Dactinomycin (actinomycin D, Cosmegen) | Cancer Research UK
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Dactinomycin (actinomycin D, Cosmegen)

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This page tells you about the cancer drug dactinomycin (also called Cosmegen or actinomycin D) and its possible side effects. There are sections about


What dactinomycin is

Dactinomycin is a chemotherapy drug. It is also called Cosmegen or actinomycin D.

It is a treatment for the following types of cancer

  • Soft tissue sarcomas
  • Wilm’s tumour
  • Testicular cancer
  • Melanoma skin cancer
  • Neuroblastoma
  • Germ cell tumours
  • Retinoblastoma
  • Choriocarcinoma

How dactinomycin works

Dactinomycin works by damaging cancer cells' DNA. When DNA is damaged, a cell cannot divide into 2 new cells, so this helps to stop the cancer growing.


How you have dactinomycin

Dactinomycin is a yellow liquid. You have it into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

The treatment plan for dactinomycin depends on the type of cancer you have. You may have it in combination with other drugs. Your doctor or nurse can give you information about your treatment.


Tests during treatment

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


About side effects

We've listed the side effects associated with dactinomycin. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)

The side effects may be different if you are having dactinomycin with other medicines.

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Feeling or being sick usually starts within 2 hours of having the drug and can last for up to 24 hours. It is usually well controlled with anti sickness medicines
  • Loss of appetite
  • Hair loss
  • Mouth sores can happen in up to 1 in 3 people (33%)
  • Diarrhoea can be severe and happens in up to 1 in 3 people (33%). It usually begins within a week of having treatment. You should have anti diarrhoea tablets to take. Drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Skin changes – you may have an acne like rash and darkening of your skin (particularly along the vein where you have your injection). It can also cause reddening of areas of skin that have had radiotherapy
  • Your skin may be more sensitive to sunlight – remember to cover up and wear factor 50 sunscreen if you have to go out in the sun

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • A high temperature (fever) or chills
  • Abdominal cramps
  • Depression
  • Difficulty swallowing
  • Inflammation around the drip site if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
  • Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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

Rare side effects

Fewer than 1 in 100 people have these effects 

  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • An increased risk of developing a second cancer some months or years after treatment
  • Some people have died during dactinomycin treatment but this is very rare

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may 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 the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


More information about dactinomycin

This page doesn't list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk.

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Updated: 3 November 2015