FAQ-Cancer Resource Center-Medication

Benadryl and Pepcid should be given for as long as your doctor instructs. This may be for a week, 6 months, 1 year, or indefinitely. These drugs rarely cause side effects. If you have questions or concerns about this, please discuss it with your oncologist.

Why do I need to give it?

Benadryl (diphenhydramine) and Pepcid (famotidine) are both anti-histamines. They block the action of histamines in the stomach—Pepcid, and systemically—Benadryl. Mast cell tumors have granules in them and these granules contain histamine amongst other chemicals. These medications are given to try to prevent side effects from excessive histamine release from the mast cell tumors.

How is it given?

Both medications are given orally.

What happens if I don't give it?

In most cases, your pet will be fine, but if you forget to give it for an extended period of time, please contact your veterinarian.

When does the drug start to work?

Both of these drugs start working immediately.

Where can I get these medications?

Both of these drugs can be purchased over the counter, meaning you do not need a prescription for them. Your veterinarian will write down the dosage for you and you can purchase these drugs at your local drug store (CVS, Walgreens, Wal-Mart, Costco, Rite-Aid, etc.)

Some medications need to be given before or after others. In addition, some drugs are never given with other drugs. In most cases, it is fine to give all the prescribed medications together. If certain medications need to be given at certain times, we will alert you and write it on the label of the prescribed medication.

Why is this important?

Some medications can interact with each other making them either more or less effective.

 

How do I remember when to give what drug?

It is best to write down what drug you are giving and what time you are giving it—the calendar we provide you with serves this purpose well. Weekly pill containers sold at most drug stores can also help.

What should I do if I give the wrong drug at the wrong time?

Please call us or your local veterinarian for advice. In most cases, we will have you re-start the correct medication at the correct time the following day.

When will my pet begin to show signs from a drug interaction?

Hopefully, this will never happen, but drug interactions can begin within hours. Again, if your pet is given medications together that were not meant to be given at the same time, please call us immediately.

Where should I take my pet if he/she does show signs?

Please take your pet the closest veterinary facility that is open.

Giving your pet metronidazole is the most effective for diarrhea but there are other options that may work. You can try mixing some canned pumpkin with your dog’s food. Plain Metamucil (1/2 of the human dose by weight- a 50lb dog would get about  1 teaspoon and small dog ½ teaspoon). If the diarrhea persists you should call our office and speak with a doctor.

Cyclophosphamide (Cytoxan) can cause irritation to the bladder wall, resulting in bloody urine. If you notice this, please contact our office as soon as possible.

Why is this important? Cyclophosphamide can cause a chemical irritation to the bladder that can cause the urine to become bloody (hemorrhagic cystitis) and the bladder to be painful. However, there are a number of causes for blood to be present in urine, such as the possibility of infection -- Therefore, if you notice blood in your pets’ urine we urge you to contact our office as soon as possible, so that one of our oncologists may better assess the situation.

What can be done to prevent this? The risk of developing cyclophosphamide-induced cystitis (bloody urine) can be reduced by giving cyclophosphamide in combination with prednisone or with a diuretic (i.e. Furosemide/Lasix), which may cause your pet to drink and/or urinate more often. As you will be informed both during and after your visit; it’s very important to offer plenty of drinking water and allow for more frequent urination. This will allow for the drug to be appropriately expelled from the bladder, hopefully preventing any such complications.

How can we fix this problem? If Cyclophosphamide is determined to be the cause of the bloody urine, treatment with this drug may be stopped and another drug may be used in its place. As previously stated, if you see blood in your pets’ urine we urge you to call our office as soon as possible so that any such decisions to alter treatment may be made by one of our oncologists.

When would I see these effects? Adverse reactions to chemotherapy normally do not occur directly after treatment. Side effects such as bloody urine may appear 2-3 days after treatment; however every patient will have an individualized response to chemotherapy.

