Monday 1 February 2016

Please advise

Hello all
I was wondering if you could help me clear up something
My dad will be finishing his radio+chemo tomorrow and he is set to start high dose of chemo on the 3rd of March 5/23.
Now I am working towards a cocktail but I am unsure if I only give him the cocktail a few days before his chemo and a few days after or do I give him it continually ?
Your advise would be much appreciated
Many thanks

13 comments:

  1. My brother takes the cocktail drugs every day.

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  2. What even the ones that are to open the bbb like Viagra and fuloxitine ?

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  3. I take my cocktail drugs everyday as well. I do find it hard to take them during the 400mg TMZ cycle days but I still try. I do a drug/supplement holiday every so often but that is for only one day.
    Marc

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  4. Dad took both viagra and prozac during Temodar and still takes both now, post temodar. The only things we eliminated when temodar was done were the disulfiram and copper. Not sure if that's what you should do also but I recall asking this group and coming to that conclusion.

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  5. Thanks for getting back to me everyone very much aprecitated.
    I don't really understand why would you would take Viagra and Prozac whilst not taking temodar I under stand taking a few days before temodar and a few days after but not every single day.
    I also understand that Viagra can help the immune system maybe this is why?

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    1. Viagra (sildenafil) inhibits immune suppressor cells in mice (hasn't been tested in humans). Prozac (fluoxetine) also has direct anti-tumor activity (again in mice).

      Also even if a drug did nothing else than increase BBB permeability, many of the other cocktail agents besides TMZ could use this help in reaching the brain.

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  6. Also another question I'd like to ask is should my dad be taking the cocktail before temodar or after ??

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  7. My doctor told me that even after you stop taking the TMZ, it is still working that is why my platlets drop thru the 28 day cycle when I am not taking TMZ. If this is true, then it helps to continue taking the drugs that have shown to help the TMZ even after you have stopped taking them in the cycle.

    Marc

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  8. Yes I see Stephen so you advise on taking the cocktail on all days not just chemo days?
    Also should the cocktail be taken before or after tmz

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    Replies
    1. That's right, most of the agents could have benefit independently of TMZ. No reason to stop for the remaining 3 weeks of the cycle, unless he is having intolerable side effects from something he's taking.

      From the Temodar prescribing information:

      "To reduce nausea and vomiting, TEMODAR should be taken on
      an empty stomach."

      If any of the drugs are specifically being used as chemosensitizers it would seem reasonable to take those at the same time (more or less) as TMZ so that peak levels co-incide with TMZ. An exception would be drugs with a long elimination half-life (like chloroquine) where timing might not be as important.

      Some have had concerns that other drugs/supplements taken at the same time as TMZ could interfere with its absorption, but I haven't found evidence of this in the literature. The only interaction listed in the prescribing information for TMZ is that valproic acid (Depakote) slows clearance of TMZ by 5%, but "The clinical implication of this effect is
      not known"

      I think most people here are taking the drugs/supplements in two or three clusters, including one before bedtime (melatonin for example).

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    2. So what drugs do you take at the same time as TMZ? I've seen some people here talking about taking viagra 30 minutes before TMZ but I don't know about any other drugs. I was also worried that taking any meds with TMZ would make my husband nauseous and potentially vomit the TMZ. For that reason he has been taking all of his drugs/supplements at dinner, then 1 hour later zofran and 1 hour after that he takes TMZ.

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  9. Thanks for the reply Stephen
    This is going to be difficult as getting drugs here is very difficult everything I have got I have managed to get without prescribtion.
    Think I better try get a lot more.
    Also Stephen is Celebrex only important whilst having radiation or is this important whilst having high dose chemo ?

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    1. Again I would say Celebrex could have benefit independently of radiation. It inhibits both COX-2 (and prostaglandin E2 downstream) as well as carbonic anhydrase 9 (CAIX), both of which are implicated in GBM pathology. By inhibiting PGE2 production it could have beneficial impact on immune response.

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