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Xeloda Side Effects: What You Should Know
Xeloda (capecitabine) is a prescription brand-name medication. The Food and Drug Administration (FDA) has approved it to treat specific types of cancers in certain adults. These include:
Here are some fast facts about Xeloda:
Your doctor may prescribe Xeloda for 6 months. Or they may prescribe the drug longer than that. This depends on your cancer type and how your body responds to the drug.
As with other drugs, Xeloda can cause side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Xeloda, including details about its uses, see this article.
Xeloda can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
These are just a few of the more common side effects reported by people who took Xeloda in clinical trials:
Mild side effects can occur with Xeloda use. This list doesn't include all possible mild side effects of the drug. For more information, you can refer to Xeloda's prescribing information.
Mild side effects that have been reported with Xeloda include:
These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Xeloda and want to tell the FDA about it, visit MedWatch.
Xeloda may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to Xeloda's prescribing information.
If you develop serious side effects while taking Xeloda, call your doctor right away. If the side effects seem life threatening or you think you're having a medical emergency, immediately call 911 or your local emergency number.
Serious side effects that have been reported and their symptoms include:
Xeloda may cause several side effects. Here are some frequently asked questions about the drug's side effects and their answers.
What side effects of Xeloda should I expect during my week off treatment?
Typically, you won't experience any new side effects during your week off Xeloda treatment. In fact, any side effects that you experience from Xeloda should improve during your week off.
Xeloda is taken in cycles. Each cycle lasts 3 weeks. In the first 2 weeks, you'll take Xeloda twice per day. Then, in the last week, you won't take Xeloda at all.
If you experience side effects with Xeloda treatment, they should ease during this week off. However, if you notice any new or worsening side effects, be sure to tell your doctor. They can help determine what may be causing these side effects.
How long before Xeloda side effects typically start?
The timing and severity of Xeloda's side effects can vary from person to person.
For example, diarrhea is the most common side effect of Xeloda. Some people may develop this side effect after taking Xeloda for just 1 day or longer than that. It's possible to also develop diarrhea after taking the drug for over a year. Among the people who had diarrhea in clinical trials, half started experiencing it about 34 days after beginning Xeloda treatment.
If you have questions about when side effects could start during Xeloda treatment, talk with your doctor. They'll recommend ways to manage them.
Learn more about some of the side effects that Xeloda may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for Xeloda.
Hand-foot syndrome
It's possible to experience hand-foot syndrome from Xeloda treatment. Hand-foot syndrome is a skin condition that can become severe. And it may occur as a side effect of taking certain drugs, such as chemotherapy. Hand-foot syndrome was a common side effect of Xeloda.
Symptoms can include the following in your hands and feet:
The above symptoms can be mild or severe. In severe cases, it's also possible for hand-foot syndrome to affect your fingerprints.
What you can do
It's important to tell your doctor if you experience any of the above symptoms. They can treat the condition right away.
If you have mild symptoms, your doctor may monitor your condition to be sure that it doesn't worsen. They may also recommend an over-the-counter drug, such as acetaminophen (Tylenol) or ibuprofen (Advil), to help relieve pain
If you have severe symptoms, your doctor may recommend pausing Xeloda treatment until your symptoms ease. In some cases, they may recommend a lower dosage of Xeloda. (To learn more about Xeloda's dosage, see this article.)
Hair loss
You may experience hair loss from taking Xeloda. Hair loss was reported in clinical trials of the drug. However, it was not a common side effect.
What you can do
If you notice hair loss during your Xeloda treatment, especially if it's severe or bothersome to you, tell your doctor. In some cases, they may recommend ways to manage your hair loss.
Eye problems
It's possible to develop problems that affect your eyes while you're taking Xeloda. Examples include eye irritation, swelling, or infection, such as conjunctivitis (pink eye).
Eye problems were not commonly reported in people taking Xeloda. And in most cases, they were mild. However, it's still important to be aware of symptoms of eye side effects before you start Xeloda treatment.
