Temozolomide Chemotherapy with Radiotherapy for High Grade Glioma

A guide on how to take your medication

This document provides a guide for patients who have been prescribed temozolomide chemotherapy to take daily alongside radiotherapy. You will need to collect your medication from outpatient pharmacy a few days before you are due to start taking it and it is important you understand when to take the chemotherapy and other medication that is prescribed with it.

You will be prescribed a number of different tablets and these include:

• Chemotherapy
• Anti-sickness
• Antibiotic

Each of the different medications is described below, with instructions on how to take them.

You should also continue with all your current medication unless the doctor tells you to stop or reduce the dose. You should not stop or reduce your steroid (Dexamethasone) dose without advice from a doctor.

Chemotherapy = Temozolomide Dose _____ mg daily

These are tablets or capsules that you should take every day (including weekends) starting on the 1st day of your radiotherapy. Everyone has a slightly different dose depending on your height and weight and you may need to take a number of tablets/capsules to make the right dose.

Timing: On the days you are having radiotherapy you should aim to take the tablet about 1 hour before treatment is due. This may mean taking it during your journey to the hospital. You should aim to take it on a relatively empty stomach, so try not to eat for at least an hour before having the tablets and you should not eat for two hours after taking them. The radiographers cannot treat you until at least an hour after taking the tablet but will aim to do the radiotherapy as close to an hour as possible.

At weekends you can take the tablet at whatever time you prefer.

Blood tests: One of the potential side effects of this medication is to lower your full blood count or very rarely cause problems with your liver function. We will ask you to have 2 blood tests each week (usually Tuesdays and Fridays) so that we can monitor your levels and ensure it is safe to continue the chemotherapy. If you develop a raised temperature, feel unwell or have abnormal bleeding or bruising you should contact the Oncology 24 hour helpline on 01223 274 224.

Collecting more tablets: We can only give you 7 days of chemotherapy at a time, so each week you will be given another week’s supply. Normally this is ready when you attend for radiotherapy on a Friday but you may need to collect from pharmacy.

Anti-sickness = Ondansetron & Domperidone

The majority of patients who have this chemotherapy during radiotherapy aren’t sick but a few patients feel sick and a small number are actually sick. We therefore give you some anti-sickness tablets to try and minimise any symptoms.

Day 1: In the packet of medication you will have 1 tablet of a strong anti-sickness medication called Ondansetron. You should aim to take this tablet approximately 30 minutes before taking the 1st dose of chemotherapy (temozolomide).

Day 2 onwards: You will also be given another drug called Domperidone. This is a milder anti-sickness tablet that you can take if you feel sick or lose your appetite. You should have enough tablets for the whole course of treatment. If you take the domperidone and are still feeling sick or are actually sick we will prescribe the stronger Ondansetron tablets for you to take each day during treatment.

Antibiotic = Co-trimoxazole

A possible side effect of taking the chemotherapy every day for a number of weeks is a specific type of chest infection (pneumocystis pneumonia). To try and prevent you developing this you will be prescribed an antibiotic which you should take every Monday, Wednesday and Friday, throughout the course of treatment. You should have enough tablets for the whole course of treatment.

This tablet does not prevent all infections and you should contact us for advice if you feel unwell or develop a raised temperature (for more information see PIN0715 – Chemotherapy (opens in a new tab))

Further information

If after reading this guide you have any questions please contact Kate Burton (Consultant radiographer) on 01223 216580 or Lorraine Muffett or Asha Philip (Clinical nurse practitioners) on 01223 256676 or ask the treatment radiographers for advice.

Privacy and dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. This means, with a few exceptions, we will care for you in same sex bays in wards with separate sanitary facilities for men and women.

In some areas, due to the nature of the equipment or specialist care involved, we may not be able to care for you in same sex bays. In these cases staff will always do their best to respect your privacy and dignity, eg with the use of curtains or, where possible, moving you next to a patient of the same sex. If you have any concerns, please speak to the ward sister or charge nurse.