Welcome to CRC 101!
The Basics
Biomarker Testing And Me
All About Scans And Imaging
Chemotherapy And Targeted Therapies
Radiation
Surgery
Diet & Lifestyle
Need Help Navigating?
Print Me Out!
Questions? Feedback?

What premeds might I receive?

Most patients taking chemotherapy experience some side effects during the duration of their treatments. Luckily, there are lots of medications to help minimize unpleasant side effects. 

These medications are often referred to as “premeds” — as many of them are given before chemo infusion to help prevent side effects from happening in the first place.

You’ll also be given other medications, sometimes referred to as “home meds” or “supportive meds” to take as needed. Before starting chemo, your oncologist will usually prescribe these medications for you to pick up at your local pharmacy. They may also recommend some over-the-counter medications to have on hand as well. Make sure to get all the recommended meds before starting treatment, as it’s difficult to rush out and pick them up when you are already feeling unwell. 

Make sure to take all your medications as prescribed, following your oncologist’s recommendations. Some meds will be given on an “as needed” basis — meaning you don’t need to take them all the time. You may be told to take others on a particular schedule, as a preventative measure. If this is the case, make sure to follow your oncologist’s recommendations, as it’s easier to prevent side effects before they start than try to get them under control later on.

As you’ll see below, there are many, many medications that oncologists can prescribe, and some will work better for you than others. Keep a journal to record your side effects, and report them to your team.

Premeds can include:

Anti-nausea medications

Akynzeo (netupitant & palonosetron)

Akynzeo is a medication used to prevent chemo-related nausea and vomiting. It’s often given orally, about an hour before your chemo infusion. This medication is usually very well-tolerated but some patients may experience some side effects, such as indigestion, constipation, skin redness, low energy, headaches, and general weakness.

Aloxi (palonosetron)

This is a medication commonly used to prevent nausea and vomiting from chemo. It’s usually given by IV about 30 minutes before starting your chemo infusion, but can also be given orally. One dose of this medication is usually effective for 3-5 days, so it is only given once. Aloxi is usually very well-tolerated, with the most common side effects being headaches and constipation in a small number of patients.

Ativan (lorazepam)

Ativan is sometimes prescribed to take at home to help combat nausea and vomiting. In addition, it also has an anti-anxiety effect, which can help patients manage treatment-related stress. It can be taken as a preventative measure before or after chemo to combat nausea. It is usually prescribed orally to take on an “as needed” basis at home, although it can be administered by IV in case of severe vomiting. Ativan is generally well-tolerated but may cause the following side effects in a small number of patients: fatigue, dizziness, weakness, confusion, depression, memory loss, and trouble maintaining balance.

Avomine, Vertigon, Phenergan, Sominex (promethazine)

This medication is usually prescribed to be taken on an “as needed” basis at home if you are experiencing nausea and vomiting. Extreme side effects from this medication are rare but some people may experience drowsiness, blurred vision, dizziness, confusion, dry mouth, muscle tremors, ringing in the ears, increased or decreased blood pressure, and increased or decreased heart rate.

Cesamet (nabilone)

This medication is used to treat extreme nausea and vomiting due to chemo. It is similar to the natural substances found in cannabis and can be addictive, so is only prescribed when absolutely necessary. It is taken orally and can be taken at any time before, during, or after your chemo cycle. Some side effects that people may experience are dizziness, drowsiness, dry mouth, feeling “high,” lightheadedness, headache, trouble sleeping, or memory problems.

Compazine (prochlorperazine)

This drug is usually prescribed to be taken at home on an “as needed” basis to help combat nausea and vomiting. It is taken orally and usually very well tolerated, with the main side effects being drowsiness and constipation.

Dexamethasone

Dexamethasone is a steroid usually given by IV prior to chemo to help prevent nausea and vomiting. It can also be given orally and is sometimes given to patients to take at home on the second and third days of chemo. Dexamethasone is quite a strong medication and often causes side effects, although many patients appreciate the increased appetite and extra energy after their treatments. Side effects that patients may experience include increased blood pressure, increased blood glucose (sugar), trouble sleeping, increased appetite, fluid retention, swelling of feet and hands, upset stomach, stomach ulcers, jitteriness, mood swings, increased white blood cell count, muscle weakness, impaired wound healing and weight gain.

