Monitor patients for myelosuppression; should not be given in patients w/ absolute neutrophil count (ANC) <1,500 cells/mm3
& platelet count <100,000 cells/mm3
. Pre-treatment w/ dexamethasone (or equivalent) & co-administration w/ folic acid & vit B12
as prophylactic measure while under treatment is recommended. Reports of serious renal events (eg, acute renal failure) & CV events (eg, MI & CVA); radiation pneumonitis &/or radiation recall in patients treated w/ radiation or radiotherapy prior, during or subsequent to therapy. Radiosensitising agents must be used w/ caution. 3rd space fluid (eg, pleural effusion or ascites). Ensure adequate anti-emetic therapy & appropriate hydration prior to &/or after receiving treatment. Concomitant use w/ live attenuated vaccine is not recommended. May affect ability to drive & operate machines. Avoid high-dose NSAIDs in patients w/ mild to moderate renal insufficiency (CrCl 45-79 mL/min) 2 days before, during, & 2 days after treatment administration. Not recommended in patients w/ CrCl <45 mL/min. Contraceptive measures or abstinence are recommended in males during treatment & up to 6 mth thereafter; counselling on sperm storage prior to treatment initiation is recommended. Women of childbearing potential must use effective contraception during treatment. Pregnancy. Discontinue breast-feeding while under therapy. 500-mg:
May affect patients on controlled Na diet.