Hyperphosphatemia
Gastrointestinal Toxicities
Dermatologic Toxicities
Ocular Toxicities
Fatigue
Hyperphosphatemia
• Dietary modifications to reduce phosphorus intake
• Phosphate-lowering therapies (phosphate binders, phosphaturic agents)
Gastrointestinal Toxicities
Dry mouth and stomatitis
• Address any underlying dental issues prior to starting therapy;
• encourage proper dental hygiene; dietary modifications
• Use of sialagogues and mucosal lubricants for dry mouth
• Dexamethasone elixir or betamethasone dipropionate gel (0.05%)
Diarrhea
• Optimize fluid intake; use of probiotics, loperamide; rule out
• infectious etiology
Dermatologic Toxicities
Dry skin, palmar-plantar erythrodysesthesia syndrome
• Regular use of skin moisturizers, urea preparations
• Prophylaxis using urea-based creams (≥ 10%); limiting rubbing activities
• on hands and feet
• Treat with agents containing urea (≥ 10%) or possibly high-potency
• topical corticosteroid
Alopecia
• Prophylaxis and treatment with minoxidil (5%), high-potency
• topical corticosteroid
Nail Changes (onycholysis, paronychia, discoloration, nail hypertrophy)
• Patient education and counseling prior to treatment
• Rule out possible fungal infection (onycholysis)
• Avoid prolonged contact with water and repeated friction/trauma to
• nails and nail beds
• Use of topical emollients
• Limit use of nail polish removers and nail hardeners
Ocular Toxicities
Dry eyes, blurry vision, floaters, trichomegaly, central serous retinopathy, retinal detachment
• Regular ophthalmic examinations at baseline and during therapy to
• ensure early identification of retinopathy or other ocular effects
• Use of artificial tears for dry eyes
Fatigue
• Comprehensive metabolic, mineral, and hematologic evaluations;
• correct for any deficiencies
• Advise on proper nutrition, exercise, sleep
• Offer psychological support if needed