Emend (aprepitant)

Emend is commonly used to help prevent nausea and vomiting. It can be administered by IV, about 30 minutes before your chemo infusion or orally, about 60 minutes before your chemo infusion. When given by IV, the medication is effective for several days, so only needs to be given once. When given orally, you may be given pills to take at home on days 2 and 3 of your chemo cycle. Emend is usually very well-tolerated in most patients. The most common side effects include fatigue, diarrhea, weakness, heartburn, stomach pains, and hiccups.

Kytril (granisetron)

This medication can be used to prevent nausea or vomiting, and in extreme cases, may be used to combat chemo-induced nausea. It is given by IV, just before your chemo infusion. Some of the side effects that patients experience may include insomnia, headaches, constipation, or diarrhea.

Maxolon (metoclopramide)

This medication may be prescribed to be taken at home on an “as needed” basis to combat nausea and vomiting. It is generally well-tolerated, but some patients may experience side effects such as drowsiness, diarrhea, dry mouth, and skin rashes.

Motilium (domperidone)

This medication may be prescribed on an “as needed” basis to take at home to combat chemo-related nausea. It is usually taken about an hour before meals and is very well-tolerated. The most common side effect that people experience is dry mouth.

Nozinan, Levoprome, Detenler, Hirnamin, Levotomin, Neurocil (levomepromazine)

This medication is usually prescribed orally to be taken on an “as needed” basis to combat severe nausea and vomiting related to chemo. Some of the more common side effects of this medication include drowsiness, constipation, headache, and dry mouth.

Zofran (ondansetron)

This medication is given to take at home to prevent or treat nausea and vomiting related to chemo. It is taken orally and is usually very well-tolerated. The main side effect from Zofran is constipation.

Zyprexa (olanzapine)

This medication can be given orally to help prevent nausea and vomiting related to chemo. The most common side effects include drowsiness and weight gain.

Anti-diarrhea medications

Atropine

This drug is commonly given to patients receiving FOLFIRI. The “IRI” stands for a chemo drug called irinotecan, which can cause extreme diarrhea and stomach cramps. Atropine is meant to help prevent these side effects. It is usually given intravenously just before receiving your infusion of irinotecan. Some side effects that patients may experience due to atropine include increased heart rate, sensitivity to light, dry eyes, dry mouth, constipation, decreased sweating, abdominal pain, and delays when urinating.

Imodium (loperamide)

Imodium can be taken at home on an “as needed” basis to help manage diarrhea. Patients on the FOLFIRI chemo regimen often experience diarrhea, which can come on as late as 10-12 days following your infusion, so it is always a good idea to have some Imodium on hand just in case you need it. The most common side effects include drowsiness and constipation, so be careful not to overdo it!

Lomotil (diphenoxylate & atropine)

Lomotil may be prescribed to be taken at home on an “as needed” basis to help manage diarrhea. Patients on the Folfiri chemo regimen often experience diarrhea, which can come on as late as 10-12 days following your infusion. The most common side effects include drowsiness, dizziness, headache, blurred vision, dry mouth, and loss of appetite.

Dietary recommendations

While medications are often useful for managing acute diarrhea, there are also important dietary factors to consider to help prevent dehydration and stop your diarrhea from getting worse. If you are experiencing diarrhea, make sure to increase your fluid intake and replace lost electrolytes with an electrolyte drink, such as Pedialyte. It is also a good idea to follow a low fiber diet, like the BRAT diet (bananas, white rice, apples, and white toast) until your diarrhea has improved. 

Laxatives

Colace (docusate)

This medication is used to treat constipation. It works by adding water back into poop, helping soften it. This medication is taken orally on an “as needed” basis and side effects may include stomach pain, diarrhea, or cramping.

