Vertigo and Folfirinox?

I got vertigo AFTER my chemo was done. It literally woke me up in the middle of the night with the bed spinning. I was alone and away on vacation in another country, so when it happened, I did the epley maneuver on my bed with a pillow. As per a simple google search, it explains you may need to do this several times over several days. It worked. And I did need to repeat it again the next day cause I was still pretty dizzy and afraid to jump back on my bicycle. It worked. Be patient. It never returned after these incidents. If you research it, it has to do with crystal in your inner ear. I always remind myself that these things, along with neuropathy, are minor things I need to deal with to be ALIVE !! Thank you chemo !

My husband has been light headed continually for the last few months from chemo, but has not described it as vertigo. He thought at first it was from blood thinners, but the oncologist and nurses felt more likely from dehydration.

Four causes of syncope (dizziness) come to mind when I was on Folfirinox treatment.:

Orthostatic hypotension (postural hypotension) is one common cause. It happens after lying or sitting down. It happened to me several times with the worst episode of passing out and hitting the ground. A cardiovascular exam found no issues with cardiac output, BP or occlusions in the arteries.

A second cause is dehydration and this was my most frequent cause, especially when I was on Folfirinox. Post infusion hydration therapy was helpful in stopping it.

Vertigo (Benign Paroxsimal Positional Vertigo-BPPV) also happened when on Folfirinox. It results from crystals of calcium carbonate in a semi-circular canal of the inner ear that break off and float into a different semi-circular canal affecting balance. If diagnosed, there is a procedure done by an occupational therapist making head positional movements to get the crystals back into the middle loop. There are YouTube videos for self-treatment if diagnosed, but I found it just as easy seeing an occupational therapist that resolved the symptoms within minutes.

The fourth cause was occurring from a maintenance drug I take that causes anemia. With a significant decrease in RBC’s, Hgb and HCT parameters, there is less oxygen carrying capacity of RBC’s.I would notice the symptoms doing strenuous activities, getting up suddenly from a lying position or after squatting. That was the clue I needed to take a short break from the medication to give the bone marrow a rest so more RBC’s got produced. When caused by suppression by medication impacting the bone marrow, it took about three weeks to recover. I am aware of onset of symptoms and don’t try to push it to the point I would need a transfusion. Taking pauses every six months of the drug has been effective.

Thank you. Yes, my husband passed out once too from standing from a sitting position and walking up the stairs. Luckily he was at the top of the steps when he went down. He's now more careful about going from laying down, sitting up straight, and getting ready to stand and that has helped the fainting. He's been going in for hydration every few days. Just had #12 a week ago, so we'll see next week what the doctor will suggest next... and hopefully this was a folfirinox issue that will be resolved. I appreciate your comprehensive reply!

My husband is now on Gem/Abrax after 10 months on Folfirnox and continues with the light headed feeling. Worse lately. Not sure if it is caused by other drugs he is taking... or as others have mentioned, possibly dehydration. It is concerning. His blood counts... white, red, platelets ... are low so maybe that?

I did not experience vertigo on either Folfirinox or GemAbraxCis, but did have frequent other issues related to dehydration.

Similar to the first response, I did have episodes of vertigo about 5 weeks after stopping the GemAbraxCis. They were apparently related to dehydration, were pretty short in duration, and resolved on their own after 1-2 weeks.

It's easier to become dehydrated (chronically in my case) than you think. If you're getting regular blood tests, low EGFR, high creatine, and high BUN (to some extent) may be indicative of the need for more fluids.

Oxaliplatin (in Folfirinox) and Cisplatin (in my GAC) are both tough on the kidneys, and may require extra fluids and/or dose reductions to avoid longer-term kidney damage. Either/both may relieve the vertigo as well.

I get an extra liter of saline by IV after my biweekly GA chemo, another liter at home the day after, and another liter a week after that.

Has he had his vitamin D level checked? The reason I ask is because the physical therapist my husband saw for the vertigo issue mentioned that it could be caused by a vitamin D deficiency. MSK's blood work did not include checking vitamin D level, so he had his primary care doctor order it and it was severely low, like practically non existent! He started taking a vitamin D supplement and did not have any more vertigo issues. It might be worth looking into. I hope he gets some relief soon.

thank you lisn. Definitely worth checking. I appreciate your suggestion.