Chapter 8. Malignant Disease and Immunosuppression

NHSL Medicines Guidance
NHS Lanarkshire

Section Under Review

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General Notes

The recommended doses and schedules of cytotoxic drugs vary according to the tumour type and regimen. Chemotherapy treatment should always be prescribed under the supervision of an oncology specialist. Recommendations on choice, dosage and use of these agents are beyond the scope of this document.

All chemotherapy drugs cause side-effects and a balance has to be struck between likely benefit and acceptable toxicity. All the supportive medicines listed are prescribed via the chemotherapy clinic for the patients to take home. Some are prescribed prophylactically while others are prescribed in response to an observed side-effect of treatment.

Manufacturers’ product literature should be consulted for full details of side-effects associated with individual drugs.

The following information covers some of the main side-effects and some of the medications that are prescribed to help these. Further details can be found on the West of Scotland Cancer Network (WoSCAN) Supportive Care Guidelines (NHS Staff Intranet Access).

Antiemetics

DEXAMETHASONE

DOMPERIDONE

GRANISETRON

LEVOMEPROMAZINE

METOCLOPRAMIDE

ONDANSETRON

PROCHLORPERAZINE

Prescribing Notes:

Oral Hygiene

CHLORHEXIDINE GLUCONATE 0.2% mouthwash

BENZYDAMINE HYDROCHLORIDE 0.5% oral rinse

NYSTATIN 100 000 units/ml oral suspension

Prescribing Notes:

  • A sore mouth is a common complication of cancer chemotherapy. It is best to prevent the complications by maintaining good oral hygiene, e.g. rinsing the mouth frequently and brushing with a soft brush 2 to 3 times daily.
  • Once a sore mouth has developed, treatment is less effective.
  • In general, mucositis is self-limiting but with poor oral hygiene it can be a focus for blood-borne infection.

Antidiarrhoeals

LOPERAMIDE

CODEINE PHOSPHATE

Laxatives

LACTULOSE

SENNA

CO-DANTHRAMER (palliative care only)

MACROGOL 3350

Prescribing Notes:

Eye Drops

HYPROMELLOSE eye drops 0.3% (tear deficiency)

Prescribing Notes:

  • Gritty eyes can be a side effect of some chemotherapy treatments due to inflammation of the cornea.

Cream

AQUEOUS CREAM

HYDROCORTISONE 1% cream

Prescribing Notes:

  • Aqueous cream can be used in the prophylaxis against ‘hand/ foot’ syndrome.
  • Hydrocortisone cream is occasionally effective in controlling ‘hand/ foot’ syndrome for patients receiving certain chemotherapy treatments.

Proton Pump Inhibitors (PPIs)

LANSOPRAZOLE capsules

OMEPRAZOLE capsules

Prescribing Notes:

  • Dyspepsia can be exacerbated in certain susceptible patients receiving chemotherapy. PPI’s or H2 antagonists (e.g. ranitidine) can effectively control symptoms during the period of chemotherapy treatment.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.