Dulcolax (bisacodyl)

This medication is used to treat constipation associated with chemo or other medications. It helps stimulate the contraction of the bowels, which moves stool through the digestive system. This medication is taken orally on an “as needed” basis and side effects may include abdominal pain or cramping and diarrhea.

Miralax (polyethylene glycol 3350)

This medication is used to treat constipation associated with chemo or other medications. It works by drawing water from the colon into the stool, softening it, and helping it to pass more easily through the digestive tract. This medication is taken orally on an “as needed” basis and side effects may include diarrhea, stomach pain, bloating,  gas, and nausea.

Senokot (senna)

This medication helps stimulate the contraction of the bowels, which moves stool through the digestive system. This medication is taken orally on an “as needed” basis and side effects may include abdominal pain/cramping, nausea, and diarrhea.

Dietary recommendations

While medications are often important for managing constipation induced by chemo, intestinal blockages and pre-meds, there are also important dietary factors to consider to help regulate bowel function. If you are experiencing constipation, make sure to increase your fluid intake, consider gentle exercise and adjust the amount of fiber in your diet. 

Skin creams and mouthwashes

Doxycycline

Doxycycline is an antibiotic shown to potentially prevent (or reduce the severity of) skin rashes caused by the EGFR inhibitors Vectibix (panitumumab) and Erbitux (cetuximab). It is prescribed as an oral tablet and should be taken according to the instructions provided by your oncologist. The most common side effects experienced are upset stomach, loss of appetite, and mild diarrhea.

Emla cream (lidocaine)

This cream is often prescribed to patients with a port to help minimize pain when the nurse inserts the needle to access your port. If you are having your port accessed, apply a generous amount of cream to the area before leaving your house, ideally about an hour before your port is accessed. Cover it with plastic wrap or a Tegaderm type dressing to hold the cream in place and keep it from drying out or rubbing off on your clothes. When your nurse accesses your port, you should barely feel the needle going in.

Magic mouthwash

Magic mouthwash is a general term that refers to a collection of different types of mouthwashes that are usually produced by compounding pharmacies to help relieve mouth sores caused by chemo. While there is no standard formula, magic mouthwash often contains some of the following ingredients:

  • Local anesthetics (such as lidocaine) to reduce pain
  • Corticosteroids to reduce inflammation
  • Antihistamines to reduce swelling
  • Antibiotics to reduce the chance of bacterial infection
  • Antifungals to reduce the chance of fungal infections such as thrush
  • Antacids to help coat the mouth and throat and form a barrier against the sores
  • Mucosal protective agents to provide a barrier to protect the underlying mouth sore from irritation by foods and drinks
  • Flavoring to improve the taste

The main side effects of magic mouthwash include temporary tingling or burning, temporary changes in taste, and dry mouth.

You can also try a mix of baking soda, salt, and water for quick and easy relief.

Moisturizers

Good quality moisturizers can be very helpful for managing skin rashes due to Vectibix (panitumumab) and Erbitux (cetuximab), hand-foot syndrome caused by 5FU intravenous chemo, and Xeloda (capecitabine) tablets and radiation-related skin issues. Look for good quality, unscented creams and moisturizers. Your oncologist should be able to make a recommendation if you need one.

Antihistamines

Allercalm, Allerief, Hayleve, Piriton, Pollenase (chlorophenamine)

This medication can be used before chemo infusions for patients that experience mild allergic reactions to certain drugs. Your oncologist may recommend this medication if this situation applies to you. It is important to follow the instructions given to you by your team for taking this medication. Some side effects that people may experience include drowsiness, headaches and dry mouth.

Benadryl (diphenhydramine)

This medication can be given prior to chemotherapy to help prevent allergic reactions to certain drugs. It has also been shown to help prevent nausea and vomiting related to chemo when given in combination with other pre-meds. It can be given orally or by IV. The most common side effects of Benadryl include drowsiness, dry eyes, dry mouth, constipation and restlessness.

