Gemcitabine (Gemzar®)

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily. 
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines. 

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor. 

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. 
• Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks. 

Some people may get a rash, scaly skin, or red, itchy bumps from this medication. Tell your provider if you notice any of these changes in your skin, since it could be a reaction. Your provider may suggest:

• Using an alcohol-free moisturizer on your skin and lips, and do not use moisturizers with perfumes or scents. 
• Keep the area clean to avoid infection, especially if it cracks or bleeds.
• Using a topical medication (applied to the skin) if the itching bothers you.

Be sure to talk with your provider about how to care for your skin.

Fluid retention happens when your body holds on to too much fluid or is unable to excrete (put out) fluid. You may have swelling throughout your body, bloating of your abdomen (belly) called ascites, and a hard time breathing as fluid builds up in the lining of your lungs (pleural effusion) or around your heart.

Call your provider right away if you have new or worsening swelling, unexpected weight gain, shortness of breath, or a dry cough. 

This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.

This medication can cause a neurological (brain) disorder called posterior reversible encephalopathy syndrome (PRES or reversible posterior leukoencephalopathy (RPLS). Symptoms of PRES/RPLS are:

• Headache.
• Seizure.
• Lethargy (feeling tired, drowsy, sluggish).
• Confusion.
• Blindness and other vision changes.
• Neurological problems.

Tell your provider about any of these symptoms right away.

This medication can cause Hemolytic Uremic Syndrome (HUS). HUS damages the blood vessels in your kidneys. Your provider will watch for symptoms of HUS. Symptoms include:

• Changes in the color or amount of your urine.
• More bruising than normal.
• Diarrhea.
• Pain in your abdomen (belly).
• Nausea and/or vomiting.
• Blood in your urine.

Tell your provider if you have any of these symptoms.

Capillary leak syndrome is when blood and parts of your blood leak out of your blood vessels and into your muscles and open spaces in your body. This can cause low blood pressure (hypotension) and can stop your organs from working correctly. Symptoms may be:

• A sudden drop in blood pressure.
• Weakness.
• Fatigue.
• Sudden swelling of the arms, legs, or other parts of the body.
• Nausea.
• Lightheadedness.

If you have any of these symptoms, tell your provider right away.

Radiation recall is when a medication causes a rash that looks like sunburn in an area where you had radiation treatment.

• Redness.
• Swelling.
• Soreness.
• Peeling skin.

You may be told to put a topical steroid cream on your skin, or you may need to wait to have your next scheduled dose of chemotherapy. Tell your provider if you notice any of these symptoms.

A serious allergic reaction to this medication can cause skin and mucous membrane (inside of your mouth, nose, throat, and other body parts) problems that can also affect other organs in your body. These reactions are called severe cutaneous adverse reactions (SCARs).

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are types of serious skin reactions that need treatment right away. If you have a new rash or blisters, flu-like symptoms, or lesions (sores) on mucous membranes, call your provider right away.