Gemcitabine (Gemzar)

Gemcitabine is one of a group of chemotherapy drugs called anti metabolites. Anti metabolites are similar to normal body molecules but they are slightly different in structure. These differences mean that anti metabolites stop cells working properly. It is a treatment for

• Cancer of the pancreas
• Non small cell lung cancer
• Breast cancer that has spread, in combination with paclitaxel
• Bladder cancer, in combination with cisplatin
• Ovarian cancer, in combination with carboplatin

It is also sometimes used for other types of cancer.

Gemcitabine is a clear liquid. You have it into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. Having the drip usually takes about half an hour.

You usually have gemcitabine as a course of several cycles of treatment. The exact treatment plan depends on which type of cancer you are being treated for. To find out more about the way chemotherapy treatment is planned click on planning chemotherapy.

The side effects associated with gemcitabine are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link please look in our cancer drugs side effects section or click on search at the top of the page.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment ends
• Feeling or being sick is usually mild, but it happens to about 7 out of 10 people (70%)
• Flu like symptoms in about 2 in 10 people (20%) a few hours after treatment, including headaches, muscle aches (myalgia), a high temperature and shivering – 6 to 8 hourly paracetamol  can help
• A skin rash, which may itch,  in about 1 in 4 (25%) people
• A raised temperature about 6 to 12 hours after treatment in about 4 out of 10 people (40%) –  paracetamol 6 to 8 hourly should help
• Swelling in your face, hands and feet occurs in about 3 out of every 10 people (30%) treated – this usually goes away on its own, but tell your doctor or nurse if you have it
• This drug may have a harmful effect on a baby that is developing in your womb. It is not advisable to become pregnant or father a child if you are having this drug. Talk to your doctor about contraception before having the treatment

Between 1 and 10 in every 100 people have one or more of these.

• Diarrhoea or constipation – drink plenty of fluids and tell your doctor or nurse if it becomes severe or continues for more than 3 days
• A sore mouth or mouth ulcers
• Hair thinning
• Wheeziness or breathlessness in about 1 in 12 people – doctors are not sure this is actually to do with the gemcitabine and it may be more to do with the cancer (lung cancer for example)
• Drowsiness in about 1 in 10 people – you may be very drowsy for a while but this goes away on its own
• Loss of fertility – you may not be able to become pregnant or father children after this treatment. Talk to your doctor before starting treatment if having a child is important to you
• Women may stop having periods (amenorrhoea) – this may only be temporary

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.