Fluorouracil (Adrucil®, 5-FU)

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily. 
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines. 

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor. 

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. 
• Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks. 

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

This medication can cause sores or soreness in your mouth and/or throat, called mucositis. Tell your providers if your mouth, tongue, inside of your cheek, or throat becomes white, has ulcers, or is painful. Medications can be used to manage pain. Regular mouth care can help prevent or manage mouth sores. Some things you can do are:

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) can be used a few times each day.
• If your mouth gets dry, eat moist foods, drink plenty of fluids (6 to 8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, and drinking alcoholic beverages and citrus juices.

Alopecia is when your hair gets thin, brittle (breaks easily), or falls out. This may happen during the few weeks after treatment starts. Hair loss can be all of your body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. You may want to use scarves, wigs, hats, and hairpieces. Your hair helps keep you warm in cold weather, and it can protect you from the sun, so it is important to wear a hat if you are in cold weather or in the sun. If you are going to be out in the sun, protect your scalp by using a sunscreen with SPF 30 or higher. Wash your scalp with a mild or baby shampoo. After you are done with treatment, hair often starts to grow back.

It is important to keep your fingernails and toenails clean and dry. Your fingernails/toenails may become dark, brittle, or fall off. If any nails fall off, clean the nail bed well with soap and water and cover it with a band-aid. Nail polish is safe to use, but do not wear fake nails (gels, acrylics, overlay).

You may notice dry skin or changes in the color or tone of your skin. This medication can make your skin more sensitive to the sun, which can result in a severe sunburn or rash. Sun sensitivity can last even after you are done with chemotherapy. Avoid the sun between 10 am and 4 pm, when it is strongest. Wear sunscreen every day and reapply when you are in the sun. The best sunscreen is SPF 30 or higher and protects against both types of sunlight, UVA and UVB. Wear sunglasses, a hat, and long sleeves/pants to protect your skin, a lip balm with SPF of at least 30, and stay in the shade whenever possible.

Tell your providers if you develop red, painful, or itchy skin, sunburn, skin irritation, bumps, or thick, dry skin.

Hand-foot syndrome (HFS) is a skin reaction on the palms of your hands and/or the soles of your feet. HFS can be caused by certain chemotherapy agents being absorbed (taken in) by your skin cells. HFS can start as a mild tingling, numbness, pins-and-needles feeling, redness, or pain or swelling of your hands and/or feet. It can lead to painful swelling, blistering, or peeling skin, making it hard to do your normal activities. Tell your providers right away if you have these symptoms, as they may need to change your chemotherapy dose or take a break to let your skin heal. Some ways to help prevent HFS are:

• Keep your hands and feet clean and dry.
• Avoid tight shoes or socks.
• Avoid activities that put pressure on your palms or soles during treatment and for 1 week after treatment.
• Use an alcohol-free moisturizer often, and do not use products with perfumes or scents.
• Do not use very hot water for baths and showers

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.

This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.

This medication can cause or worsen pre-existing heart problems, like congestive heart failure, restrictive cardiomyopathy, decreased heart function, and heart attack. Symptoms may be:

• Sudden weight gain.
• Swelling in your ankles or legs.
• Chest pain or pressure.
• Pain in your left arm, back, or jaw.
• Sweating.
• Shortness of breath.
• Clammy skin.
• Nausea.
• Dizziness or lightheadedness.

If you have any of these symptoms, call 911.

Your brain, spinal cord, and nerves make up your nervous system. This medication can cause brain (neurological) changes that can affect other parts of your body through your nervous system. You may have 

• Headaches.
• Numbness or tingling (neuropathy).
• Motor skill changes, like loss of control of your arms or legs.
• A hard time understanding when someone speaks to you or being unable to speak as you normally would (called aphasia).
• A change in your mental status, such as confusion, extreme tiredness (lethargy), memory loss, being unable to focus, sleep problems, and seeing or hearing things that aren’t really there (hallucinations), among others.
• A lack of blood flow and oxygen to your brain (called encephalopathy). 
• Seizures.

Call your provider if you are having any neurological symptoms.