These medications are safe for use, and are sent home with you so that if your pet is experiencing any side effects you can go ahead and start these medications instead of waiting for a prescription to be filled. As each pet is different and each chemotherapy protocol is different, the recommendations may vary. Always call if you have any questions about side effects or medications.

Why do you prescribe these drugs right away?

At The VCC we believe in trying to prevent side effects because your pet’s well-being is always at the forefront of every decision we make. We want them to have a high quality of life at all times.

How do I get the drug if need more and you are closed?

A member of our staff is available 24 hours a day, seven days a week by calling our main number. If you need more drugs immediately, we will call a local pharmacy to fill the prescription. If you do not need the medication immediately, you can leave us a message on our answering machine and we will fill the prescription the next business day.

What if my pet is only showing signs of either vomiting or diarrhea but not both?

Your veterinarian may direct you to only give one of the medications or they may have you give both to try and prevent further side effects. Each situation is unique and if there are any questions, please call one of our staff.

When do these drugs take effect?

These medications typically work within 24-48 hours.

Where do I go if these medications do not help my pet?

If these medications do not help, please call your veterinary oncologist and he or she will come up with a plan that is best for you and your pet. It may involve you bringing your pet into our hospital, taking your pet to your local veterinarian, to the closest 24-hour facility, or trying other medications at home.

Yes, both medications should be started the same day the injectable chemotherapy is given.

Why is this important?

The reason that both medications are to be given on the same day is that this particular protocol works best with a combination of chemotherapy agents.

How do you administer the drug?

Both prednisone and procarbazine are to be given orally. We also suggest handling the procabazine with gloves as it is chemotherapy, and we want to minimize exposure to you.

What are the side effects?

Side effects of prednisone are excessive panting, increased appetite, increased thirst, and increased urination (more frequent and larger amounts). The side effects of procarbazine can be loss of appetite, nausea or vomiting, diarrhea and loss of energy level. These side effects are uncommon and if they do occur are typically mild. If you have any questions about side effects, contact your veterinary oncologist.

When should I give these medications; the morning or evening?

Medically it does not matter, but some pets handle these drugs better in the morning and some better in the evening. Whatever you decide to do regarding the time of administration, please try to be consistent.

Where should I store the procarbazine?

Procarbazine can be stored at room temperature and should be out of reach of any children in the household. 

Yes, you can give the Cerenia; remember it is given once daily. If your pet continues to vomit or vomits up the medication, please contact us or your referring veterinarian.  We may suggest he/she come in for an injection to control the vomiting, or in more severe cases, to supplement with some fluids to avoid dehydration.

If your pet vomits after receiving medication, please check to see if the medication is in the vomitus and note how long after the medication was given the vomiting occurred. Please call our office for recommendations. Please do not just administer another dose.

Why is this important?
It is important to know how long after receiving a medication or what medication it is that was so we may better assist you into taking the next best step.

How do I know if they got any of their medication into their system?
If you are unable to find the pill or capsule within the vomitus, it would probably be safe to assume that the pill remained within the pet. Please call our office if you have any questions in regards to this.

What should I do if this happens?
If your pet happens to vomit after getting an oral medication we have no way of determining how much of that drug was absorbed during that period of time so it is best to consult with the prescribing veterinarian.

Misoprostol is used to protect the stomach when piroxicam is given (piroxicam is an NSAID – non-steroidal anti-inflammatory drug).

Why is this important?
Piroxicam can cause ulcers in the stomach if misoprostol is not given. You should start it when you get the piroxicam. Women who are or may become pregnant should not handle misoprostal without gloves.

How do I administer it?
Misoprostol is a pill that should be taken with food to decrease any possible side effects. Diarrhea is a possible, but very uncommon side effect. As with any medication take misoprostol exactly as directed by your doctor.

What happens if I forget to give it or miss a day?
If you miss a dose never double the dosage the following day; just restart the medication as it was prescribed by your doctor. Always consult your doctor if you have any questions or concerns.

