I am allergic to the following medication(s):

My nausea medication(s) is/are:
Ondansetron (Zofran®) 8mg by mouth twice a day for days
Dexamethasone 4mg / 8mg by mouth twice a day for three days starting 1 day after chemotherapy treatment
Prochlorperazine (Stemetil®) 10mg by mouth every 6 hours only if needed for mild nausea
Lorazepam 0.5mg / 1mg by mouth every 6 hours only if needed for nausea that cannot be controlled with ondansetron and dexamethasone

Before each treatment, I will need to refill my prescriptions and bring them with me to Clinic.

My pain medication(s) is/are:
Codeine 15mg – 30mg by mouth every 6 hours only if needed for pain

My medication(s) for constipation is/are:
Senokot ___ tablets by mouth _______ time(s) a day
Lactulose 15mL to 30mL by mouth _____ time(s) a day
Docusate 100mg by mouth twice a day

Other medication(s) relating to my treatment include:
Loperamide (Imodium®) 4mg (2 tablets) by mouth at the first sign of diarrhea then 2mg (1 tablet) with every loose bowel movement
Loperamide (Imodium®) 4mg (2 tablets) by mouth at the first sign of diarrhea then 2mg (1 tablet) every 2 hours continuously until the diarrhea stops for 12 hours
Nystatin (Nilstat®) swish & swallow with 1 teaspoonful (5mL) four times a day for 10 days
Doctor Butler’s Mouthwash® swish & spit with 1 tablespoonful (15mL) four times a day

Other medications that I may need throughout my chemotherapy treatment may include:

Neupogen® 300mcg       DIN 01968017
Neupogen® 480mcg       DIN 01968017
Neulasta® 6mg               DIN 02249790    
Aranesp® 150mcg          DIN 02246360
Aranesp® 300mcg          DIN 02246360
Aranesp® 500mcg          DIN 02246360
Eprex® 20,000IU           DIN 02206072
Eprex® 40, 000IU          DIN 02240722

My current medication(s) that I take on a daily basis are:

Side effects of my chemotherapy treatment where I need to see my doctor (oncologist/haematologist or family doctor) or go to the Emergency Department: