Adriamycin, Cytoxan & Neulasta

The first part of my chemotherapy treatments was a double dose of two drugs…..Adriamycin & Cytoxan. I started treatment on May 23rd, the day after my 15th wedding anniversary, and had 4 treatments every other week until July 5th. I had a Neulasta shot after each treatment and my blood was tested on my weeks off to monitor my white blood cell count.

As with most of the things I have been going through during this journey, I have had friends ask me a lot of questions about various things like side effects, my experiences with the drugs, my limitations at certain times of treatment, etc…. I can only speak for the information I have benn given by my oncologist and what I have found online, but those questions and a dear friend, brought me to the idea of writing this blog and sharing as much as I am comfortable with so that I can help friends, family, anyone reading this blog, more informed about breast cancer.

As I stated in a previous blog, I am very lucky as I have had very few side effects while on these drugs. I know that side effects sound scary but just know that every cancer patient is different. Age and overall health can play a big part in how well the drugs are tolerated and it is important to read the instructions your oncologist gives you and to follow them carefully and to speak up if you are having any problems at all…..talk to your doctor, he/she can’t help you if you stay silent.

So with that….here is the information I have on my first two chemotherapy drugs and the shot I was given after each of the first four treatments.

Adriamycin: Adriamycin PFS (doxorubicin hydrochloride) Injection is a cancer (antineoplastic) medication used to treat many types of cancer. The brand name Adriamycin PFS is discontinued in the U.S. Generic forms may be available. Common side effects of Adriamycin PFS (doxorubicin hydrochloride) include:

Adriamycin PFS (doxorubicin hydrochloride) may give a reddish color to urine, tears, and sweat that may last up to several days. This is a normal side effect of Adriamycin PFS (doxorubicin hydrochloride) and should not be mistaken for blood in your urine. Temporary hair loss may occur. Normal hair growth should return after treatment with Adriamycin PFS has ended. Tell your doctor if you have serious side effects of Adriamycin PFS including:

  • cough,
  • hoarseness,
  • persistent diarrhea,
  • redness,
  • flushing of face,
  • eye itching,
  • unusual tiredness,
  • joint pain,
  • pain in the lower back/side/stomach/abdomen,
  • painful or difficult urination,
  • black/tarry stools,
  • bloody mucus or discharge in stools,
  • fast or irregular heartbeat,
  • shortness of breath,
  • dizziness,
  • swelling of ankles or feet, or
  • decreased urination

Doxorubicin is given intravenously under physician supervision. Dose is determined by clinical factors. Tell your doctor if you have had previous treatment with doxorubicin, doxorubicin liposomal, daunorubicin, daunorubicin liposomal, idarubicin, or mitoxantrone. Doxorubicin may interact with paclitaxel, progesterone, verapamil, cyclosporine, cyclophosphamide, phenobarbital, phenytoin, streptozocin, or “live” vaccines. Tell your doctor all medications you use. Doxorubicin is not recommended for use during pregnancy. It may harm a fetus. Men and women should use two forms of birth control (e.g., condoms and birth control pills) while being treated with this medication and for some time afterward. Consult your doctor to discuss birth control. This medication passes into breast milk. Because of the potential risk to the infant, breastfeeding while using this drug is not recommended.

Our Adriamycin PFS (doxorubicin hydrochloride) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Cytoxan: Cyclophosphamide is used to treat various types of cancer. It is a chemotherapy drug that works by slowing or stopping cell growth.

Cyclophosphamide also works by decreasing your immune system’s response to various diseases. It is used to treat a certain type of kidney disease in children after other treatments have not worked.

How to use Cytoxan Solution, Reconstituted (Recon Soln)

This medication is usually given by injection into a vein by a health care professional. The dosage is based on your medical condition, weight, response to treatment, and other treatments (such as other chemotherapydrugs, radiation) you may be receiving. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During treatment with this medication, it is important that you take in more fluids than usual and pass urine frequently to help avoid kidney and bladder side effects. Intravenousfluids should be given with this medication. Also, ask your doctor how much fluid you should drink and how often to empty your bladder each day, and follow these instructions carefully.

Nausea, vomiting, loss of appetite, stomachache, diarrhea, or darkening of the skin/nails may occur. Nausea and vomiting can be severe. In some cases, drug therapy may be necessary to prevent or relieve nausea and vomiting. Changes in diet such as eating several small meals or limiting activity may help lessen some of these effects. If these effects persist or worsen, notify your doctor or pharmacist promptly.

Although these effects are uncommon, immediately report any pain, swelling, or redness at the injection site.

Temporary hair loss may occur. Hair growth should return after treatment has ended or may even return during treatment. However, new hair may have a different color or texture.

People using this medication may have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.

Tell your doctor right away if you have any serious side effects, including: signs of kidneyor bladder problems (such as change in the amount of urine, pink/bloody urine), mouthsores, joint pain, easy bruising/bleeding, stopping of menstrual periods, existing wounds that are slow healing, black/bloody stools, severe stomach/abdominal pain, yellowing eyes or skin, dark urine, mental/mood changes, muscle weakness/spasm.

This medication may rarely cause very serious effects on the heart, especially when used in high doses, or in combination with radiationtreatment or certain other chemotherapydrugs (e.g., doxorubicin). Get medical help right away if you develop: chest pain, jaw/left arm pain, trouble breathing, irregular heartbeat, symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).