When should I start the misoprostol?
Our doctors will prescribe misoprostol when piroxicam is used to help prevent gastrointestinal ulcers and kidney damage. You should start the misoprostol and the piroxicam together.

Where should I store the misoprostol?
Misoprostol can be stored at room temperature out of the reach of children, like all medications.

Zeniquin is a broad-spectrum antibiotic that we preferentially use based on the success of similar drugs (fluoroquinolones) in minimizing episodes of sepsis (infection) after chemotherapy in animals.

Why is this important?
Being a broad spectrum oral antibiotic we are able to start our patients on this antibiotic right away instead of waiting for further testing.

How does it work?
Zeniquin kills susceptible bacteria through its action on the bacteria's DNA.

What are the side effects?
Some side effects your pet may experience are loss of appetite, vomiting and decreased activity level. Please consult your oncologist if any of these side effects occur.

When should I start giving it?
Like any medication you should start giving it when your veterinarian instructs you to. Usually we will have you start it the same day it is prescribed and we will tell you otherwise if that is not the case.

Where can I have this prescription filled?
Zeniquin is a medication only carried by a licensed veterinarian; it cannot be filled at your local family pharmacy.

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

These medications are used to treat and /or prevent the side effects of chemotherapy. If there is any question whether to start these drugs, please call and speak to one of our staff members.

Cerenia (an anti-nausea/vomiting medication) – When your pet has had no vomiting episodes for at least 24 hours and his/her appetite has returned to normal, it is typically all right to skip a dose or stop giving the Cerenia. Your veterinarian may also tell you to give the Cerenia for a set number of days, then stop for a day or two and then re-start the medication.  

Metronidazole (an anti-diarrhea medication)– We recommend continuing this medication for at least three days once started. It may be used for longer periods and may be prescribed intermittently.

Why is this important to give these drugs?

It is always easier to prevent side effects from occurring than waiting for them to start and treating them. We are as concerned about your pet’s quality of life as you are. We therefore want to do everything we can to prevent chemotherapy side effects from occurring.

How do I give these drugs if my dog is vomiting?

If your pet is vomiting, please call your local veterinarian or us as Cerenia can be given by an injection subcutaneously (under the skin).

What should I do if they vomit the drug up?

Do not just give another dose. Please call your local veterinarian or us to advise you. We may recommend waiting and trying to give another oral dose or we may recommend bringing your pet in for an injection of the medication.

When should I be concerned about my dog’s health if he is showing these signs?

If the nausea, vomiting, or diarrhea is more than mild (small amounts, 1-2 times per day, 1-2 days in duration) or if you are unsure they are mild, please call our staff and we will advise you.

Where should I call or take my pet if I feel he/she is getting worse?

You can always reach a member of our staff 24 hours a day/seven days a week if you are a client of ours. If not, please call your local veterinarian or local veterinary oncologist. If your pet is critical or having an emergency, please take your pet to the closest veterinary hospital that is open.

In most cases, antibiotics should be stopped when instructed by the doctor. If you think you need to stop antibiotics before the prescribed time, please call our office.

Why is this important?

In order to kill all of the bacteria, and avoid making the bacteria resistant to a particular antibiotic, veterinarians prescribe antibiotics for particular length of time. It is very important to finish the course of antibiotics as instructed by your veterinarian.

How do I know when to stop giving antibiotics?

Please do not stop giving antibiotics unless told otherwise by your veterinarian.

What are the signs of infection?

An infection may be small and localized such as an abscess or it can be systemic and generalized as in sepsis. The most common signs are fever (typically a temperature of greater than 102.5), lethargy (loss of energy), anorexia (loss of appetite), or a painful swelling with or without discharge at a particular site.

When should I become concerned?

You know your pet. If there are any abnormal signs, and you think they are more than mild, or if you are unsure if they are mild, please call our office so that we can further instruct you.

Where can I get a refill on the antibiotics when we run out?

