Amsacrine is a chemotherapy drug that is usually given in combination with other chemotherapy drugs to treat types of adult and childhood leukaemia. This information describes amsacrine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of leukaemia, which give more information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Amsacrine is an orange/red coloured fluid.

Amsacrine is given by a drip (infusion):

• through a fine tube (cannula) placed into the vein, usually in the back of the hand 
• through a central line, inserted under the skin into a vein near the collar bone, or into a PICC line which is inserted into a vein in the crook of your arm.

The infusion usually takes about 60 minutes.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is given amsacrine, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and also some of the rarer ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or chemotherapy nurse.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick, this may begin a few hours after the treatment is given and last for up to a day. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor, as they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Lowered resistance to infection Amsacrine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 11–13 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next course of chemotherapy.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Amsacrine can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with amsacrine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Discoloured urine Your urine may become an orange colour. This may last up to 24 hours after you have had amsacrine and is due to the colour of the drug. It is quite normal and nothing to worry about.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Hair loss If your hair falls out it usually starts 3–4 weeks after the first dose of amsacrine, although it may happen earlier. Your hair might fall out completely or may just get thinner. You may also have thinning and loss of your eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will regrow once the treatment ends.

Mouth sores and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe special mouthwashes and medicines, which prevent or clear any mouth infection.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Abdominal pain Let your doctor know if you develop any abdominal (tummy) pain. It can usually be controlled with mild painkillers.

Pain and swelling at the injection site If you feel pain, tell the doctor or nurse. They can slow the drip down to reduce the feeling.

Changes to the normal rhythm of the heart If this happens, it is usually temporary and can be reversed with medication. Your heart function is likely to be checked before treatment starts. You will also have regular blood tests to check the chemicals in the blood, as changes in the level of one of these chemicals (potassium) can affect the normal rhythm of the heart.

Injection site If the area around the injection site becomes red or swollen at any time you should tell either the nurse or doctor on the ward, or, if you are at home, ring the clinic or ward and ask to speak to someone.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy (including those you can buy in a shop or a chemist). Let your doctor know about any medication you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking amsacrine as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based upon our Amsacrine factsheet which has been compiled using information from a number of reliable sources, including:

• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry, Lippincott, Williams and Wilkins, 2001.
• The Cancer Chemotherapy Handbook (6th edition). Ed. D S Fischer et al, Mosby, 2003.
• Cancer Chemotherapy Handbook (2nd edition). D C Baquiran, Lippincott's, 2001.

For further references, please see general bibliography.