Poor appetite; do not feel like eating; weight loss

• Eat foods that you like and try to eat regular small meals.
• Use meal supplements if possible. See a dietitian.

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.*

Tiredness

• Rest often; take naps if needed. Move slowly when getting up.
• Eat well-balanced meals and drink plenty of fluids. Light exercise may help.
• Do not drive a motor vehicle or operate machinery when feeling tired.

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

• May occur in days to weeks after your dose is given/ after treatment starts
• May be due to low platelets, but may occur even with normal platelets
• Use a soft toothbrush. Be careful not to cut or bruise yourself.
• Check with your doctor before any surgery or dental work.
• Use acetaminophen (Tylenol®) for fever, mild headache, aches or pains.
• Do not take drugs that affect bleeding such as ibuprofen (Advil®) or naproxen (Aleve®) or aspirin, since they may increase bleeding risk. If taking aspirin regularly, talk to your doctor before you stop taking it.
• Also see Low Platelets pamphlet.*

Mouth sores

• Maintain good mouth hygiene. Regular teethbrushing with a soft toothbrush or Toothette®
• 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.*

Fever, chills, infection

• May occur in days to weeks after the dose is given / after treatment starts
• Low white blood cells may make the body more prone to infection.
• 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 healthcare 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 (Tylenol®), since it may mask fever.
• Wash your hands often. Avoid sick people and crowds.
• Check with your doctor before getting any vaccines.
• Also see Low White Blood Cells pamphlet.*

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.*

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 tissues if it leaks from the vein during injection

Liver problems
(yellow skin or eyes, dark urine)

Effects on the brain
(severe headache, loss of consciousness, seizures, confusion)

Heart problems
(irregular heartbeat, chest pain, fainting, swelling, shortness of breath)

Low blood pressure, change in heart rate, irregular heart beat

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.

Yellow-orange skin discolouration

• Will return to normal when drug discontinued