hydroxyurea

Trade Name:

Hydrea®

Appearance:

capsule

Monograph Name:

hydroxyurea

Monograph Body:

Drug Monograph

A - Drug Name

hydroxyurea

COMMON TRADE NAME(S): Hydrea®

B - Mechanism of Action and Pharmacokinetics

Hydroxyurea acts primarily as an inhibitor of ribonucleotide reductase. This leads to the depletion of essential DNA precursors. Repair of DNA damage is also inhibited. Hydroxyurea is cell cycle phase-specific (S-phase) and is a known radiosensitizer, possibly due to G1 arrest.

Absorption

Bioavailability

Oral bioavailability ≥ 80%. Peak levels reached in 1-4 hours after oral dosing. Increasing doses result in a greater than proportional exposure.

Effects with food

Unknown

Distribution

Distributed throughout body, crosses placenta, found in ascitic fluid. Concentrates in leukocytes and erythrocytes.

Cross blood brain barrier?

Yes

PPB

75-80%

Metabolism

Up to 50% metabolized in liver; a minor pathway involves degradation by urease in intestinal bacteria.

Active metabolites

Unknown

Inactive metabolites

Yes

Elimination

Hepatic and renal; renal is the major route of elimination.

Urine

80% within 12 hours

Half-life

2 to 4.5 hours

C - Indications and Status

Health Canada Approvals:

Head and neck cancer (excluding the lip)
Chronic myelocytic leukemia

Refer to the product monograph for a full list and details of approved indications.

Other Uses:

Hematological, including:
- Acute lymphoblastic leukemia
- Acute myeloid leukemia
- CMML and myeloproliferative disorders

D - Adverse Effects

Emetogenic Potential:

Minimal – No routine prophylaxis; PRN recommended

ORGAN SITE	SIDE EFFECT* (%)	ONSET**
Dermatological	Alopecia (rare) (may occur after several years of long-term therapy)	E L
	Dermatomyositis (dermatomyositis-like changes)	E
	Nail disorder (including melanonychia) (atrophy may occur after several years of long-term therapy)	E L
	Radiation recall reaction	I E
	Rash (≥10%) (may be severe)	E L
	Skin hyperpigmentation , atrophy (may occur after several years of long-term therapy)	E L
Gastrointestinal	Anorexia (≥10%)	E
	Constipation	E
	Diarrhea (≥10%)	I
	GI irritation	E
	Mucositis	E
	Nausea, vomiting (≥10%)	I E
General	Chills	E
	Fatigue (≥10%)	E
	Fever (≥10%) (drug-induced)	E
Hematological	Hemolytic anemia (rare)	E
	Myelosuppression (≥10%) (leukopenia most common; rapid recovery after dose interruption)	E
	Other (megaloblastosis)	E
Hepatobiliary	Cholestasis (<10%)	E
	↑ LFTs (<10%) (may be severe)	E
	Pancreatitis (rare, in HIV)	E
Immune	Autoimmune disorder – systemic or cutaneous lupus (rare)	L
Metabolic / Endocrine	Tumor lysis syndrome (rare)	I E
Neoplastic	Secondary malignancy (including skin cancer; rare)	L
Nervous System	Dizziness (rare)	E
	Hallucinations (rare)	E
	Headache (rare)	E
	Peripheral neuropathy (rare, in HIV)	E
	Seizure (rare)	E
Renal	Creatinine increased (uncommon)	E
Respiratory	Pneumonitis (acute; rare)	I
	Pulmonary fibrosis (acute; rare)	I
Urinary	Dysuria (rare)	E
Vascular	Peripheral ischemia (cutaneous ulcers, gangrene; rare)	E
	Vasculitis (cutaneous; rare) (may be severe)	E

* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare" may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal reports.

** I = immediate (onset in hours to days) E = early (days to weeks)
D = delayed (weeks to months) L = late (months to years)

Hydroxyurea has the potential to enhance radiation injury to tissues. While often-called radiation recall reactions, the timing of the radiation may be before, concurrent with or even after the administration of hydroxyurea. Recurrent injury to a previously radiated site may occur weeks to months following radiation.

Megaloblastic erythropoiesis, which is self-limiting, is often seen early in the course of hydroxyurea therapy. The macrocytosis is not related to vitamin B12 or folic acid deficiency, but may mask the incidental development of folic acid deficiency; thus, prophylactic administration of folic acid may be warranted.