This medication can lower the body’s ability to fight an infection. Notify your doctor promptly if you develop any signs of an infection such as fever, chills or persistent sore throat.

Cyclophosphamide may lessen the chance of having children in both men and women. Sterility is usually temporary with this medication, but can be permanent in some cases. Consult your doctor for more details.

Although cyclophosphamide is used to treat cancer, in some patients it may increase the risk of developing another form of cancer, sometimes months to years after treatment. Consult your doctor for more details. It is important to be closely monitored by your doctor during treatment. You should also see your doctor regularly after treatment is finished. Tell your doctor right away if you develop: unusual growths or lumps, swollen glands, unexplained or sudden weight loss, night sweats, pain in the pelvis, painful or frequent urination.

A very serious allergic reaction to this drug is unlikely, but get medical help right away if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Neulasta: Neulasta is a biologic response modifier. It is classified as a colony stimulating factor. (For more detail, see “How this drug works” section below).

What This Drug Is Used For:

  • This medicine is used to stimulate the growth of “healthy” white blood cells in the bone marrow, once chemotherapy is given. White blood cells help the body to fight infection. This is not a chemotherapy drug.
  • This medication is usually given at least 24 hours after chemotherapy to stimulate the growth of new, healthy, white blood cells (WBC).
  • Pegfilgrastim is a longer acting form of filgrastim and the manufacturer recommends that it should not be given within 14 days prior to chemotherapy.
  • Pegfilgrastim is given as a single injection.

Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful.

How This Drug Is Given:

  • This medicine can be given as a shot underneath the skin (subcutaneous [SQ]), in pre-filled syringes. The dose of pegfilgrastim depends upon why you are receiving this drug.
  • The amount of this medication you will receive also depends on many other factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of pegfilgrastim:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration.
  • Side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
  • Pegfilgrastim is a support medication. The following list includes side effects attributed to pegfilgrastim. Other side effects experienced were attributed to the chemotherapy and/or the disease.

The following side effects are common (occurring in greater than 30%) for patients taking pegfilgrastim:

  • Note: There are no common side effects of pegfilgrastim

These side effects are less common side effects (occurring in about 10-29%) of patients receiving pegfilgrastim:

  • Pain (bone pain)
  • Blood test abnormalities (temporary elevation in lactate dehydrogenase)
  • These will return to normal once treatment is discontinued
  • Tenderness at the site of injection

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4° F (38° C), chills, sore throat (possible signs of infection)
  • Shortness of breath
  • Rapid heart beat
  • Bleeding that does not stop after a few minutes
  • Any new rashes on your skin

The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following:

  • Bone pain that does not go away despite taking recommended pain reliever

Always inform your health care provider if you experience any unusual symptoms.


  • Before starting pegfilgrastim treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • The manufacturer recommends that the first dose of pegfilgrastim be given no sooner than 24 hours after chemotherapy. Your doctor will discontinue therapy with pegfilgrastim when your white blood cell count has reached acceptable levels.
  • Pegfilgrastim may be inadvisable if you have had a hypersensitivity (allergic) reaction to filgrastim, pegfilgrastim or E. coli-derived proteins.
  • Do not receive any kind of immunization or vaccination without your doctor’s approval while taking pegfilgrastim.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus).
  • For both men and women: Do not conceive a child (get pregnant) while taking pegfilgrastim. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking this medication.
  • Pegfilgrastim should be used with caution in people taking lithium.

Self-Care Tips:

  • If you are performing your own subcutaneous self-injections, remove the syringe from the refrigerator 30 minutes prior to injection. This will reduce local stinging at the injection site.
  • You may experience bone or joint pain as a result of this medication. Ask your healthcare provider if you may take a mild pain medicine to relieve this. Acetominophen (Tylenol®) may help.
  • Apply a warm compress if you have any pain, redness or swelling at the injection site, and notify your doctor.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • Avoid contact sports or activities that could cause injury.
  • This medication causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Sucking on lozenges, and chewing gum may also help.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking pegfilgrastim to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How This Drug Works:

Colony-Stimulating Factors:
In the body’s bone marrow (the soft, sponge-like material found inside bones) blood cells are produced. There are three major types of blood cells; white blood cells, which fight infection; red blood cells, which carry oxygen to and remove waste products from organs and tissues; and platelets, which enable the blood to clot. Cancer treatments such as chemotherapy and radiation therapy can effect these cells which put a person at risk for developing infections, anemia and bleeding problems. Colony-stimulating factors are substances that stimulate the production of blood cells and promote their ability to function. They do not directly affect tumors but through their role in stimulating blood cells they can be helpful as support of the persons immune system during cancer treatment.

Pegfilgrastim is a growth factor that stimulates the production, maturation and activation of neutrophils. Pegfilgrastim also stimulates the release of neutrophils (a type of white blood cell) from the bone marrow. In patients receiving chemotherapy, pegfilgrastim can accelerate the recovery of neutrophils, reducing the neutropenic phase (the time in which people are susceptible to infections). Pegfilgrastim is a long-acting version of filgrastim.

Pegfilgrastim is filgrastim with a substance called polyethylene glycol (PEG) attached to it. The attachment process is called pegylation, and is used to allow active substances (the filgrastim) to stay in the body longer before they are broken down and eliminated.

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