Talking to Your Pharmacist
Cancer patients usually must take medications to treat their disease and manage side effects of treatment. Drugs that cancer patients take may include chemotherapy drugs, drugs to prevent nausea, drugs to help control pain, drugs for anxiety or depression, and sometimes vitamins or other nutritional supplements.
If you are taking medications for cancer, you may be receiving your drugs intravenously in a hospital or a clinic or you may have prescriptions filled at a special oncology pharmacy or at your local pharmacy. The prescriptions you have filled may be for drugs you take orally or for injections given to you at home. Intravenously given drugs may be given either through a temporary catheter in your hand or arm or a peripherally inserted central catheter (PICC line). These catheters may also be used to administer intravenous drugs at home.
Chemotherapy drugs taken by mouth need to be absorbed through the digestive system and be processed by the liver to enter the bloodstream and attack the cancer. Eventually, the drugs are eliminated from the body through excretion in the kidneys or metabolism in the liver. Chemotherapy drugs are designed to kill fast-dividing cells like cancer cells. They are very powerful drugs. Interactions with other drugs or foods can change the way these drugs work in your body. Interactions might mean you get too much or too little of the drugs.
Chemotherapy drugs can be toxic in slightly larger doses than prescribed. And too little of the required dose might mean the drugs are too weak to kill the cancer. So it is especially important that cancer patients ask the pharmacist questions and be sure that they understand everything about the drugs they are taking. The effectiveness or toxicity of drugs may also be affected by certain foods, by vitamins or other nutritional supplements, and by smoking or drinking alcohol. Over-the-counter drugs, such as painkillers, cold medicines, or antacid tablets, might also affect the drugs.
For example, if you are taking medications for pain or nausea, you might accidentally cause an overdose by combining them with over-the-counter drugs. A prescription drug, such as acetaminophen with codeine, when combined with over-the-counter acetaminophen (the main ingredient in Tylenol) might cause problems for your liver. Herbal supplements — such as Echinacea, kava, and grape seed — may interfere with the absorption of chemotherapy drugs in the digestive system.
If possible, you should fill all your prescriptions at the same pharmacy. But whether you are using one or several pharmacies, you should bring a list of all the medications for the pharmacist to check for potential drug interactions. Also make sure to tell the pharmacist if you have any allergies to medications or foods. Your list should include vitamins, herbal remedies and other nonprescription medications.
Questions to Ask
1. What is the name of the medication and what is it supposed to do? The drug may be a drug to kill the cancer cells, or it may be a drug to help with the side effects of some of your other drugs.
2. When and how do I take it? Some drugs should be taken at certain times of day, some drugs should be taken on an empty stomach, and some drugs should be taken with or after food. It is important, especially with cancer drugs, that you take your drugs exactly as directed or they may not help you.
3. What side effects might there be to this drug? Some chemotherapy drugs have side effects that do not show up until the drug has been taken for a while. Ask your pharmacist what the side effects are and when they might begin to occur. What should you do if they occur? Is there anything you can do to eliminate or decrease the side effects, such as taking the medicine at a different time of day or with food?
4. When should you call your doctor about side effects that you are concerned about?
5. How should the medication be stored?
6. Are allergic reactions common with this medication?
7. Should you avoid alcohol, any other medication, food, or physical activities while taking this medicine?
8. What if you forget to take the medication? Recommendations for a missed dosage are not the same for all drugs. Sometimes you should take a missed dose as soon as you remember, and sometimes you should skip the dose and wait until time for the next dose. It is important to get specific instructions from your pharmacist.
9. Is it safe to become pregnant or breastfeed while taking this medication?
Ask the pharmacist for written instructions regarding each medication. In addition, write down the answers to all of your questions.