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Raltitrexed (Tomudex)

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This page tells you about a chemotherapy drug called raltitrexed (Tomudex) and its possible side effects. There is information about


What raltitrexed is

Raltitrexed is also known by its brand name, Tomudex. It is one of a group of drugs known as anti metabolites. Anti metabolites are similar to some normal body molecules, but they are slightly different in structure. They stop cells making and repairing DNA. Cancer cells need to make and repair DNA so they can grow and multiply. Raltitrexed is used to treat bowel (colorectal) cancer that has spread.


How you have raltitrexed

You have raltitrexed 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 just before your course of treatment starts and it stays in place as long as you need it.

You usually have raltitrexed chemotherapy as a 15 minute drip (infusion) every 3 weeks. Your doctors will discuss with you how many treatments you need.

Raltitrexed side effects are listed below. You can use the links to find out more about each side effect or look in our cancer drug side effects section. Side effects may be worse in people with kidney damage. You may need to have the drug dose reduced.


Common side effects

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

A temporary drop in the number of blood cells made by the bone marrow, causing

  • 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, sore throat, pain passing urine or feel cold and shivery
  • 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)

Some of these side effects can be life threatening, particularly infections. Contact your doctor or nurse if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

  • Diarrhoea affects about 1 in 3 people (30%) and can start a few days after the chemotherapy – occasionally diarrhoea can become severe so contact your doctor straight away if you have diarrhoea
  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after the treatment
  • Feeling or being sick affects about half the people treated and usually starts in the first week – tell your doctor or nurse if your anti sickness drugs are not helping, as you can try other types
  • Mouth sores and ulcers, including a sore throat and difficulty in swallowing
  • Liver changes that are mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but your doctor will check your liver with regular blood tests
  • Skin rashes affect about 1 in 10 (10%) people and may be itchy
  • Loss of appetite and weight loss
  • Indigestion and stomach pain
  • Constipation – drink plenty of fluids and let your doctor or nurse know if the constipation last for longer than 3 days
  • 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 about fertility before starting treatment if you plan to have a baby in the future

Occasional side effects

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

  • Hair thinning
  • Joint pain
  • Muscle cramps
  • Swollen hands, ankles or feet from fluid build up
  • Yellow skin and eyes (jaundice) – let your doctor or nurse know straight away if you have this
  • Tenderness, redness and swelling under the skin (cellulitis)
  • Sweating
  • Headaches
  • Taste changes
  • Sore, red or itchy eyes (conjunctivitis) – your doctor or nurse can give you eye drops to help

Important points to remember

The side effects above 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)
  • Other drugs you are having

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.

Drugs that may react with raltitrexed include

  • Some vitamins or vitamin supplements
  • Some medicines that thin your blood and stop it clotting (anti coagulants)

Raltitrexed can harm a baby developing in the womb. It is not advisable to become pregnant or father a child while having this drug or for 6 months afterwards. Talk to your doctor or nurse about contraception before beginning treatment if there is any chance that you or your partner could become pregnant.

Breastfeeding is not advisable 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 raltitrexed

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

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Updated: 20 May 2013