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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 and RNA, 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

Any drugs or supplements that interfere with blood clotting can 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

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. Pancreatic cancer patients are 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 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, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or 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. If this occurs, it is usually a few weeks 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 cause 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 kidneys or liver, which in some people can be severe. Your doctor may test your blood to be sure that the kidneys and liver are 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 you are making less urine, if your skin or eyes turn yellow, or if you have pain in the upper right part of your belly.

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.

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
  • Abnormal blood tests which suggest that the drug is affecting the liver or kidneys (your doctor will discuss the importance of this finding, if any.)

Less common

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

Rare

  • Sleepiness or drowsiness (sedation)
  • Numbness or tingling
  • Bleeding*
  • Capillary leak syndrome (low blood pressure, low blood oxygen levels, inflamed blood vessels, gangrene, and shock; can be life-threatening, but comes and goes)
  • 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: 06/27/2013
Last Revised: 06/27/2013