Early (onset days to weeks)
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Neutropenia
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Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively.
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Thrombocytopenia
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A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding.
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Skin rash
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Temozolomide can cause skin reactions including pruritis, erythema, and generalised maculopapular rash, which may be delayed in onset. An oral desensitisation protocol may be considered to rechallenge a patient with a cutaneous reaction to temozolomide, where there are no suitable alternative agents. Consult a specialist neuro-oncology centre and/or an immunologist for expert advice regarding temozolomide desensitisation.
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Side effects of corticosteroids
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Insomnia, oedema, increased risk of infection e.g. oral thrush, gastric irritation, worsening of peptic ulcer disease, increased blood sugar levels, loss of diabetic control, mood and behavioural changes - including anxiety, euphoria, depression, mood swings, increased appetite and weight gain, osteoporosis and fractures (long term use), bruising and skin fragility are associated with corticosteroid use.
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