IXEMPRA

Tiredness/fatigue

Feeling tired is a common side effect of IXEMPRA. Even with plenty of rest, you can still feel tired.

• In one clinical trial, 60% of women who received IXEMPRA and Xeloda and 29% of women who received Xeloda alone had fatigue
• In another clinical trial, 56% of women who received IXEMPRA alone had fatigue

Below are tips you may want to talk with your doctor about trying.

Try to pace yourself. Decide on the most important things to do each day. Then pace yourself. Let others help
with shopping, cooking, and driving Take short walks. For some people, being active can help more than resting. Ask your healthcare provider about
exercise. Research shows that the right amount, type, and time of exercise may help lessen fatigue and also help
you sleep better. Your healthcare provider may be able to suggest other ways to be more active Sleep at least 8 hours at night. You may not be used to sleeping a full 8 hours. Your body may need more sleep
than it needed before you started chemotherapy Keep track of how you feel. This may help you plan your activities for the day

Loss of appetite

IXEMPRA may affect your appetite. You may not feel like eating for different reasons, such as a changed sense of taste or smell, nausea, pain, or depression.

Loss of appetite

• In one clinical trial, 34% of women who received IXEMPRA and Xeloda and 15% of women who received Xeloda alone had a loss of appetite
• In another clinical trial, 19% of women who received IXEMPRA alone had a loss of appetite

Change in taste

• In one clinical trial, 12% of women who received IXEMPRA and Xeloda and 4% of women who received Xeloda alone had a change in taste
• In another clinical trial, 6% of women who received IXEMPRA alone had a change in taste

Below are tips you may want to talk with your doctor about trying.

Eat frequent mini meals or snacks, instead of 3 big meals Eat high-calorie, high-protein foods and drinks, like chicken, ice cream, peanut butter, and milk shakes, when
you do feel like eating. If you have diarrhea or constipation, you may need to be careful about the foods you eat.
Talk with your healthcare provider about what you should eat Have liquid meals, such as smoothies, juices, soup, or nutritional drinks Take a short walk before meals to increase your appetite

Problems with your toenails and fingernails

With IXEMPRA^® (ixabepilone), nails may turn dark or yellow or get brittle and cracked. Nails sometimes fall off.

• In one clinical trial, 24% of women who received IXEMPRA and Xeloda and 10% of women who received Xeloda alone had problems with nails
• In another clinical trial, 9% of women who received IXEMPRA alone had problems with nails

Below are tips you may want to talk with your doctor about trying.

Wear gloves when washing dishes, gardening, or cleaning the house Use a nail strengthener. For brittle or cracked nails, use products that you apply to your nails to make them stronger

Hair loss

With IXEMPRA^® (ixabepilone) may damage the cells that cause hair growth. Hair loss can occur anywhere on your body.

• In one clinical trial, 31% of women who received IXEMPRA and Xeloda and 3% of women who received Xeloda alone had hair loss
• In another clinical trial, 48% of women who received IXEMPRA alone had hair loss

Below are tips you may want to talk with your doctor about trying.

Consider cutting your hair. This may help you adjust to the physical and emotional changes that happen with hair loss Buy a wig while you still have some hair. Then you can match the color and style of the wig to your own hair.
Check to see if your insurance covers the cost of a wig, which may be called a hair prosthesis

Fever

Call your healthcare provider right away if your temperature is 100.5F or higher.

This may be a sign of infection. If you get a fever or infection when your white blood cell count is very low, you can become seriously ill and die. You may need treatment in the hospital with antibiotic medicines. Your healthcare provider will monitor your white blood cell count often with blood tests.

• In one clinical trial, 10% of women who received IXEMPRA and Xeloda and 4% of women who received Xeloda alone had fever
• In another clinical trial, 8% of women who received IXEMPRA alone had fever.

Below are tips you may want to talk with your doctor about trying.

Drink lots of liquids, such as soup, juice, water, or soda, or eat ice pops Take your temperature every 2 to 3 hours and record the readings. Share this information with your healthcare provider Use cold compresses on your forehead if you feel hot

Decreased red blood cell count (anemia)

With fewer red blood cells, your body may not get enough oxygen. This can make you tired. You may also have shortness of breath and feel dizzy. These are common symptoms of anemia They also may be symptoms of a serious side effect. If you have any of these symptoms, call your healthcare provider right away.

• In one clinical trial, 10% of women who received IXEMPRA and Xeloda and 5% of women who received Xeloda alone had anemia
• In another clinical trial, 8% of women who received IXEMPRA alone had anemia

Below are tips you may want to talk with your doctor about trying.

Stand up slowly after lying down. This may prevent feeling dizzy or faint Get enough rest. Try to sleep for at least 8 hours every night Eat the right foods. You need enough calories to keep your weight up. You also need enough protein to help your
body heal. Let your healthcare provider or a dietitian help you plan a healthy menu

Joint and/or muscle pain

With IXEMPRA^® (ixabepilone), you may feel pain in your body.