Claritin (loratadine)

This medication is sometimes recommended to patients on Neulasta/Neupogen injections to help boost neutrophil counts. These injections can cause bone pain, and Claritin can be taken orally on an “as needed” basis to help. If Claritin alone doesn’t work, it can be combined with Aleve (naproxen).

Singulair (montelukast)

This medication is given to patients to help prevent allergic reactions due to chemotherapy. It is given orally. If you are prescribed this medication by your oncologist, it is important to take it exactly as instructed to allow you to receive chemotherapy safely. The most common side effects of Singulair are abdominal pain, nausea, diarrhea and headaches, although these are not very common.

Acid reflux and heartburn medications

Bentyl (dicyclomine)

This medication is often used to treat abdominal pain and cramping due to chemo. It is usually taken orally on an “as needed” basis. Some possible side effects include dry mouth, upset stomach, constipation, loss of appetite, drowsiness and headaches.

Pepcid (famotidine)

This medication is used to help control heartburn and acid reflux. It works by reducing the amount of acid that your stomach produces. It is usually taken orally at home on an “as needed” basis. Very few patients experience significant side effects on this medication, but some may experience diarrhea, constipation, headache, dizziness.

Prilosec, Losec (omeprazole)

This medication is used to help control heartburn and acid reflux caused by chemo. It works by reducing the amount of acid that your stomach produces. It is usually taken orally at home on an “as needed” basis. Very few patients experience significant side effects on this medication but some may experience constipation, nausea, diarrhea and headaches.

Selanz (Iansoprazole)

This medication is used to help control heartburn and acid reflux caused by chemo. It is usually taken orally at home on an “as needed” basis. Although this medication is very well-tolerated by most patients, some people may experience stomach upset, constipation, diarrhea, headache and drowsiness.

Pain medications

Pain relief medication may be recommended to patients on chemo to help deal with pain caused by tumors or also bone/joint pain and other types of pain that may be caused by chemo drugs or targeted therapies.

Tylenol (acetaminophen)

Tylenol is an over-the-counter medication used for mild pain relief. If you have any issues with liver function, it is best to check with your oncologist before using this medication, as long-term use of this drug can cause liver problems. Never exceed the recommended 24-hour dose listed on the package.

Non-steroidal anti-inflammatories (NSAIDs)

NSAIDs like Advil, Motrin (ibuprofen) and Aleve (naproxen) work by reducing inflammation in the body and can help relieve mild to moderate pain. Check with your oncologist before starting any new medications and never exceed the dose listed on the package. Long-term use of these drugs can cause stomach ulcers and bleeding as well as kidney issues.

Anticonvulsant medications

These are very strong prescription medications, traditionally used in conditions such as epilepsy that interrupt pain signals to the brain. They have been shown to be very effective in treating nerve pain and should only be prescribed when absolutely necessary. Some examples include Gabarone (gabapentin) and Lyrica (pregablin). The most common side effects of these medications are drowsiness, dizziness and nausea.

Corticosteroid medications

These are very strong prescription medications that work by reducing swelling and inflammation in a particular part of the body. They should only be prescribed when absolutely necessary. Some examples of corticosteroid medications are methylprednisolone, prednisolone, and prednisone. Side effects may include weight gain, mood changes, difficulty sleeping, weakened immune system, thinning of the bones and skin and high blood sugar levels.

Opioid medications

These are very strong prescription medications that change how your brain perceives pain signals. They can be very addictive so should only be prescribed when absolutely necessary, ideally for a limited period of time. Codeine, fentanyl, hydrocodone, oxycodone and morphine are some examples of opioid medications. Side effects of these medications include drowsiness, nausea/vomiting, constipation, itching, breathing problems and addiction.

Want to learn more about side effect medications?

Check out the Chemo Experts website for more information on premeds and to look up individual medications, doses and side effects.

Want to learn more about premeds?

Join one of our COLONTOWN Facebook groups:

  • Corner Cupboard is a place to discuss treatment side effects and management

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

Last updated: May 18, 2022