What you can do
Tell your doctor if you notice any eye problems during your Xeloda treatment. They can help determine if Xeloda is the cause of these side effects. Your doctor or pharmacist can also recommend the best way to treat these side effects. In some cases, they may recommend medications, such as eyedrops, to help prevent these eye problems from occurring.
Severe skin reactions
It's rare, but possible for Xeloda to cause severe skin reactions. Some of these may be serious and even life threatening. Examples of these conditions include Stevens-Johnson syndrome and toxic epidermal necrolysis. It isn't clear whether these reactions occurred in clinical trials of the drug. However, rare types of skin reactions have been reported after the drug became available for use. Due to this risk, you should be aware of the possible symptoms of skin reactions.
What you can do
If you develop symptoms of a severe skin reaction, see a doctor right away. They can help get treatment for your skin reaction as soon as possible.
If you have a severe skin reaction, your doctor will likely recommend you stop taking Xeloda. They may prescribe a different medication to treat your cancer.
It's also possible for Xeloda to cause another skin condition called hand-foot syndrome. This is a skin problem that can occur in people taking certain medications. Your doctor can help determine what skin condition you're experiencing. (For more information on hand-foot syndrome, see "Hand-foot syndrome" above.)
Neuropathy
It's possible for Xeloda to cause neuropathy (nerve damage). Neuropathy was not a common side effect reported in clinical trials of Xeloda. Specifically, Xeloda may cause peripheral neuropathy. This is a type of neuropathy that affects your hands and feet.
Symptoms of peripheral neuropathy can include the following in your hands or feet:
It's also possible for Xeloda to cause another condition called polyneuropathy. With polyneuropathy many nerves are affected.
What you can do
If you notice symptoms of neuropathy during your Xeloda treatment, tell your doctor. They may recommend medications to decrease your neuropathy symptoms. In some cases, they may recommend a different treatment option for your cancer.
Allergic reaction
Symptoms can be mild or serious and can include:
What you can do
Be sure to tell your doctor about any medications that you're allergic to. If you've had an allergic reaction to a chemotherapy drug called fluorouracil, you may also have an allergic reaction to Xeloda.
For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Xeloda. But if your symptoms are serious and you think you're having a medical emergency, immediately call 911 or your local emergency number.
Tell your doctor about any medications or medical conditions that you have before you start treatment with Xeloda. They can help you determine if Xeloda may be safe for you.
Boxed warning: Risk of interaction with warfarin
Xeloda has a boxed warning for the risk of interaction if it's taken with certain blood thinners, including warfarin (Jantoven). This is a serious warning from the Food and Drug Administration (FDA).
If you take Xeloda along with certain blood thinners, you may have an increased risk of bleeding. In some cases, this bleeding may be serious or even life threatening. Bleeding may occur within a few days of starting Xeloda treatment. However, in some people, it can occur even 1 month after stopping Xeloda treatment. If you're over 60 years old, your risk of bleeding may be higher.
Before you start Xeloda treatment, it's important to tell your doctor about any medications you're taking. They can help you determine if it's safe for you to take Xeloda with these drugs.
In some cases, if you're taking certain blood thinner drugs, your doctor may monitor your blood more often. If needed, they can adjust the dosage of your blood thinner to avoid an increased risk of bleeding.
Other precautions
Be sure to talk with your doctor about your health history before you take Xeloda. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:
Kidney problems. It's possible for Xeloda to cause dehydration due to severe digestive side effects, such as diarrhea or vomiting. This may lead to kidney problems. If you already have kidney problems, taking Xeloda may worsen your condition. Due to this risk, your doctor may prescribe a lower dosage* of Xeloda. If you have severe kidney problems, your doctor may recommend a different treatment option for you.
