This page tells you about the chemotherapy drug combination PAD. There is information about
PAD is the name of a combination of chemotherapy drugs used to treat myeloma. It is made up of the drugs
- Bortezomib (Velcade) – this was originally called PS341, which is where the P comes from
- Doxorubicin (Adriamycin)
- Dexamethasone (a steroid)
The links above take you to information about the individual side effects of each drug.
You have PAD chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have up to 4 cycles, taking 12 weeks (3 months) in total.
You have doxorubicin and dexamethasone 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. The tube stays in place throughout the treatment.
You usually have bortezomib as an injection under the skin but some people have it into the bloodstream.
You have each 3 week cycle of treatment in the following way. Day 1 is the first day of treatment for each cycle.
- Bortezomib as an injection just under the skin or as an injection into your bloodstream on days 1, 4, 8 and 11
- Doxorubicin as a continuous drip (infusion) from days 1 to 4
- Dexamethasone – for the first cycle of treatment you take this as tablets on days 1 to 4, then days 8 to 11, and days 15 to 18. With the next cycles of treatment you take it on days 1 to 4. You need to swallow the tablets whole after breakfast
It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, 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. And never stop taking a cancer drug without talking to your specialist first.
The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with PAD are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have one or more of these effects.
- 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
- Tiredness and weakness (fatigue) affects a quarter of people (25%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Temporary numbness or tingling in fingers and toes (peripheral neuropathy) and pain affect more than half of people having treatment. It can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks and usually goes within a few months of finishing treatment
- Feeling or being sick is usually well controlled with anti sickness medicines
- Diarrhoea – drink plenty of fluids. Tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
- Constipation – your doctor or nurse may give you laxatives to help prevent this. Tell a member of your treatment team if you are constipated for more than 3 days
- A sore mouth
- Sensitivity to sunlight – don’t sit out in the sun. Do cover up or use sun block on exposed skin
- Brown skin markings following the line of the vein where the chemotherapy was injected
- Watery eyes
- Sleep disturbances can occur with dexamethasone. Taking it early in the day can help. Let your doctor or nurse know if it is causing problems
- Hair loss – most people have complete hair loss but the hair will grow back once the treatment ends
- Your urine may become a pink or red colour for 1 or 2 days after treatment – this won't harm you
- Changes in mood and behaviour – you may feel more anxious and emotional than usual and may be a bit tired and sad for a while
- Loss of appetite
- A change in blood sugar levels – tell your doctor or nurse if you get very thirsty or if you are passing urine more than usual
- Low blood pressure (hypotension) affects just over 1 in 10 people – it can make you feel lightheaded or dizzy
- About 1 in 10 people get shingles – you may have to take an anti viral medicine to prevent this
- Women may stop having periods (amenorrhoea) but this may 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
Between 1 and 10 in every 100 people have one or more of these effects.
- Some people have an allergic reaction while having treatment, usually at the first or second treatment. Let your treatment team know straight away if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
- Reddening of the skin in areas where you have had radiotherapy in the past – the skin may get dry and flaky and feel sore and hot. This goes away on its own but keep affected areas out of the sun
- Inflammation around the drip site – if you notice any signs of redness, pain, swelling or fluid leaking at your drip site, tell your nurse straight away
- Liver changes that are very mild and unlikely to cause symptoms may occur – the liver will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
- 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
- Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your kidneys are working
Not everyone will get these side effects. You may have 1 or 2 or several. 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
- The way you have the drugs
- 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.
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.
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.
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 www.mhra.gov.uk.
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