Cutaneous vasculitic toxicities including vasculitic ulcerations and gangrene have occurred in patients with myeloproliferative disorders during therapy with hydroxyurea. These vasculitic toxicities were reported most often in patients with a history of, or currently receiving, interferon therapy.

Drug-induced pyrexia has been reported with hydroxyurea, usually occurring within 6 weeks of initiation and resolving after discontinuation. In some cases, it may present with gastrointestinal, pulmonary, musculoskeletal, hepatobiliary, dermatological or cardiovascular effects. Fever may recur within 24 hours of re-challenge.

Interstitial lung disease including pulmonary fibrosis, lung infiltration, pneumonitis, and alveolitis/allergic alveolitis (including fatal cases) have been reported in patients with myeloproliferative neoplasm treated with hydroxyurea.

Hepatitis and/or cholestasis has been commonly described and may be severe. Fatal hepatic events were reported during post-marketing in HIV-infected patients treated with hydroxyurea and other antiretroviral agents.

E - Dosing

Refer to protocol by which patient is being treated.

Screen for hepatitis B virus in all cancer patients starting systemic treatment. Refer to the hepatitis B virus screening and management guideline.

Severe anemia must be corrected prior to initiation of treatment with hydroxyurea.

Patients at risk of tumour lysis syndrome (i.e. high tumour burden) should have appropriate prophylaxis and be monitored closely.

Skin cancer has been reported in patients on long-term hydroxyurea. Patients should be advised to protect skin from sun exposure.

Adults:

Dosing should be based on patient’s actual or ideal weight, whichever is less.

CML:

Daily: 20-30 mg/kg po, adjusted to white cell count

Head and neck cancer:

Refer to product monograph.

Dosage with Toxicity:

Doses should be modified according to the protocol by which patient is being treated; if no guidelines available, refer to Dosage Modification for Hematologic and Non-Hematologic Toxicities.

Toxicity	Action
Mild to moderate anemia	Transfuse if symptomatic; do not interrupt.
Worsening or persistent anemia	Consider hold and evaluate for hemolysis. Discontinue if hemolytic anemia is confirmed.
Severe mucositis or gastric distress (e.g., nausea, vomiting, and anorexia)	Hold until ≤ grade 1.
Vasculitis	Discontinue.
Hepatitis or cholestasis	Discontinue.
Interstitial lung disease	Discontinue. Manage with corticosteroids.

Dosage with Hepatic Impairment:

No data available; close hematologic monitoring recommended.

Dosage with Renal Impairment:

Hydroxyurea should be used with caution in patents with renal impairment; close hematologic monitoring is recommended. In patients with CrCl < 60 mL/min (or ESRD), there was an approximate 64% increase in mean hydroxyurea exposure.

Creatinine Clearance (mL/min)	Starting Dose (% usual dose)
> 60	100%
10-60	50%
<10	20%* or Discontinue

*Give hydroxyurea after dialysis on dialysis days.

Dosage in the elderly:

May be more sensitive to toxic effects. Consider dosage adjustment.

Children:

Safety and efficacy have not been established.

F - Administration Guidelines

To minimize the risk of exposure, always wash hands before and after handling hydroxyurea. Always wear impervious gloves when handling hydroxyurea capsules or packaging.
If patient is unable to swallow capsules, capsule contents may be emptied into a glass of water and taken immediately. Some inert material used as vehicle in the capsule may not dissolve and float on the surface.
Patients should not allow the drug powder to come in contact with their skin or mucous membranes and avoid inhaling the powder when opening the capsules.
Store at room temperature (15 - 30°C) and protect from excessive heat and moisture.

G - Special Precautions

Contraindications:

Patients with marked myelosuppression (WBC < 2.5 x 10⁹/L or platelets < 100 x 10⁹/L), or severe anemia
Patients who have demonstrated a previous hypersensitivity to hydroxyurea or any other component in its formulation

Other Warnings/Precautions:

Avoid the use of live vaccines.
Patient’s antibody response to inactivated vaccines may be suboptimal.
Avoid combination of hydroxyurea with antiretrovirals, particularly didanosine and/or stavudine, due to risk of serious toxicities. (Refer to interactions.)
Use with caution in patients who have recently received extensive radiotherapy or chemotherapy.
Exercise caution when driving or using machinery since hydroxyurea may cause drowsiness or other neurologic effects.
Some brands of hydroxyurea contain lactose; carefully consider use in patients with hereditary galactose intolerance, severe lactase deficiency or glucose-galactose malabsorption.

