Prevention and management of frequent side effects of novel drugs
| Type of side effect . | Prevention . | Management . |
|---|---|---|
| Infections | ||
| Herpes zoster | Antiviral prophylaxis with aciclovir or derivative | Use same drugs (aciclovir, valaciclovir, famciclovir, penciclovir) at therapeutic doses |
| Influenza | Vaccination | Oseltamivir, zanamivir |
| Bacterial infections | Vaccination against pneumococci, H influenzae. Antibacterial prophylaxis (quinolon or trimethoprim-sulfamethoxazole) only in patients with high risk for infections | β-Lactam antibiotics, macrolides, fluoroquinolons |
| Gastrointestinal disorders | ||
| Nausea/emesis | Domperidon, alizapride, metoclopramide in case of severe nausea: 5HT3 antagonists, neurokinin-1 antagonists w/o 5HT3 antagonists | Alizapride, metoclopramide in case of severe nausea/emesis: 5HT3 antagonists (aprepitant, fosaprepitant, rolapitant), neurokinin-1 antagonists w/o 5HT3 antagonists (netupitant/palonosetron), dexamethasone |
| Constipation | Fiber-rich diet, adequate fluid intake, physical exercise, macrogol | Osmotic laxatives (macrogol, lactulose, sorbitol, polycarbophil), stimulant laxatives (senna, bisacodyl, sodium picosulfate); in case of opioid-induced bowel atony: naltrexone or naloxone, distigmin, pyridostigmin |
| Diarrhea | Normal diet | Loperamid, diphenoxylate + atropine, probiotics; in case of severe symptoms: long-acting somatostatin; in case of bile acid malabsorption, cholesevelam |
| Neuromusculoskeletal disorders and pain | ||
| Peripheral neuropathy | Regular and careful monitoring of symptoms of PN | Dose reduction, regimen modification or discontinuation of neurotoxic drugs; in case of painful PN: gabapentin, pregabalin, amitriptyline, duloxetine, venlafaxine, opioids (tramadol, fentanyl, buprenorphine, others); lidocaine patches/cream, acupuncture, TENS |
| Orthostatic dysregulation, hypotonia | Regular and careful monitoring of symptoms, adequate fluid intake, physical exercise | Dose reduction and/or discontinuation of neurotoxic drugs or blood pressure–lowering drugs; midodrine, mineralocorticoids, physical exercise |
| Type of side effect . | Prevention . | Management . |
|---|---|---|
| Infections | ||
| Herpes zoster | Antiviral prophylaxis with aciclovir or derivative | Use same drugs (aciclovir, valaciclovir, famciclovir, penciclovir) at therapeutic doses |
| Influenza | Vaccination | Oseltamivir, zanamivir |
| Bacterial infections | Vaccination against pneumococci, H influenzae. Antibacterial prophylaxis (quinolon or trimethoprim-sulfamethoxazole) only in patients with high risk for infections | β-Lactam antibiotics, macrolides, fluoroquinolons |
| Gastrointestinal disorders | ||
| Nausea/emesis | Domperidon, alizapride, metoclopramide in case of severe nausea: 5HT3 antagonists, neurokinin-1 antagonists w/o 5HT3 antagonists | Alizapride, metoclopramide in case of severe nausea/emesis: 5HT3 antagonists (aprepitant, fosaprepitant, rolapitant), neurokinin-1 antagonists w/o 5HT3 antagonists (netupitant/palonosetron), dexamethasone |
| Constipation | Fiber-rich diet, adequate fluid intake, physical exercise, macrogol | Osmotic laxatives (macrogol, lactulose, sorbitol, polycarbophil), stimulant laxatives (senna, bisacodyl, sodium picosulfate); in case of opioid-induced bowel atony: naltrexone or naloxone, distigmin, pyridostigmin |
| Diarrhea | Normal diet | Loperamid, diphenoxylate + atropine, probiotics; in case of severe symptoms: long-acting somatostatin; in case of bile acid malabsorption, cholesevelam |
| Neuromusculoskeletal disorders and pain | ||
| Peripheral neuropathy | Regular and careful monitoring of symptoms of PN | Dose reduction, regimen modification or discontinuation of neurotoxic drugs; in case of painful PN: gabapentin, pregabalin, amitriptyline, duloxetine, venlafaxine, opioids (tramadol, fentanyl, buprenorphine, others); lidocaine patches/cream, acupuncture, TENS |
| Orthostatic dysregulation, hypotonia | Regular and careful monitoring of symptoms, adequate fluid intake, physical exercise | Dose reduction and/or discontinuation of neurotoxic drugs or blood pressure–lowering drugs; midodrine, mineralocorticoids, physical exercise |
TENS, transcutaneous electrical nerve stimulation; w/o, without.