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This page tells you about the chemotherapy drug combination FAD and its possible side effects. There is information about


What FAD is

FAD is the name of a combination of chemotherapy drugs. It is made up of the drugs

  • F – Fludarabine
  • A – Doxorubicin (also called Adriamycin)
  • D – Dexamethasone – a steroid

The links above take you to more information about the individual side effects of each of these drugs.

FAD is a treatment for some types of low grade lymphoma.


How you have FAD treatment

Fludarabine is a clear colourless fluid and doxorubicin is a red fluid. You have these drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them 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 just before your course of treatment starts and it stays in place as long as you need it.

You have FAD chemotherapy as cycles of treatment. You may have up to 6 or 8 cycles. Each treatment cycle lasts 4 weeks.

  • On the first day you have injections of doxorubicin and fludarabine into a cannula or central line
  • You take dexamethasone tablets for the first 5 days
  • On the second and third day you have fludarabine injections
  • For the next 23 days you have no treatment

This completes one treatment cycle. You then repeat the cycle.

The side effects associated with FAD are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.


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. You will have regular blood tests to check your blood cell levels
  • 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 petechia)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • A raised temperature happens in up to 6 people out of 10 (60%)
  • Hair loss affects most people and may include all body hair but this is temporary – your hair will grow back once treatment ends
  • Feeling or being sick is generally well controlled with anti sickness injections and tablets. If your sickness is not controlled, tell your doctor or nurse, as you can try other anti sickness medicines
  • You may have dark marks in the creases of your skin when having doxorubicin – this is particularly common in children
  • Sensitivity to the sun – cover up and stay in the shade while you are having treatment with doxorubicin. Use a high factor sun cream on any exposed skin
  • Watery eyes occur in about 1 out of 4 people (25%) who have doxorubicin. It may last for several days after the beginning of each treatment
  • Your urine may become a pink or red colour for about a day after treatment with doxorubicin – this won't harm you
  • Steroids can change the level of sugar in your blood. You will have regular blood tests to keep an eye on this. You may also need to have tests to check for sugar in your urine
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – 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

Occasional side effects

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

  • Inflammation around the drip site caused by drugs leaking into the tissues. Tell your nurse or doctor if you have any stinging or burning, or leakage of fluid. Let them know if you have redness or swelling around your drip site during or after treatment
  • An allergic reaction to doxorubicin affects about 3 in 100 people (3%) – you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins, which should clear up within a few days
  • Reddening of the skin in areas treated with radiotherapy in the past. The skin may also get dry and flaky and feel sore and hot. This goes away on its own but keep affected areas out of the sun
  • Damage to heart muscle from doxorubicin, which is usually temporary. For a small number of people it may be permanent. Your doctor will check your heart before and after your treatment
  • Diarrhoea – drink plenty of fluids, and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Loss of appetite
  • Nails may become darker and white lines may appear on them
  • Fludarabine may permanently affect your production of blood cells – it may cause autoimmune haemolytic anaemia, thrombocytopenia and thrombocytopenic purpura

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Numbness or tingling in fingers and toes can cause difficulty doing small things such as doing up buttons. This starts within a few days or weeks. It usually goes within a few months of finishing treatment
  • A cough or difficulty breathing
  • A sore mouth
  • High uric acid levels in your blood due to cancer cells being broken down by the body. You will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
  • Sore eyes

There is a small risk that you may get a second cancer some years later after FAD treatment.


Important points to remember

You will not get all of these effects. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

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

These drugs 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.


Do not breastfeed during this treatment because the drugs 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.


Related information


More information about FAD

This page does not 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: 27 November 2014