Frequency and severity of adverse events have been shown to be dose-related and schedule dependent. Most adverse events are self-limiting and usually reversible within two to three days of discontinuation of therapy. This can lead to severe hypotension, oedema, hypovolaemia, weight gain as a result of fluid retention, pleural effusion, respiratory dysfunction, cardiotoxicity and nephrotoxicity . An intensive care facility and specialists skilled in cardiopulmonary or intensive care medicine must be available. Clinicians should be knowledgeable about adverse events that may occur.
Toxicity is mild, manageable , transient and reversible with no evidence of capillary leak syndrome.
No significant renal dysfunction or electrolyte imbalances are seen. Fluids 2 to 3 litres each day. Pethidine 12.5-25 mg IV PRN for severe rigors. Metoclopramide tablets 10mg three times a day at mealtimes prn for nausea and vomiting. Chlorhexidine may be useful in preventing mucositis.