Raltitrexed (Tomudex) | Cancer Research UK
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What raltitrexed is

Raltitrexed is also known by its brand name, Tomudex. It is a treatment for bowel (colorectal) cancer that has spread.


How raltitrexed works

Raltitrexed 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.


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 before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

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.


Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with raltitrexed below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.

You may have a few side effects. They 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)

The side effects may be different if you are having raltitrexed with other drugs.

Tell your doctor or nurse straight away if any of the side effects get severe.


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
  • 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 petechiae)
  • Diarrhoea affects about 1 in 3 people (30%) and can start a few days after the chemotherapy. Occasionally diarrhoea can become and it is important to contact your doctor or nurse straight away if it does
  • 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
  • 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
  • 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 this treatment. 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.

  • Hair loss or 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
  • Feeling very thirsty and dry skin due to dehydration – let your doctor or nurse know if you have this
  • Headaches
  • Taste changes
  • Sore, red or itchy eyes (conjunctivitis) – your doctor or nurse can give you eye drops to help

Rare side effects

Fewer than 1 in 100 people have very red, inflamed, peeling skin. Let your doctor or nurse know straight away if you have this.


Important points to remember

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. Don't take any supplements that contain folinic acid or folic acid as they can stop raltitrexed working.

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 and for at least 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 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

You can read our information about 

Treatment for advanced bowel cancer



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 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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Updated: 29 April 2015