Pixantrone (Pixuvri) | Cancer Research UK
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Pixantrone (Pixuvri)

This page tells you about the chemotherapy drug pixantrone (pronounced pick-san-trone). There are sections about


What pixantrone is

Pixantrone is also called Pixuvri. It is a chemotherapy drug used to treat non Hodgkin lymphoma. It is for people who have already had other treatments that are no longer working. You may also have it as part of a trial for other cancers.

One of the ways pixantrone works is by binding to the cancer cells’ DNA. DNA is the genetic code in each cell. This slows or stops the growth of cancer cells.


How you have pixantrone

You have pixantrone through a drip into a vein (intravenously). This may be through a small tube usually put into your arm or hand, called a cannula. Or you may have it through a central line, a portacath or PICC line. These are long, plastic tubes that go into a large vein in your chest. The tube stays in place as long as you need it.

You usually have pixantrone as a course of several cycles of treatment. You have up to 6 cycles. Each cycle of treatment lasts 4 weeks. So the treatment can take up to 6 months.

You have each cycle in the following way. On the first day you have pixantrone. You have another dose a week later and then again a week later. Each dose takes about an hour. After the third dose you have no treatment for 12 days. Then your next cycle of treatment starts.

We have a page about the way doctors plan chemotherapy.

The side effects associated with pixantrone are listed below. You can use the links (underlined) to find out more about how to manage each side effect. Where there is no link, look in our cancer drug side effects section or 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 side 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 from a drop in red blood cells (anaemia). You may need a blood transfusion
  • Bruising more easily from 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)
  • Weakness happens in about 1 in 4 people (25%)
  • Feeling or being sick affects about 2 out of every 10 people (20%). This is usually well controlled with anti sickness medicines
  • A cough and shortness of breath occurs in about 2 out of 10 people (20%)
  • Abdominal pain affects about 2 out of 10 people (20%)
  • A high temperature occurs in about 2 out of 10 people (20%)
  • Hair thinning affects about 1 in 10 people (10%)
  • Your urine may become a bluish colour for one or two days after treatment because the drug is blue. This won't harm you
  • Your skin and the whites of your eyes may also become bluish for a few days. It won’t harm you
  • Constipation happens in about 1 in 10 people (10%). Your doctor or nurse may give you medicines to help prevent this. But tell them if you are constipated for more than 3 days
  • Tiredness occurs in about 1 in 10 people (10%) during and after treatment. Most people find their energy levels are back to normal within 6 months to a year  
  • A sore mouth occurs in about 1 in 10 people (10%)
  • Swollen legs may occur due to fluid build up (known as peripheral oedema)
  • Women may stop having periods 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

Occasional side effects

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

  • Loss of appetite
  • Loss of taste
  • Headaches
  • Drowsiness
  • Sore, red eyes (conjunctivitis) or watery eyes – your nurse can give you eye drops to help
  • Diarrhoea – it is important to drink plenty of fluids if you have diarrhoea. Tell your nurse or doctor if you are worried about how bad it is, or if it continues for more than 3 days
  • Indigestion
  • Damage to heart muscle, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
  • Changes to your blood chemistry – your levels of sodium and potassium may be lower than normal. You may not have any symptoms from this. You will have regular blood tests to check the levels
  • Skin changes – you may have a rash or red, dry, itchy skin
  • Bone pain
  • Kidney changes that are mild and unlikely to cause symptoms. Your kidneys will usually go back to normal when treatment is finished. You will have regular blood tests to check how well your kidneys are working

Rare side effects

Fewer than 1 in 100 people have these side effects

  • Chills
  • Soreness and irritation around the injection site
  • Feeling sad
  • Anxiety
  • Difficulty sleeping
  • Dizziness
  • Night sweats
  • An allergic reaction while you have the treatment, causing a skin rash, a high temperature (fever), chills, shivering (rigors), a headache and feeling faint. Let your nurse know straight away if you have any of these effects. They will stop or slow your drip if you have a reaction
  • Liver changes that are very mild and unlikely to cause symptoms. 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
  • Spontaneous erection   
  • A build up of fluid (pleural effusion) around the lung or lung inflammation, causing breathlessness and a cough

Important points to remember

You may have 1 or 2 or a few of the side effects listed. They may be mild or more severe. A side effect may get better or 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

Tell your doctor or nurse straight away if you are worried about any of the side effects or how bad they are.

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so that 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 with this drug and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not 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 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.


More information about pixantrone treatment

We don’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 we don’t list here and you think it may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority at www.mhra.gov.uk.

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Updated: 18 July 2014