
• Drink plenty of fluids (6-8 glasses per day) and void (urinate) frequently.

Liver problems
(yellow skin or eyes, dark urine)

Pain, burning, redness, or swelling on skin where drug was injected

• Let your healthcare team know right away when this happens, since this drug can harm or irritate tissue if it leaks from the vein during injection.

Serious skin rash (may include blisters or skin peeling)

Proteins in Urine; Kidney problems
(lower back pain, body swelling)

• Also look for passing little or no urine, darkening or blood in urine, or recent unusual weight gain 
• Your doctor may monitor for proteins in the urine regularly.

Loss of consciousness, seizures