VAD | Cancer Research UK
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About VAD

VAD is the name of a chemotherapy drug combination usually used to treat multiple myeloma. It is made up of the drugs

  • V – Vincristine
  • A – (Adriamycin) – now called doxorubicin
  • D – Dexamethasone, which is a steroid drug

There are a number of combinations of drugs for people with myeloma. VAD is just one type of treatment. Your doctor will decide which drugs are best to treat your type of myeloma and the stage of your myeloma.


How you have VAD

You have the drugs into your bloodstream (intravenously). You can have them 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 chemotherapy as cycles of treatment. You have VAD in 4 week cycles, every 28 days. 

Most people have between 4 to 6 cycles of treatment over 4 to 6 months. The number of cycles you have depends on

  • How well your cancer responds to the drugs
  • Whether your cancer has spread

On the 1st day of the treatment cycle you start a 4 day treatment with all 3 drugs. You have the vincristine and doxorubicin slowly over the 4 days through an infusion pump. The pump is connected to a drip line, but you can go home with the infusion pump on.

Then you have a break with no treatment for 24 days. This competes 1 cycle. At times during the treatment cycle you will have dexamethasone tablets to take. Usually you take them for 4 days at a time. You may take up to 3 lots of dexamethasone tablets during each cycle of chemotherapy. It is very important that you take the tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach 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.

Once the cycle is complete you start the next cycle.


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 VAD 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 VAD 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)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Nerve problems causing tummy (abdominal) cramps, constipation, jaw pain, double vision or temporary incontinence of urine. Tell your doctor or nurse if you have any of these effects
  • Numbness and 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
  • Feeling or being sick – this may begin a few hours after treatment and last for a few days. It is usually possible to control this side effect with anti sickness injections and tablets. Tell your doctor or nurse if you are still being sick
  • Hair loss
  • A sore mouth
  • Your urine may become a pink or red colour for one or two days after having doxorubicin – this won't harm you
  • Sensitivity to the sun – cover up and stay in the shade while you are having treatment. If you have to go out in the sun, use a high factor sun cream (at least SPF 50)
  • Gritty eyes, blurred vision or watery eyes from an increased production of tears
  • 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 effects.

  • An allergic reaction to doxorubicin affects 3 people in 100 (3%). This causes a sudden rash of pink, itchy bumps on your skin and reddening of the skin along the veins. It should clear up within a few days
  • Reddening of the skin in areas where you have had radiotherapy in the past. The skin may get dry and flaky and feel sore and hot. This goes away on its own but keep affected areas out of the sun
  • Taking dexamethasone may change your blood sugar levels and you will need to have regular blood tests. If you are diabetic, talk to your diabetes doctor or nurse about the best way to control your diabetes
  • Temporary damage to the muscles of the heart, which may change the rhythm of the heartbeat. In most cases this goes back to normal after the treatment is completed. There is a small, more serious risk of heart failure. Your doctor will check your heart before you start treatment, and at times through your treatment course
  • Taste changes
  • Nails may become darker and white lines may appear on them
  • You may develop black or brown discoloration in the creases of your skin
  • Inflammation around the drip siteif you notice any signs of redness, pain, swelling or leaking at your drip site, tell your nurse straight away
  • Dexamethasone may cause bruising of the skin, an increased appetite, skin spots, and shoulder or hip muscle weakness. Let your doctor or nurse know if you get any of these effects

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.

Pregnancy and contraception

These drugs 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 a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drugs 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 VAD

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: 27 April 2015