Allergic reaction. If you've had an allergic reaction† to Xeloda or any of its ingredients, your doctor will likely not prescribe the drug. Also, your doctor will likely not prescribe Xeloda if you've had an allergic reaction to a chemotherapy drug called fluorouracil. (When you take Xeloda, your body converts it into fluorouracil.) Ask your doctor what other medications may be better options for you.
Heart conditions. It's possible for Xeloda to cause heart problems, such as irregular heartbeat or heart attack. If you already have heart disease, you may have an increased risk of developing these heart problems from taking Xeloda. Xeloda may also worsen your existing condition. Your doctor can help determine if it's safe for you to take Xeloda.
Liver problems. Tell your doctor if you have any liver problems before starting treatment with Xeloda. Liver problems may increase your risk of side effects from taking Xeloda. If you have liver problems, your doctor can determine if it's safe for you to take the drug.
Dihydropyrimidine dehydrogenase deficiency. Tell your doctor if you have a condition called dihydropyrimidine dehydrogenase (DPD) deficiency. People with this condition have lower levels of DPD (a type of enzyme) than usual. If you have this condition, you may have an increased risk of side effects from taking Xeloda. In most cases, your doctor will not prescribe you Xeloda if you have DPD deficiency. Talk with your doctor about the best treatment options for you.
Alcohol use with Xeloda
However, drinking alcohol during your Xeloda treatment may worsen any side effects you may develop from the drug.
For example, both Xeloda and alcohol can cause similar symptoms, including:
So, drinking alcohol while you're taking Xeloda can further increase your risk of these side effects. In addition, alcohol may make mouth sores more painful. (Mouth sores are a possible side effect of Xeloda.) So, if you have mouth sores, your doctor may recommend avoiding alcohol.
If you'd like to drink alcohol during your treatment with Xeloda, talk with your doctor.
Pregnancy and breastfeeding while taking Xeloda
Xeloda is not safe to take during pregnancy or while you're breastfeeding.
This medication can cause harm to a developing fetus. There haven't been any studies done in humans taking Xeloda during pregnancy. However, in animal studies, Xeloda caused pregnancy loss. But keep in mind that animal studies do not always indicate what may happen in humans.
Due to this risk, your doctor will have you take a pregnancy test before starting Xeloda treatment. Females* who can become pregnant should also use birth control while taking Xeloda. And they should use it for at least 6 months after stopping treatment.
Males* who have female partners taking Xeloda should use birth control during treatment and for at least 3 months after their last dose.
It's not known if Xeloda passes into breastmilk or what effects the drug may have on a breastfed child. Due to the possible risks, your doctor will not recommend breastfeeding during your Xeloda treatment. And they won't recommend it for at least 2 weeks after your last dose.
* Sex and gender exist on spectrums. Use of the terms "female" and "male" in this article refers to sex assigned at birth.
You may experience side effects from your treatment with Xeloda. In most cases, side effects may be mild. However, it's possible to develop severe side effects from this drug.
If you'd like to learn more about Xeloda, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.
Besides talking with your doctor, you can do some research on your own. These articles might help:
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Side Effect(s) Of Capecitabine
Review the side-effects of Capecitabine as documented in medical literature. The term "side effects" refers to unintended effects that can occur as a result of taking the medication. In majority of the instances these side-effects are mild and easily tolerable, however sometimes they can be more severe and can be detrimental.If the side effects are not tolerable adjusting the dosage or switching to a different medication can help to manage or overcome side effects. If you have any doubts or questions, we recommend seeking advice from your doctor or pharmacist.
