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This page tells you about the chemotherapy drug combination PEI for testicular cancer and its possible side effects. You may also hear this combination called VIP or IPE.

There is information about


What PEI is

PEI is the name of a combination of chemotherapy drugs used to treat testicular cancer that has spread or come back. It is made up of the drugs

  • P = CisPlatin
  • E = Etoposide
  • I = Ifosfamide

The links above take you to information about the individual side effects of each drug.

You also have injections of GCSF with each treatment.


How you have PEI

You usually have PEI chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks (21 days). You have 4 cycles, taking 3 months (12 weeks) in total.

You have the drugs as injections into a vein or through a drip (intravenously). You have them through a plastic tube put into your chest, called a central line, a portacath or a PICC line. The tube gives the drugs into a major vein near the heart and stays in throughout your whole course of treatment.

You have all 3 drugs for the first 5 days of your treatment cycle. During this time you stay in hospital as an inpatient. Then for 16 days you have no treatment. You then start the next treatment cycle.

You usually have ifosfamide with another drug called mesna as a drip (infusion). Mesna is not a chemotherapy drug. It stops the ifosfamide from irritating your bladder lining and making it bleed.

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 PEI are listed below.

You can use the underlined links to find out more about each side effect. If there is no link, see our side effects of cancer drugs section. Or you can use the search box at the top of the page.


Common side effects

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
  • 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 during and after treatment – most people find their energy levels are back to normal within 6 months to a year  
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • A sore mouth and tongue swelling
  • Kidney damage due to cisplatin – you will have blood tests before your treatment, to make sure your kidneys are able to cope with the drug. To help prevent damage it is important to drink plenty of water. You will also have fluids by drip into your vein before and after your treatment
  • You may have some hearing loss, especially with high pitched sounds – let your doctor or nurse know if you have this
  • Skin changes, including reddening or darkening of your skin
  • Changes to your nails, such as ridges forming
  • Hair loss – most people have complete hair loss but the hair will grow back once the treatment ends
  • Loss of taste or a metallic taste may occur
  • Loss of appetite

Occasional side effects

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

  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
  • Some people have an allergic reaction while having PEI treatment, usually at the first or second treatment – let your treatment team know immediately 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
  • Irritation of the bladder and kidneys – drink as much water as possible to flush out the drugs. You will have fluids into your drip before and after your treatment. You will have a drug called mesna to protect your bladder and kidneys. Make sure that you pass urine often and especially before you go to sleep. You will have a urine test every morning before having the chemotherapy
  • Numbness or tingling in fingers and toes 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. Some people may have permanent numbness
  • Liver changes that are very mild and unlikely to cause symptoms – these will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your liver is working
  • Loss of fertility – we don’t know exactly how this drug affects fertility. Talk to your doctor before starting treatment if you think you may want to have a baby in the future
  • Diarrhoea or constipation – drink plenty of fluids. Let your doctor or nurse know if either of these effects lasts for more than 3 days or gets severe
  • Abdominal (tummy) pain
  • Dizziness
  • Ringing in the ears (tinnitus) happens in about 3 in 10 people (30%) but nearly always gets better on its own
  • About 1 person in 8 has confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations with ifosfamide – if you have any of these, it is important to tell your doctor or nurse straight away

Rare side effects

Fewer than 1 in 100 people have these effects.

  • High blood pressure
  • Changes to lung tissue causing a cough or breathlessness
  • There is a small risk that you may get a second cancer some years after PEI treatment
  • Difficulty swallowing – let your nurse know if you have this
  • Temporary changes in eyesight

Important points to remember

You may have a few of the effects mentioned on this page. 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 father a child while you are having treatment with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having treatment 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 treatment. 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

On this website you can read about 

Testicular cancer






More information about these drugs

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

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 You will need to look at each drug individually.

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Updated: 14 April 2014