Many TGCT patients that are on medications for their TGCT have side effects. While these medications help the progression and symptoms associated with TGCT, patients commonly have edema, facial swelling, rash, nausea, constipation, tiredness, and in some cases, change in skin and hair pigment. In order to cope with some of those side effects, doctors may prescribe or recommend other drugs to be given in combination with your treatment.
Antiemetic is a drug class for medications that prevent vomiting and nausea. These drugs treat motion sickness, drug side effects, post-operative nausea, and in some cases, nausea associated with pregnancy. Often times these drugs can be taken through a dissolvable tablet, a capsule, or a skin patch. The two most commonly prescribed antiemetic are ondansetron (Zofran) and promethazine (Phenergan). There are two ways these drugs work, 1) ondansetron works by blocking serotonin signaling in your brain. This disrupts the signal between your brain to your gut. 2) phenergan works by blocking histamine signaling in your brain. This allows your brain to signal to your gut to relax. Other anti-histamines, such as Benadryl, can block histamine signaling and lead to decreased nausea.
There are two main classes of medications used to treat constipation. These drugs can be taken orally or through suppositories. They can be broken down into Laxatives and Surfactants:
Laxatives: Laxatives work by stimulating bowel movement. This simulation can help speed up movement through the gastrointestinal tract. Some laxatives work by increasing the water and bulk of the stool, allowing stool to move through the gastrointestinal tract undigested. The other type of laxative increases bowel movement frequency by causing the colon to retain water.
Surfactants: Surfactants, also known as stool softeners, work by increasing the amount of water absorbed in stool. This allows more moisture to be absorbed, leading to softened stool that can move through the gastrointestinal tract easier. The most commonly prescribed surfactants is docusate (Colace, Doculax).
Edema is caused by excessive fluid trapped in your bodies tissue. Commonly, Edema presents either in the limbs or face and can be a side effect of these CSF1 inhibitors. It is important to drink more water than usual. Often times when you're dehydrated, your body holds onto water. Therefore it's important you consume around 3.7 liters (men) and 2.7 liters (women) (5). However, if significant swelling has occurred, diuretics can be used. One of the most commonly prescribed diuretic is furosemide (Lasix). Your bodies water is commonly regulated by systemic sodium concentrations. Most of these drugs help rid your body of water through releasing more sodium into your urine. While the sodium leaves your body, it brings water from the blood along with it. This can also reduce blood pressure.
Many CSF1 inhibitors result in itching, also called pruritus. Many drugs stimulate a cell that can release histamines, a chemical in your body that's known for its role in causing allergy symptoms. Thus, the treatment for drug-induced itching is often anti-histamines like benadryl (diphenhydramine) or zyrtec (cetirizine).
A rash is the change in appearance or feel of the skin often characterized by redness, raised appearance, itching, or swelling. CSF1 inhibitors may lead to rash as CSF1 plays a critical role in the immune system in skin inflammation. Many patients on CSF1 inhibitors for TGCT may develop a rash at some point in their treatment. If so, these rashes are commonly monitored and a patient may be treated with a corticosteroid ointment or topical treatment. Dose interruptions or modification can also be used to reduce the extent or frequency of rashes.
References
1. Gelhorn HL, Tong S, McQuarrie K, et al. Patient-reported Symptoms of Tenosynovial Giant Cell Tumors. Clin Ther. 2016. doi:10.1016/j.clinthera.2016.03.008 2. Darkovska-Serafimovska M, Serafimovska T, Arsova-Sarafinovska Z, Stefanoski S, Keskovski Z, Balkanov T. Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases. J Pain Res. 2018. doi:10.2147/JPR.S160556 3. Russo M, Calabrò RS, Naro A, et al. Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation. Neural Plast. 2015. doi:10.1155/2015/656582 4. Blake DR, Robson P, Ho M, Jubb RW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology. 2006. doi:10.1093/rheumatology/kei183