Capecitabine And Temozolomide (CAPTEM)
Capecitabine and temozolomide are chemotherapy drugs. This combination is also known as CAPTEM. You pronounce the drug names as: ka-pe-site-a-been teh-moh-zoh-loh-mide It is a treatment for neuroendocrine tumours (NETs). NETs are a type of neuroendocrine cancer. How do capecitabine and temozolomide work? These chemotherapy drugs destroy quickly dividing cells, such as cancer cells. How do you have capecitabine and temozolomide? You take capecitabine as a tablet. You swallow it whole with a glass of water. You usually take the tablets twice a day, about 12 hours apart. You should take them with food or within 30 minutes of finishing a meal. Your doctor will tell you the amount (dose) of capecitabine you need to take. You might have two different strengths of tablets to make up the correct dose. You take temozolomide as a capsule. You swallow it whole with a glass of water. You can take the capsules twice a day, about 12 hours apart or once a day. Your doctor will tell you how to take them. You should take the capsules on an empty stomach, for example, an hour before you plan to eat a meal. Taking your tablets or capsules You must take tablets and capsules according to the instructions your doctor or pharmacist gives you. Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose. How often do you take capecitabine and temozolomide? You take capecitabine and temozolomide as cycles of treatment. This means you take the drugs and then have a rest to allow your body to recover. Each cycle lasts 4 weeks (28 days). You usually have up to 13 cycles. Or you have it for as long as it works and the side effects are not too bad. You have each cycle in the following way: Day 1 to 9You take capecitabine as a tablet twice a day, 12 hours apart. Day 10 to 14You take capecitabine as a tablet twice a day, 12 hours apart.You take temozolomide as a capsule twice a day, 12 hours apart or once a day. You then start the next cycle of treatment. Tests You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working. Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV
. This is called a viral screen. It's important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this. You will have an ECG before starting treatment. Thereafter, you may have it if needed. What are the side effects of capecitabine and temozolomide? Side effects can vary from person to person. They also depend on what other treatment you are having. When to contact your team Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if: you have severe side effects your side effects aren't getting any better your side effects are getting worse the side effects are affecting your daily life Early treatment can help manage side effects better. Contact your advice line immediately if you have signs of infection, including a: temperature of 37.5C or above temperature below 36C severe skin reaction Signs of a severe skin reaction include peeling or blistering of the skin. We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time. Common side effects These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include: Increased risk of getting an infection Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when weeing, or generally feeling unwell. You might have other symptoms depending on where the infection is. Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. Breathlessness, looking pale or coughing You might be breathless and look pale due to a drop in red blood cells. This is called anaemia. Less commonly, you may have a cough. Rarely, you may have scarring or inflammation of the lungs, or a serious condition where the lungs can't provide enough oxygen to the blood. Let your healthcare team know if you are very short of breath, have fast breathing, feel confused, or your skin or lips turn blue. It is also rare to get a type of anaemia called haemolytic anaemia. Bruising, bleeding gums or nosebleeds This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae). Less commonly you might have bleeding from elsewhere in your body. Loss of appetite You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks. Nerve changes Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. Other nerve changes include burning, itching or pain. Less commonly, you may have shaking or trembling, a sharp, severe shooting pain along a nerve, or increased or decreased sensitivity to touch, pain or temperatures. Taste or smell changes Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes. Rarely, you may have changes to your smell, causing normal odours to smell unpleasant. Headaches Tell your healthcare team if you keep getting headaches. They can give you painkillers to help. Eye changes Eye changes may include watery eyes. Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). Tell your doctor or nurse if this is a problem for you. They can prescribe medicines to help. Try to avoid dust, pollen or animal hairs as they can make the watering worse. Less commonly, you may have dry eyes or eye pain, or changes in your vision, including blurred or double vision or a loss of vision that may be permanent. Or you may have a loss of vision in half of your visual field. Your visual field is how wide of an area you can see when focusing on something, Leg, foot or facial swelling You may have swelling in your legs and feet due to a build up of fluid (oedema). Rarely, you might have face swelling. Blood pressure changes Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. These symptoms may be caused by high blood pressure. Less commonly, your blood pressure might go very high. Or you may have low blood pressure causing you to feel dizzy, lightheaded or faint. You will have your blood pressure checked regularly. Blood clots Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn't common. Symptoms of a blood clot include: • pain, redness and swelling around the area where the clot is and may feel warm to touch• breathlessness• pain in your chest or upper back – dial 999 if you have chest pain• coughing up blood Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot. Throat changes You may have a sore throat or an unpleasant tingling or burning sensation in the throat. Less commonly, you may have throat pain, a hoarse voice or loss of voice. Difficulty pooing (constipation) Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed. Indigestion You may have pain or discomfort in the upper part of your tummy (abdomen). Let your doctor or pharmacist know. They can prescribe medicines to help. Hair loss You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. Nail changes Nail changes include brown or black discolouration, nails separating from the nailbed or nail inflammation. Arm, leg, back, joint or muscle pain You might have aches or pain in your arms, legs, muscles or joints. Speak to your doctor or nurse about what painkillers you can take to help with this. Less commonly, you may have muscle spasms or weakness. High temperature You might get a high temperature (fever) for a few hours after having this treatment. Tell your doctor or nurse if you have a fever. Tiredness and weakness You might feel very tired and as though you lack energy. Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting. Less commonly, you may feel drowsy. Difficulty adjusting your body temperature Your body may find it hard to adjust its temperature. You may be more sensitive to hot or cold environments. Feeling or being sick Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help. It is important to take anti sickness medicines as prescribed even if you don't feel sick. It is easier to prevent sickness rather than treat it once it has started. Diarrhoea Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Try to eat small meals and snacks regularly. It's best to try to have a healthy balanced diet if you can. You don't necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day. Skin changes Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help. The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome. Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use. Less commonly, you may have red raised bumps or spots, or raised, itchy bumps (hives). Rarely, you may have a severe skin reaction that may start as tender red patches, which lead to peeling or blistering of the skin. You might also feel feverish, and your eyes may be more sensitive to light. This is serious and could be life threatening. Or your skin may turn darker or lighter in areas. There isn't enough information to say how often this may occur, but you may have a severe skin reaction with a flat, red rash. You may also have a temperature, swollen lymph nodes, swelling in your face and dry, cracked lips. Fits (seizures) Tell your doctor or nurse straight away if this happens. Rarely, this drug may cause fits that last 5 minutes or longer. This is a serious condition, and you should get medical care immediately. Muscle problems You may have weakness or an inability to move your body on one side. Speak to your healthcare team if you notice this. Less commonly, you may have problems with muscle control, which causes clumsy movements and poor balance. Rarely, you might have twitching or jerking of muscles that you can't control. Speech problems You may have difficulty speaking or understanding speech. Tummy (abdominal) pain Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. Mouth sores and ulcers Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers. Occasional side effects These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include: an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening. Tell your nurse if you notice any of these symptoms low levels of minerals and salts in your blood, such as sodium, potassium, magnesium and calcium. This will most likely go back to normal when you finish treatment. You have regular blood tests during treatment to check this high blood sugar levels that can cause headaches, feeling thirsty and blurred vision. You may have tests to check your blood sugar levels. You may need to check your levels more often if you have diabetes difficulty falling or staying asleep anxiety - symptoms include a feeling of unease, worry or fear. Other symptoms may include a fast heartbeat, feeling dizzy or shaky or having a dry mouth ear problems that include ringing in your ears (tinnitus), difficulty hearing in one or both ears, or earache. Rarely, you may have increased sensitivity to sounds, making them appear very loud or uncomfortable changes to your heart, including an irregular heartbeat, the heart muscle not getting enough oxygen or a heart attack. Tell your doctor or nurse straight away if you have any chest pain sudden reddening and warmth of the neck, upper chest and face (flushing) or hot flushes hiccups stomach changes that include bleeding in the stomach – symptoms include vomiting bright red blood or black, tarry poos. Or you may have inflammation of the lining of the stomach (gastritis) – symptoms include bloating, tummy pain or discomfort or indigestion acid from the stomach leaking up into the food pipe (oesophagus) – symptoms