Gemcitabine is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat non-small cell lung cancer, pancreatic, bladder and breast cancer. This information describes gemcitabine, 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 cancer, 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.

Gemcitabine is a colourless fluid.

Gemcitabine is given by a drip (infusion):

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

The infusion usually takes about 30 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 in this information won't affect everyone who is given gemcitabine, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we haven't 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 in this information, please discuss them with your doctor, chemotherapy nurse or pharmacist.

Lowered resistance to infection Gemcitabine 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 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straight away 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 Gemcitabine 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, and bleeding gums.

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

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; 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.

Loss of appetite This is usually mild and may last a day or so. A dietitian or specialist nurse at your hospital can give advice and tips on boosting your appetite, coping with eating difficulties and maintaining weight.

Temporary effect on liver function Gemcitabine may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. You're very unlikely to notice any problems but your doctor will check your liver is working properly before each treatment.

Change in kidney function Some people have a small amount of blood or protein in their urine when it is tested. You are very unlikely to notice any change and it rarely causes any harm.

Skin changes Gemcitabine can cause a rash, which may be itchy. Your doctor can prescribe medicines to relieve the symptoms. You may also notice some swelling of your ankles. This is usually mild and goes away after the treatment ends.

Flu-like illness Occasionally a flu-like illness may occur with gemcitabine. You may have headaches, aching joints and muscles and a high temperature. You should always let your doctor know about a high temperature immediately.

Fluid retention This may cause swelling of the ankles or breathlessness. Let your doctor know if you notice this effect.

Tiredness and feeling weak It is important to allow yourself plenty of time to rest.

Sore mouth 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 reduce the risk of this happening. Tell your doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

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

Breathlessness Rarely, gemcitabine can cause temporary breathlessness. Contact your doctor if you feel breathless.

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

Constipation This can usually be managed by eating a high fibre diet and drinking plenty of fluids.

Hair loss It is rare for gemcitabine to make all your hair fall out, but this may occasionally happen. More commonly, your hair may just become thinner. Hair loss is temporary and your hair will regrow once the treatment ends. Your nurse can give you advice about coping with hair loss.

Gemcitabine may cause drowsiness. Take care if you are driving or operating machinery following this treatment.

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 straight away 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 (including those you can buy from a shop or chemist) can be harmful to take when you are having chemotherapy. Tell your doctor about any medications 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 gemcitabine, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

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

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Medicines.org.uk website – www.medicines.org.uk (November 2008).
• The Chemotherapy Source Book (4th edition). Ed. Perry. Lippincott, Williams and Wilkins, 2007.

For further references, please see general bibliography.