Antibiotics are typically not meant to be given for extended periods. Most of the antibiotics that we dispense are to be given only for 7-14 days, depending on the particular antibiotic and the reason for using them. Please consult with your veterinarian if you have any questions regarding this.

Some chemotherapy protocols will ask that the owner administer oral chemotherapy at home. It is important to wear gloves when handling these medications-as these medications are prescribed for your pet, not you—so we want to minimize your exposure. If you do not have gloves The VCC will provide them for you.

Why is this important?
It is best to act conservatively when handling chemotherapeutic medications. Although the possibility of having a serious reaction is rare, these drugs are known to be carcinogenic and mutagenic in humans. Using gloves and disposing of them properly minimizes any unnecessary exposure. Pregnant women and immuno-suppressed people should not handle chemotherapy drugs.

How do administer the chemo pill?
With the exception of wearing the gloves the administration of the chemotherapy pill is the same as any other oral medication. If you need assistance the first time one of our technicians will be happy to show you before you leave the office

What happens if I touch the pill without gloves? 
Most if not all of these types of medications are safety coated. Wearing gloves is a precaution to help minimize any possible contamination. Wash your hands if you accidentally touch the pills.

When should I put the gloves on and take them off?
The exterior container of prescription is contamination free. Put your gloves on, open the container, remove the pill and give it to your pet. Once you have completed pilling your pet, take your gloves off by pulling them inside out and then put the cap back on the container.

Where should I dispose of the gloves?
Again, these pills are safety coated and the chance of contamination is very low. The gloves can be disposed of in you every-day garbage. If you are still concerned you may bring them back to us and we will dispose of it for you.

Most non-chemo medications are dosed based on weight in kilograms; also it’s an easier conversion to metered square, which is the unit how most chemotherapy medications are dosed.

Cats don’t get Lasix-- a diuretic-- with Cytoxan because they are not prone to developing sterile hemorrhagic cystitis (a severe irritation to the bladder wall) that is sometimes seen in dogs.

Why don’t they?

The reason why cats don’t commonly get sterile hemorrhagic cystitis from cyclophosphamide is unknown, but it may have to do with a different way they metabolize the drug or a different way their kidneys excrete it or their bladder’s sensitivity to cyclophosphamide.

How are they different from dogs?

The saying “Cats are not small dogs” is quite accurate. Their metabolism, their dietary requirements, their susceptibility to certain drugs/toxins are different from dogs.

What is furosemide (Lasix)

Lasix is a diuretic, a drug that increases the rate of urine formation.

When does my cat need furosemide (Lasix)?

Lasix is most frequently given for high blood pressure or in certain cases of heart disease.

Where is it administered?

Lasix can be given orally and via injection.

Interestingly, cats very seldom get sick following CeeNu administration, so we opt to not stress them with daily antibiotic administration unless necessary.

Why don’t they get infections following lomustine (CeeNu)?

Despite their white blood count dropping after CeeNU administration, most cats do not feel ill. We believe this is because they don’t get septic (an infection with secondary systemic severe inflammatory response) due to bacteria from the gastrointestinal tract crossing into the blood stream very frequently.

How does giving antibiotics stress my cat?

Any oral medication can cause a cat some stress. Most cats are more difficult than dogs to give oral medication to. In addition, it has been our experience that a higher proportion of dogs will eat Pill Pockets®.

What medications do cats need with CeeNu?

Cats unlike dogs do not need any medications with CeeNU.

When does my cat need antibiotics?

There are various conditions where cats need antibiotics—abscesses, pyothorax (severe infection of the chest cavity), bacterial infections of the mouth, and many others.

Where do I call if I think my cat does have an infection?

If your cat is currently undergoing chemotherapy, please call our office, as we are available 24 hours a day, seven days a week by phone. If your pet is not on chemotherapy, or you think the infection is not related to the cancer or the treatment, please call your local veterinarian.