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Read about the chemotherapy drug combination FMD, how you have it and what side effects it can have.

What it is

FMD is the name of a combination of chemotherapy drugs used to treat non Hodgkin lymphoma. It is made up of the drugs:

  • F – fludarabine (Fludara)
  • M – mitoxantrone (Onkotrone)
  • D – dexamethasone, a steroid

How it works

The chemotherapy drugs in the FMD combination destroy quickly dividing cells such as cancer cells.

How you have it

Mitoxantrone is a blue liquid and fludarabine is a clear liquid. Fludarabine also comes as a 10mg pink tablet. You have liquid fludarabine and also tablets as part of FMD treatment. You take the dexamethasone as white tablets. Your doctor will tell you the dose you need to take. 

You have mitoxantrone and some of the doses of fludarabine into your bloodstream (intravenously). 

Into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking your tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Never stop taking a cancer drug without talking to your specialist first.

When you have it

You usually have FMD chemotherapy as cycles of treatment. Each cycle of treatment lasts 4 weeks. Depending on your needs, you may have up to 6 cycles. 

You have each cycle in the following way.

On the 1st day you have
  • fludarabine and mitoxantrone either as an injection into your cannula or central line, or as a drip (infusion).
  • you also start taking the dexamethasone tablets
On the 2nd and 3rd day you have
  • fludarabine as an injection or tablets
  • dexamethasone tablets
On the 4th and 5th day you have
  • dexamethasone tablets

Then you have no treatment for just over 3 weeks. This completes one cycle. You then start your next cycle.

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Don’t breastfeed during this treatment because the drug may come through in your breast milk.


You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Treatment for other conditions

Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.


Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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