• If you are allergic to any medicines, dyes, additives, or foods.

• If you have any type of liver disease (including hepatitis). This drug is cleared from the body mainly by the liver. Reduced liver function might result in more drug than expected staying in the body, which could lead to unwanted side effects. Your doctor may need to adjust your dose accordingly.

• If you have a history of or are taking medicines for gout or kidney stones. This drug may raise blood levels of uric acid, which could make these conditions worse and might require adjustments in these medicines.

• If you have any other medical conditions such as kidney disease, heart disease, diabetes, high blood pressure, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.

• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems with the fetus if taken at the time of conception or during pregnancy. Men and women who are taking this drug should use some kind of birth control during treatment. It is important to check with your doctor about what kinds of birth control can be used with this medicine. In pregnant women, treatment with this drug should be used only if the potential benefit to the mother outweighs the risk to the fetus.

• If you are breast-feeding. While no studies have been done, this drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug.

• If you think you might want to have children in the future. This drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs.

No other serious interactions with other drugs are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug may cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain.

This drug may increase your risk of constipation, which in some cases can be severe. Your doctor will likely prescribe a laxative or similar medicine to help prevent this from happening.

This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. These are sometimes related to being exposed to hot or cold temperatures. These symptoms can sometimes progress to include trouble walking or holding something in your hands. You will be watched closely for these symptoms. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better.

This drug may cause hair loss. You may want to talk to your doctor or nurse about getting a wig before starting treatment. If your insurance does not cover it, there may be other resources to help you. Hair loss is usually temporary, and your hair will likely grow back during or after treatment.

This drug can cause the rapid killing of tumor cells, which in some cases has led to serious kidney damage within the first 24 hours of treatment (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids to help prevent this.

Your doctor will likely test your blood frequently throughout your treatment, looking for possible effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccinations), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

• constipation*
• hair loss*
• feeling tired

• pain or redness at the infusion site*
• nausea/vomiting*
• loss of appetite
• diarrhea
• changes in how things taste
• lowered white blood cell count with increased risk of infection*
• lowered blood platelet count with increased risk of bleeding*
• lowered red blood cell count (anemia)

• numbness, tingling, or pain in the hands, feet, or elsewhere*
• mouth sores*
• allergic reaction (may include rash, fever, rapid heart rate, shortness of breath, throat swelling, dizziness)
• trouble urinating
• headache
• depression
• jaw pain
• skin rash

*See the "Precautions" section for more detailed information.