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HYDREA may cause macrocytosiswhich is self-limitingand is often seen early in the course of treatmentThe morphologic change resembles pernicious anemiabut is not related to vitamin B12 or folic acid deficiencyThis may mask the diagnosis of pernicious anemiaProphylactic administration of folic acid is recommended.

Bone marrow suppressiondrop in white blood cellred blood cell and platelet countsanorexianauseavomitingdiarrheaconstipationsores in the mouthskin rashswelling in the handsfeetlegs and facechanges in skin pigmentationhair losspainful urinationdrowsinessheadachedizzinessdisorientationhallucinationsseizuresliver problemsshortness of breathmetabolic disturbancesand kidney problems.

Three mechanisms of action have been postulated for the increased effectiveness of concomitant use of hydroxyurea therapy with irradiation on squamous cellepidermoidcarcinomas of the head and neckIn vitro studies utilizing Chinese hamster cells suggest that hydroxyurea1is lethal to normally radioresistant S-stage cellsand2holds other cells of the cell cycle in the G1 or pre-DNA synthesis stage where they are most susceptible to the effects of irradiationThe third mechanism of action has been theorized on the basis of in vitro studies of HeLa cellsIt appears that hydroxyureaby inhibition of DNA synthesishinders the normal repair process of cells damaged but not killed by irradiationthereby decreasing their survival rateRNA and protein syntheses have shown no alteration.

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