include heartburn, stomach acid coming back into the mouth, or pain or difficulty swallowing an abnormal sensation in the mouth, including tingling, burning or numbness. Rarely, you may have a dry mouth liver changes, including inflammation of the liver causing yellowing of the skin or white of the eyes. You will have regular tests to check this excessive sweating or night sweats jaw pain or difficulty opening your mouth kidney changes, including blood or protein in your urine. Rarely, your kidneys may stop working or urine may build up in the kidney pain or burning when peeing, peeing more often than usual or leaking urine you might have chills. Let your doctor know if you have this. They may be able to prescribe medicines to help flu-like symptoms - you might have symptoms such as headaches, aching muscles, a high temperature or runny nose feeling confused - you or the people around you may notice you are confused. Tell your doctor or nurse if this happens a swollen or puffy face with acne and increased facial hair (Cushing syndrome). You may also have stretch marks feeling agitated memory loss and problems with your thinking and concentration having a low mood for weeks or months (depression). Speak to your GP or healthcare team if you feel like this being in a state where you appear awake but can't respond normally dizziness feeling generally unwell weight changes a skin reaction to areas of previous radiotherapy passing wind (flatulence) low levels of fluid in the body (dehydration) Rare side effects These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include: sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to Accident and Emergency (A&E) immediately if you have any of these symptoms a urinary tract infection (UTI) – symptoms include pain or burning when peeing, needing to pee suddenly or urgently, or more often than usual during the day or night, cloudy or bloody pee, lower tummy or back pain, pain just under the ribs, a high temperature, or feeling hot and shivery, or a very low temperature below 36C a second cancer, such as a blood cancer a condition where your body stops making enough new red blood cells (aplastic anaemia) a non cancerous lump called a lipoma reactivation of previous infections with cytomegalovirus (CMV), hepatitis B or herpes simplex peeing large amounts and feeling thirsty often behaviour changes, including having mood swings, a lack of interest or motivation, or hearing, seeing, smelling, tasting or feeling things that appear real to you but not to others (hallucinations) a blocked nose poo (stool) leaking from your bottom (bowel incontinence) heavy bleeding from your vagina or no periods vaginal inflammation – symptoms may include changes in vaginal discharge, itching or pain breast pain problems getting or keeping an erection (impotence) or having a low sex drive your tongue changing colour teeth problems blood in your poo (stool) or piles (haemorrhoids). Let your healthcare team know if you have any bleeding a high level of fats in your blood. You may have tests to check this fainting a collapsed lung – symptoms included a sudden shortness of breath and chest pain. Chest pain could be worse when coughing or breathing coughing up blood asthma, which can cause breathing problems. Symptoms include wheezing, coughing, shortness of breath, and your chest feeling tight a blocked bowel – symptoms include feeling bloated and full, pain, feeling sick, vomiting large amounts or constipation a build up of fluid in the tummy – symptoms include your clothes feeling tighter, bloating, tummy pain or breathlessness Other side effects If you have side effects that aren't listed on this page, you can look at the individual drug pages: Coping with side effects We have more information about side effects and tips on how to cope with them. What else do you need to know? Other medicines, food and drink Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs. Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have. Loss of fertility It is not known whether this treatment affects fertility in women. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men might not be able to get someone pregnant after treatment with this combination. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this. Pregnancy and contraception This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least 6 months after the end of treatment. Men should not get someone pregnant for at least 3 months after treatment. Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. Breastfeeding Don't breastfeed during this treatment and for 2 weeks after your last dose, because the drug may come through into your breast milk. Treatment for other conditions If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist. Immunisations Don't have immunisations with live vaccines while you're having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations. In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever. You can usually have: other vaccines, but they might not give you as much protection as usual the flu vaccine (as an injection) the coronavirus (COVID-19) vaccine Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment. Contact with others who have had immunisations You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened. Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine. More information For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website. You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme. 
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