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Gemcitabine

(jem-site-uh-bean)

Trade/other name(s): Gemzar

Why would this drug be used?

Gemcitabine is used to treat pancreatic cancer, breast cancer, ovarian cancer, and lung cancer, and may be used for other cancers as well.

How does this drug work?

Gemcitabine is a member of a group of chemotherapy drugs known as anti-metabolites. It prevents cells from making DNA, which stops cell growth and causes the cells to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heavy alcohol use, heart disease, congestive heart failure, lung problems, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are getting radiation therapy. The drug can worsen radiation’s side effects, such as mouth sores and lung problems, if it is given within a week of getting radiation.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if a woman is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

This drug can lower platelet counts which can increase the risk of serious bleeding. Any drugs or supplements that interfere with blood clotting can further raise the risk of bleeding during treatment with gemcitabine. These include:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • Warfarin (Coumadin)
  • Ticlopidine (Ticlid)
  • Clopidogrel (Plavix)
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Any type of heparin injections such as enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Gemcitabine is given as an injection in a vein over a period of 30 minutes. How often it is given depends on what cancer is being treated. For example, pancreatic cancer patients are usually given gemcitabine once a week for up to 7 weeks to start, then a week without treatment. After that, the dose is once a week for 3 weeks followed by a week off. When given for breast or ovarian cancer, it’s usually once a week for 2 weeks, then 1 week off. For lung cancer or other cancer patients, it usually is given weekly for 3 weeks with 1 week off. The dose depends on your size, your blood counts, how well you did on the last cycle of treatment, and the cancer being treated.

Precautions

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on your liver or kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Be sure to keep all your appointments for lab tests and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This is more common if gemcitabine is combined with another chemotherapy drug during treatment. A low white blood cell count can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given. This is more common if gemcitabine is combined with another chemotherapy drug during treatment. If the platelet count gets too low, it can increase your risk of bleeding. Your doctor will check your blood and platelet counts. If your platelet count becomes low, you should avoid drugs and supplements that might affect your body’s ability to stop bleeding (see “Interactions with other drugs”). Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

This drug may lower your red blood cell count. This can occur weeks or months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

This drug can also cause the body to start to attack and destroy red blood cells and then damage the kidneys. This, called hemolytic-uremic syndrome (HUS), can lead to kidney failure. Your doctor will watch your blood for signs of kidney damage and HUS and will stop gemcitabine if they are seen.

This drug can cause serious lung problems in some people. Tell your doctor right away if you start to notice cough, wheezing, trouble breathing during exercise, shortness of breath when lying down, or in other situations.

This drug can damage the liver, which in some people can be severe. Your doctor may test your blood to be sure that the liver is working OK both before and during treatment with gemcitabine. If there are signs of poor function, your doctor may stop your treatment with this drug. Tell your doctor right away if your urine changes color, if your skin or eyes turn yellow, or if you have pain in the upper right part of your belly.

Very rarely, people can get a serious brain condition called posterior reversible encephalopathy syndrome (PRES). Tell your doctor right away if you notice headache, confusion or changes in thinking, seizure, blurred vision, or loss of vision.

Another very rare complication is capillary leak syndrome, which might start with swelling, weakness, and fatigue before it progresses to faintness or dizziness due to low blood pressure, trouble breathing, shock, and even death. Get help right away.

Severe and even life threatening side effects can occur if this drug is given during or within a week of radiation therapy.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor’s OK. Gemcitabine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Avoid pregnancy during treatment, since exposure to this drug may harm the fetus. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them. The side effect listed below are based on studies in which gemcitabine was given by itself. Side effects may be more severe and other side effects may be seen if this drug is given along with another chemotherapy drug.

Common

  • Low white blood cell count with increased risk of infection*
  • Low platelet count with increased risk of bleeding*
  • Low red blood cell count (anemia) with symptoms like tiredness, weakness, or shortness of breath*
  • Nausea
  • Vomiting
  • Loss of appetite
  • Tiredness (fatigue)*
  • Fever
  • Swelling of the arms and legs or other parts of the body
  • Skin rash
  • Abnormal blood or urine tests which suggest that the drug is affecting the liver or kidneys (your doctor will discuss the importance of these findings, if any.)

Less common

  • Diarrhea
  • Sores in mouth or on lips
  • Flu-like symptoms (headache, muscle aches, fever)
  • Trouble breathing or shortness of breath*
  • Infection*
  • Swelling of hands, ankles, or face*
  • Hair loss or thinning, which may include face and body hair
  • Itching
  • Bleeding*
  • Sleepiness or drowsiness (sedation)
  • Numbness or tingling

Rare

  • Capillary leak syndrome*
  • Dizziness or faintness, low blood pressure*
  • Posterior reversible encephalopathy syndrome (headache, blindness or other problems with vision, confusion)*
  • Allergic reaction
  • Death due to kidney failure, liver failure, lung damage, infection, or other causes

*See “Precautions” section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1996.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 08/06/2014
Last Revised: 08/06/2014