Other Drug Properties:

Carcinogenicity: Yes

Pregnancy and Lactation:

Fetotoxicity: Yes
Teratogenicity: Yes
Genotoxicity: Yes
Mutagenicity: Yes

Hydroxyurea is not recommended for use in pregnancy. Adequate contraception should be used by both sexes during treatment, and for at least 6 months after the last dose (for females) and 12 months after the last dose (for males).
Excretion into breast milk: Yes
Breastfeeding is not recommended.
Fertility effects: Probable

Male fertility may be affected, but may be reversible. Sperm banking should be offered for males due to effects on fertility.

H - Interactions

AGENT	EFFECT	MECHANISM	MANAGEMENT
Cytarabine	↑ Cytarabine toxicity	Unknown	Caution
Didanosine +/- stavudine, other antiretrovirals	↑ incidence of pancreatitis, liver failure and neurotoxicity	Unknown	Avoid
Myelosuppressive agents or radiation therapy	Can potentiate bone marrow depression	Additive	Caution
Uricosuric agents	↓ uricosuric effect	Hydroxyurea may ↑ uric acid levels	Adjust dose of uricosuric agents as necessary.
In vitro enzymatic assays	↑ urea, uric acid and lactic acid levels	Analytical interference by hydroxyurea	Caution; unknown relevance

I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Refer to the hepatitis B virus screening and management guideline for monitoring during and after treatment.

Recommended Clinical Monitoring

Monitor Type	Monitor Frequency
CBC	Baseline and as clinically indicated
Renal function tests	Baseline and as clinically indicated
Liver function tests	Baseline and as clinically indicated
Clinical assessment of fever, infection, bleeding, TLS, secondary malignancies (including skin), respiratory, skin, gastrointestinal, and neurologic effects	At each visit

Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

Monitor Type	Monitor Frequency
Serum folic acid	Baseline and as clinically indicated

J - Supplementary Public Funding

ODB - General Benefit (ODB Formulary )

hydroxyurea ()

K - References

Antonioli E, et al. Hydroxyurea-related toxicity in 3,411 patients with Ph'-negative MPN. Am J Hematol. 2012 May;87(5):552-4.

Belt RJ, Haas CD, Kennedy J, et al. Studies of hydroxyurea administered by continuous infusion: toxicity, pharmacokinetics, and cell synchronization. Cancer 1980;46:455-62.

Golightly L, Teitelbaum I, Kizer TH, et al. (Eds ). Dosage adjustment of medications eliminated by the kidneys, Springer, New York 2013.

Hydroxyurea monograph. Cancer Drug Manual. British Columbia Cancer Agency (BCCA). Accessed Jan 4, 2021.

Hydroxyurea: eDrugDex, Micromedex Healthcare Series.

Mason WP, Gentili F, Macdonald DR, et al. Stabilization of disease progression by hydroxyurea in patients with recurrent or unresectable meningioma. J Neurosurg 2002; 97: 341–6.

Product Monograph: Hydrea® (hydroxyurea). Bristol-Myers Squibb Canada, November 2022.

Rodriguez GI, Kuhm JG, Weiss, GR, et al. A bioavailability and pharmacokinetic study of oral and intravenous hydroxyurea. Blood 1998:91:533-41.

Summary of Product Characteristics: hydroxyurea (Hydrea®). Bristol-Myers Squibb Pharmaceuticals Ltd. (UK), July 2019.

March 2023 Updated Adverse effects, Dosing (including dose modification), and Monitoring sections

L - Disclaimer

Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.

The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.

Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.

While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.

CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.

Info Sheet Name:

hydroxyurea (patient)

Info Sheet Introduction:

For treating certain types of blood cancers, and may be used to treat other types of cancers

Info Sheet Date: Mercredi, mars 1, 2023 Info Sheet body:

Medication Information Sheet

hydroxyurea (Hi-drox-ee-your-EE-ah)

This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Hydrea®

Appearance:

capsule

What is this medication for?

For treating certain types of blood cancers, and may be used to treat other types of cancers

What should I do before I have this medication?

