Pluvicto (Lu177) side effects... please hydrate!

[noahware]

I thought about posting this a few days ago, and the recent post on chemo by AlvinSD reminded me to do it. It's been a full week since I did my 5th Pluvicto infusion, and I am still suffering from some side effects. Some of those SEs are new to this infusion, some are ones I experienced after prior sessions but are worse this time.

While I can't be sure, I attribute this primarily to insufficient hydration this time around. For all four of the prior infusions, I made a point of drinking LOTS of fluids not just on the day of (and after) the treatment, but for a few days BEFOREHAND. This time I had been suffering some non-cancer-related back pain for the few weeks prior and had not been sleeping well at all. I was exhausted, groggy and depressed during the days leading up to my Pluvicto and I completely neglected any conscious effort to pre-hydrate, let alone stay well-hydrated on that day. Trying to catch up the day after isn't gonna cut it.

Fatigue has been much worse, and still persists. I am having minor headaches and generally feel like crap. My appetite exists but has not returned to normal, as I am only happy now with carbs like bread, beans, pasta and fruit and even the thought of many vegetables, healthy-fat and high-protein foods -- that I normally enjoy -- can repel me. [Actual nausea is the one side effect I am experiencing LESS OF than I did with a few prior infusions, thanks to taking Zofran (ondansetron) for a few days. I highly recommend this medication for preventing nausea... it worked not just for the Pluvicto, but for the contrast used with CT scans that had been causing me problems.]

A side effect new to me arose with this infusion: dry mouth. Even after a week, I am finding I need to sip something multiple times during the night, mouth completely dry. This is not due to dehydration I am experiencing NOW, but it seems to make sense that my salivary glands could have suffered due to the dehydration I was experiencing last week.

Maybe it's just the the glands took more of a hit this time because they got increasingly PSMA-avid relative to the cancer cells in my body. But that's not something I can control. Drinking water is. So please remember to stay WELL-hydrated with this therapy!

[cesces]

thanks for

[EdBacon]

How bad is the nausea? I will be starting Pluvicto in January.

[noahware in reply to EdBacon]

On my first and third infusions, it hit about six hours after (bad enough that I lost my dinner on the first), and lingered a bit into the following day. This is supposedly not that common.

By the fourth infusion, I decide to take Zofran (one pill just befor infusion, another 8 hours later) and experienced no nausea.

Fatigue was mild but noticeable, 1-3 days (usually peaking day 2). This seems more common. No other effects for me, until my fifth, where I was dehydrated.

Good luck!

[Biobro]

Hi noahware,. Sorry to hear about your side effects. One thing that might help with dry mouth is to suck sour lemon drops. Hubby had second infusion last week in Austin TX and the doc handed him a ton of the drops and said suck one every 2 hours for the first 24 then as needed. This was a new recommendation. It seems to have worked. It gets the saliva streaming immediately and apparently prevents dry mouth from setting in.

[noahware in reply to Biobro]

Thanks. Actually, I was very good about this on my first four infusions, but again, let my guard down on my fifth.. Way back in the spring before I started, I thought it made sense for increased saliva flow to flush salivary glands (just as hydrating helps flush the kidneys). So I got gum and mints specifically designed to stimulate saliva for those with dry mouth.

As well as lemon, ginger is also very good at stimulating saliva. (I further theorized that spitting as much excess saliva as possible into a receptacle may be better than swallowing it and putting it into your digestive tract.)

Good luck with the treatments!