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This page tells you about the chemotherapy drug treosulfan and its possible side effects. There is information about


What treosulfan is

Treosulfan is a chemotherapy drug used to treat ovarian cancer. It is also sometimes used for other types of cancer when other treatments are not working. You sometimes have it in combination with other cancer drugs.

Treosulfan is an alkylating agent. These drugs work by sticking to one of the cancer cell's DNA strands. The cell cannot then divide into 2 new cells.


How you have treosulfan

Treosulfan comes as capsules or a liquid given into a vein. Very rarely it is given by injection into the tummy (abdominal cavity).

Treosulfan capsules

Treosulfan comes as white capsules in 250mg strength. You swallow the capsules whole with plenty of water. It is very important that you take them according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach, for example, 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.

You may have the capsules in one of the following ways

  • 4 times a day for 4 weeks, followed by 4 weeks with no treatment
  • 4 times a day for 2 weeks, followed by 2 weeks with no treatment
  • 3 times a day for 1 week, followed by 3 weeks off treatment

The treatment is repeated as necessary and your doctor will adjust the dose if they need to.

Treosulfan into your bloodstream

Treosulfan also comes as a clear fluid that you have 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 treosulfan chemotherapy into your bloodstream every 1 to 3 weeks. as a course of several cycles of treatment. The treatment plan depends on which type of cancer you have. There is more information in our section about how doctors plan chemotherapy.

Treosulfan into the tummy

You may have treosulfan by injection straight into the tummy (abdomen). This is called intraperitoneal injection. It is usually only used as part of research trials. This method may cause less side effects than treosulfan capsules or treosulfan into a vein.

The general side effects of treosulfan capsules and treosulfan into a vein are listed below. You can use the links to find out more about each side effect or go to the cancer drug side effects section.


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. You should 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

  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
  • Feeling or being sick occurs in about half the people treated but is usually mild and easily controlled with anti-sickness injections and tablets – tell your doctor or nurse if your sickness is not controlled as you can try other anti sickness drugs
  • Bronze colouring to the skin in up to 1 in 3 people (30%) – this should go back to normal within a few months of treatment finishing
  • Hair loss or hair thinning happens in about 1 in 6 people (15%) although complete hair loss is rare – your hair will grow back when your treatment is finished
  • Women may stop having periods (amenorrhoea), but this may only be temporary
  • Loss of fertility – you may not be able to get pregnant or father a child after treatment with treosulfan, so it is important to talk to your doctor about your fertility before starting treatment if having a baby is important to you

Occasional side effects

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

  • If treosulfan leaks into the tissues of the arm around the injection site it can cause damage – tell your nurse or doctor if you have any stinging or burning around the injection site, leakage of fluid, or redness or swelling around the injection area
  • Long term treosulfan capsule therapy can increase the risk of developing a type of acute leukaemia or other types of blood disorder – your doctor will discuss this with you

Rare side effects

Fewer than 1 in 100 people have these.

  • A skin rash
  • Inflammation of the bladder lining (cystitis) – drink plenty of fluids while having this treatment and for the next 24 hours, to flush the drug through your kidneys and bladder. Let your doctor or nurse know if you have any blood in your urine
  • Scarring in the lungs that may cause breathlessness and a cough months or years after treatment

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.

Treosulfan may harm a developing baby so it is not advisable to become pregnant or father a child if you are having this drug. Talk about contraception with your doctor or nurse before having the treatment if there is any chance of you or your partner becoming pregnant.

You should not breastfeed while having this drug as it 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

On this website you can read about


ovarian cancer



More information about treosulfan

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: 17 May 2013