Tell your health care team if you have or had significant medical condition(s), especially if you have / had:

HIV or AIDS,
kidney or liver problems,
recent chemotherapy or radiotherapy,
a low blood count (anemia), or
any allergies.

Hydroxyurea capsules may contain a small amount of lactose. If you cannot have lactose, talk to your health care team.

Remember to:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.

How will this medication affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

How this medication may affect your sexual health.
How this medication may affect your ability to have a baby, if this applies to you.

This medication may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time for at least 6 months after your last dose (if you are female) and 12 months after the last dose (if you are male). Talk to your health care team about which birth control options are best for you.
Do not breastfeed while on this medication.

How is this medication given?

This medication is usually taken at about the same time on each treatment day. Talk to your health care team about how and when to take your medication.
Swallow whole with a glass of water, with or without food. If you have trouble swallowing capsules, talk to your health care team about what to do.
If you forget to take a dose of your medication, do not take extra (double up). Follow the instructions given to you or talk to your health care team if you are unsure about what to do. If you are unable to talk to your health care team, take your next dose at the usual time.
If you vomit (throw up) after taking your medication, talk to your health care team about what to do.
If you take too much of your medication by accident, or if you think a child or a pet may have swallowed your medication, you must call the Ontario Poison Control Center right away at: 1-800-268-9017.

To Prevent Tumor Lysis Syndrome (TLS)

TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough. TLS can make you very sick. Ask your health care team if you are at risk for TLS.

If you are at risk for TLS, you may be given medications before your hydroxyurea treatment to help prevent it.

These are called anti-uricemics (such as allopurinol), or others.

What else do I need to know while on this medication?

Will this medication interact with other medications or natural health products?

This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications and all other drugs, such as marijuana (medical or recreational)
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
Check with your health care team before starting or stopping any of them.

What should I do if I feel unwell, have pain, a headache or a fever?

Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
- Fever can be a sign of infection that may need treatment right away.
- If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

You have a fever if your temperature taken in your mouth (oral temperature) is:
- 38.3°C (100.9°F) or higher at any time
  
  OR
- 38.0°C (100.4°F) or higher for at least one hour.

If you do have a fever:

Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
Ask your health care team for the Fever pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

What to DO while on this medication:

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO talk to your health care team about your risk of getting other cancers after this treatment.
DO drink plenty of fluids (unless you have been told otherwise) to prevent kidney problems, especially when you first start taking this medication.
DO protect your skin from the sun. Wear a long sleeved shirt, long pants and a hat. Apply sunscreen with UVA and UVB protection and an SPF of at least 30.

What NOT to DO while on this medication:

DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel drowsy or dizzy.

How should I safely store this medication?

Do not throw out any unused medications at home. Bring them to your pharmacy to be thrown away safely.
Keep this medication in the original packaging at room temperature in a dry place, away from heat and light. Keep out of sight and reach of children and pets.
How to safely touch oral anti-cancer medications

If you are a patient:
- Wash your hands before and after touching your oral anti-cancer medication.
- Swallow each pill whole. Do not crush or chew your pills.
If you are a caregiver:
- Wear nitrile or latex gloves when touching tablets, capsules or liquids.
- Wash your hands before putting on your gloves and after taking them off, even if your skin did not touch the oral anti-cancer medication.
- Throw out your gloves after each use. Do not re-use gloves.
- Do not touch oral anti-cancer medications if you are pregnant or breastfeeding.
What to do if oral anti-cancer medication gets on your skin or in your eyes

If medication gets on your skin:
- Wash your skin with a lot of soap and water.
- If your skin gets red or irritated, talk to your health care team.
If medication gets in your eyes:
- Rinse your eyes with running water right away. Keep water flowing over your open eyes for at least 15 minutes.

What are the side effects of this medication?

The following table lists side effects that you may have when taking hydroxyurea. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on hydroxyurea.