• In one clinical trial, 39% of women who received IXEMPRA and Xeloda and 5% of women who received Xeloda alone had joint and muscle pain
• In another clinical trial, 49% of women who received IXEMPRA alone had joint and muscle pain

Below are tips you may want to talk with your doctor about trying.

Use heat packs or a heating pad. Be sure that the heating pad is not too hot. Do not put a heating pad on bare skin. Do not fall asleep with a heating pad on Take warm baths to soothe aching muscles. Distract yourself. Try meditation, watching TV, listening to music, or visiting with family and friends

Headache

With IXEMPRA^® (ixabepilone) may cause headache.

• In one clinical trial, 8% of women who received IXEMPRA and Xeloda and 3% of women who received Xeloda alone had headache
• In another clinical trial, 11% of women who received IXEMPRA alone had headache

Below are tips you may want to talk with your doctor about trying.

Practice relaxation techniques to relieve any tension. Try deep breathing or picturing a peaceful place Distract yourself with music.Listen to music that is slow and quiet

Bleeding and bruising easily

Platelets help your blood clot when you bleed. When you don’t have enough platelets, you may get nosebleeds, a rash of tiny red dots, or purple bruises when you bump into things.

• In one clinical trial, 8% of women who received IXEMPRA and Xeloda and 4% of women who received Xeloda alone had decreased platelet count
• In another clinical trial, 7% of women who received IXEMPRA alone had decreased platelet count

Below are tips you may want to talk with your doctor about trying.

Bleeding and bruising easily Blow your nose gently Apply gentle pressure on any cuts until the bleeding stops Use a very soft toothbrush. Before you brush, run hot water over the bristles to soften them more. Avoid flossing and
using toothpicks. Talk with your healthcare provider about ways to care for your mouth and teeth during treatment Use an electric shaver instead of a razor for injury Be careful when you’re active.Choose activities that have less chance for injury

Nausea and vomiting

Nausea and vomiting can occur with IXEMPRA^® (ixabepilone). These side effects can occur during or right after treatment, or days later.

Nausea

• In one clinical trial, 53% of women who received IXEMPRA and Xeloda and 40% of women who received Xeloda alone had nausea
• In another clinical trial, 42% of women who received IXEMPRA alone had nausea

vomiting

• In one clinical trial, 39% of women who received IXEMPRA and Xeloda and 24% of women who received Xeloda alone had vomiting
• In another clinical trial, 29% of women who received IXEMPRA alone had vomiting

Below are tips you may want to talk with your doctor about trying.

Eat when it is right for you. Some people feel better eating before treatment. Other people feel better having
treatment on an empty stomach. Decide what works best for you Keep away from foods with a strong odor, like onions, coffee, fish, and garlic. Strong odors can trigger nausea Eat a diet of bland, easy-to-digest foods.These could include clear broth, cranberry juice, broiled/baked chicken without
the skin, instant oatmeal, white toast, saltine crackers, noodles, gelatin, canned fruit, and sherbet or sorbet Suck on ice chips, or try taking small bites of ice pops or fruit ices

Diarrhea

Diarrhea may happen when IXEMPRA^® (ixabepilone) harms the healthy cells that line the intestines.

• In one clinical trial, 44% of women who received IXEMPRA and Xeloda and 39% of women who received Xeloda alone had diarrhea
• In another clinical trial, 22% of women who received IXEMPRA alone had diarrhea

Tell your healthcare provider if your diarrhea lasts more than 24 hours or if you have pain or cramping. Below are tips you may want to talk with your doctor about trying.

Drink at least 8 cups of liquid every day to stay hydrated. Choose water, clear broth, or sports drinks. Have your
drinks at room temperature Eat low-fiber foods. High-fiber foods can worsen diarrhea. Try eating chicken or turkey (skinless), eggs,
cottage cheese,
white rice, boiled or mashed potatoes, bananas, clear juice, canned fruit, gelatin, saltine crackers, and sherbet
or sorbet Eat foods high in sodium and potassium to replace what you may lose with diarrhea. Examples are bananas,
oranges, peach or apricot nectar, and boiled or mashed potatoes Avoid alcohol, caffeine (coffee, tea, cola, chocolate), milk products, and greasy or fried foods

Constipation

IXEMPRA^® (ixabepilone) may causeconstipation You may have gas cramping, or a bloated and nauseated feeling.

• In one clinical trial, 22% of women who received IXEMPRA and Xeloda and 6% of women who received Xeloda alone had constipation
• In another clinical trial, 16% of women who received IXEMPRA alone had constipation

Talk with your healthcare provider if you have not had a bowel movement in 2 days.

Your healthcare provider may suggest additional ways to deal with your constipation.

Below are tips you may want to talk with your doctor about trying.