Common Side Effects
Side effects and what to do	When to contact health care team
Low neutrophils (white blood cells) in the blood (neutropenia) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for? If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen). Do not eat or drink anything hot or cold right before taking your temperature. You have a fever if your temperature taken in your mouth (oral temperature) is: 38.3°C (100.9°F) or higher at any time OR 38.0°C (100.4°F) or higher for at least one hour. What to do? If your health care team has told you that you have low neutrophils: Wash your hands often to prevent infection. Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist. Keep a digital thermometer at home so you can easily check for a fever. If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.	If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.
Low platelets in the blood When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for? Watch for signs of bleeding: bleeding from your gums unusual or heavy nosebleeds bruising easily or more than normal black coloured stools (poo) or blood in your stools (poo) coughing up red or brown coloured mucus dizziness, constant headache or changes in your vision heavy vaginal bleeding red or pink coloured urine (pee) What to do? If your health care team has told you that you have low platelets: Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication. Check with your healthcare team before you go to the dentist. Take care of your mouth and use a soft toothbrush. Try to prevent cuts and bruises. Ask your health care team what activities are safe for you. Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a blood transfusion. If you have signs of bleeding: If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes. If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.	Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency help right away.
Low Appetite What to look for? Loss of interest in food or not feeling hungry. Weight loss. What to do? Try to eat your favourite foods Eat small meals throughout the day. You may need to take meal supplements to help keep your weight up. Talk to your health care team if you have no appetite Ask your health care team for the Loss of Appetite pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Diarrhea What to look for? Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment. What to do? If you have diarrhea: Take anti-diarrhea medication if your health care team prescribed it or told you to take it. Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol. Eat many small meals and snacks instead of 2 or 3 large meals. Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less. Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy. Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day. Ask your health care team for the Diarrhea pamphlet for more information.	Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day)
Nausea and vomiting What to look for? Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do? To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. If you were given anti-nausea medication(s), take them as prescribed, even if you do not feel like throwing up. Drink clear liquids and have small meals. Get fresh air and rest. Do not eat spicy, fried foods or foods with a strong smell. Limit caffeine (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: nausea lasts more than 48 hours vomiting lasts more than 24 hours or if it is severe	Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe
Rash; dry, itchy skin (May be severe) What to look for? You may have cracked, rough, flaking or peeling areas of the skin. Your skin may look red and feel warm, like a sunburn. Your skin may itch, burn, sting or feel very tender when touched. The rash may be seen in areas where you have had radiation before. What to do? To prevent and treat dry skin: Use fragrance-free skin moisturizer. Protect your skin from the sun and the cold. Use sunscreen with UVA and UVB protection and a SPF of at least 30. Avoid perfumed products and lotions that contain alcohol. Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less. Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.	Talk to your health care team if it does not improve or if it is severe
Fatigue What to look for? Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep. What to do? Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise. Pace yourself, do not rush. Put off less important activities. Rest when you need to. Ask family or friends to help you with things like housework, shopping, and child or pet care. Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less). Avoid driving or using machinery if you are feeling tired. Ask your health care team for the Fatigue pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

Yellowish skin or eyes, unusually dark pee, clay-coloured or white stools (poo)
New severe pain in the belly
Chest pain, or trouble breathing
Severe headache, loss of consciousness, seizures, confusion or hallucinations
Red or purple patches on the skin, a rash that looks like small bruises or skin ulcers
Fever, confusion, swelling in your hands, ankles, feet or other areas, unusual weight gain, lower back pain, muscle twitches or cramps, peeing less than usual
Severe fatigue, worsening muscle or joint pain/weakness, itchy red skin when exposed to sunlight, rash that is scaly, ring-like, or on the face (usually on cheeks and bridge of nose)

Who do I contact if I have questions or need help?

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

Other Notes:

____________________________________________________________________________

March 2023 Updated/Revised info sheet

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

Info Sheet (English):

hydroxyurea patient.pdf Info Sheet (French):

hydroxyurea pour le patient.pdf Monograph:

hydroxyurea.pdf Funding Program: ODB - General Benefit Funding Instance:

hydroxyurea

Phonetic Spelling:

Hi-drox-ee-your-EE-ah

Cancer Type: Hematologic Leukemia - Acute Lymphoblastic (ALL) Leukemia - Acute Myeloid (AML) Leukemia - Chronic Myeloid (CML) Myeloproliferative Neoplasms (MPNs) Type of Content: Drug Monograph Status: Null Info Sheet Status: Null Global Date: Jeudi, mars 2, 2023 Universal Date: 2023-03-02 00:00:00 AddThis: Title URL: hydroxyurea Drug Display Status: Active Revision Summary:
Drug Monograph: Updated Adverse effects, Dosing (including dose modification), and Monitoring sections
Patient Info Sheet EN: Updated/Revised info sheet
Patient Info Sheet FR: Updated/revised info sheet (Fiche d’information mise à jour/révisée)