Drink at least 8 cups of water or other fluids every day. Drinks that may help with constipation include warm or hot
coffee or tea, and prune juice Avoid grapefruit juice while you are receiving IXEMPRA. Drinking grapefruit juice may cause you to have too much IXEMPRA in your blood and may lead to side effects Eat high-fiber foods to help soften your stools. Choose food such raw or cooked vegetables, cooked dried beans and peas,
whole-grain breads and cereals, brown or wild rice, fresh and dried fruit, nuts, and popcorn Try to be active every day. Ask your healthcare provider about the type and amount of activity that is right for you.
He or she can suggest chair or bed exercises, if needed

Abdominal Pain

Talk with your healthcare provider if you are experiencing abdominal pain. He or she can provide you with tips to cope with the side effect.

Sores on the lips, in the mouth, and in the throat

Damage to the fast-growing cells lining the lips, the mouth, and the throat may cause you to have open red sores and greater sensitivity to heat and cold.

• In one clinical trial, 31% of women who received IXEMPRA and Xeloda and 20% of women who received Xeloda alone had sores on the lips, in the mouth, and in the throat
• In another clinical trial, 29% of women who received IXEMPRA alone had sores on the lips, in the mouth, and in the throat

Below are tips you may want to talk with your doctor about trying.

Puree cooked foods in a blender to make them easier to eat Clean your teeth with cotton swabs if brushing with a toothbrush is too painful Choose foods you can eat cold or at room temperature if hot foods hurt your mouth or throat Suck on ice chips or ice pops to help soothe mouth pain Avoid eating foods that may hurt your mouth. Examples are sharp, crunchy foods, spicy foods, citrus fruit or juices
(such as orange, lemon, and grapefruit), high-sugar foods and drinks, alcoholic drinks, and tobacco products Gently floss every day, avoiding any areas that hurt or bleed

Tender, red hands and feet (hand-foot syndrome)

The palms of your hands and the soles of your feet may look sunburned and may be painfully sensitive. In severe cases, the skin may blister and become dry and peel. There may also be numbness and tingling.

• In one clinical trial, 64% of women who received IXEMPRA and Xeloda and 63% of women who received Xeloda alone had hand-foot syndrome
• In another clinical trial, 8% of women who received IXEMPRA alone had hand-foot syndrome

Below are tips you may want to talk with your doctor about trying.

Keep out of the sun as much as possible Apply sunscreen of at least 30 SPF at least 1 to 2 hours before you go outside. Wear protective clothing and a hat
whenever you’re outside Put gel inserts in your shoes if your feet are sensitive Avoid wearing tight-fitting shoes Bathe in lukewarm or cool water instead of hot water Use mild soaps and body wash that do not have perfume, alcohol, or dye Moisturize twice a day with a thick lotion or a cream that does not contain perfume, dye, or alcohol Apply lotion when skin is still damp

Tingling, numbness, or burning in the hands or feet, or extreme sensitivity to touch (peripheral neuropathy)

Peripheral neuropathy (PN) is an an unpleasant feeling in the hands and feet that is caused by nerve damage. This can lead to problems, such as weakness, balance problems, and trouble walking. Your dose of IXEMPRA may need to be lowered or stopped until these symptoms get better. Or you may need to stop taking IXEMPRA permanently. Be sure to follow your healthcare provider’s advice on ways to manage PN.

• In one clinical trial, 67% of women who received IXEMPRA and Xeloda had PN
• In another clinical trial, 63% of women who received IXEMPRA alone had PN

Tell your healthcare provider as soon as you notice these symptoms. When they do happen, these symptoms often appear early in treatment and may be new or get worse. Your dose of IXEMPRA may need to be decreased, stopped until your symptoms get better, or stopped totally

Below are tips you may want to talk with your doctor about trying.

Be careful when you handle sharp objects, like scissors and knives Avoid slipping hazards. Remove small rugs; use no-slip mats; use handrails Wear shoes with rubber soles inside and outside the house Use a thermometer to check your bath or shower water temperature, instead of your hand Wear gloves for household chores like dish washing, gardening, and cleaning

Low white blood cell count (neutropenia)

Having a low white blood cell count means your body cannot fight infections very well and you have a greater chance of getting an infection. Signs of infection can include fever (temperature over 100.5F), chills, cough, and/or burning or pain when urinating. If you get a fever or infection when your white blood cells are very low, you can become seriously ill and die. You may need treatment in the hospital with antibiotics medicines. Your healthcare provider will monitor your white blood cell count often with blood tests. Tell your healthcare provider right away or go to the nearest emergency room if you have signs of infection.

• In one clinical trial, 36% of women who received IXEMPRA and Xeloda and 2% of women who received Xeloda alone had severe neutropenia
• In another clinical trial, 23% of women who received IXEMPRA alone had severe neutropenia

Below are tips you may want to talk with your doctor about trying.

Stay away from people who are sick. Do not be around people with colds, flu, measles, or chicken pox Be careful not to cut or nick yourself. Use an electric shaver, and be careful using scissors, needles, or knives Clean cuts right away, using warm water, soap, and an antiseptic Do not get any vaccine without first talking with your healthcare team. Some vaccines contain live viruses, which may make you sick