Z-DEX (Idarubicin and dexamethasone) | Cancer Research UK
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Z-DEX (Idarubicin and dexamethasone)

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This page tells you about the cancer drug combination Z-DEX, which is also called I-DEX, and its possible side effects. There are sections on


What Z-DEX is

Z-DEX is the name of a combination of cancer treating drugs that includes

  • Idarubicin (Zavedos) – a chemotherapy drug
  • Dexamethasone – a steroid

Z-DEX is a treatment for myeloma. Sometimes this drug combination is called I-DEX.


How you have Z-DEX

You usually have Z-DEX chemotherapy as cycles of treatment. Each cycle lasts 3 weeks. Depending on your needs, you may have up to 6 cycles, taking 4 to 5 months in total.

Idarubicin comes as capsules. Swallow them whole with a glass of water. You can take them with a meal.

Dexamethasone comes as tablets or as a liquid that you swallow. Take it after a meal, or with milk, because it can irritate your stomach lining. It can also make it difficult to sleep but taking it early in the day can reduce this effect.

For the first 4 days of each treatment cycle you take both idarubicin and dexamethasone once a day. Then you have no treatment for 17 days. You then start the next treatment cycle.

It is very important that you take your medicines according to the instructions your doctor or pharmacist gives you. Check the pack leaflet and follow the instructions it gives. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.


Tests during treatment

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


About side effects

We've listed the side effects associated with Z-DEX. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects 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 Z-DEX with other medicines.

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 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
  • 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 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) – most people find their energy levels are back to normal within 6 months to a year after treatment ends
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • Loss of appetite
  • Hair loss – most people have complete hair loss but the hair grows back after treatment ends
  • A sore mouth
  • Your urine may turn pink or red for up to 2 days after having idarubicin – this won’t harm you
  • Diarrhoea – drink plenty of fluids. Tell your doctor or nurse if you are worried about how bad it is or it continues for more than 3 days
  • A high temperature (fever) and chills – taking paracetamol every 6 to 8 hours can help
  • Headaches

Occasional side effects

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

  • Your skin may become more sensitive to the sun during your treatment and for several months afterwards. You need to cover up and stay in the shade. Use a high factor sun cream (SPF50 or higher) if you do go out
  • If you have had radiotherapy in the past, the skin in the treatment area might become dry and flaky. You may have some pain and burning similar to sunburn
  • Your nails may become darker and white lines may appear on them
  • Black or brown discoloration may occur in the creases of your skin. This is particularly common in children
  • Liver changes that are very mild and unlikely to cause symptoms. The liver will almost certainly go back to normal when treatment is finished
  • Damage to heart muscle, which is usually temporary. It may change the rhythm of your heartbeat. For a small number of people the change may be permanent. Your doctor or nurse will check your heart before and after your treatment
  • Stomach ache and bleeding from the small bowel – let your doctor or nurse know straight away if your poo (stool) looks darker or you notice blood
  • Skin rashes or itching
  • Indigestion, stomach pains or discomfort
  • A change in blood sugar levels – tell your doctor or nurse if you get very thirsty or if you are passing more urine than usual
  • A puffy face and ankles can occur due to fluid build up
  • An increased appetite with possible weight gain
  • Difficulty sleeping
  • Mood swings
  • Drowsiness (somnolence)
  • Dizziness

Rare side effects

Fewer than 1 in 100 people have these side effects.

  • An allergic reaction causing a raised temperature, shivering and a rash – tell your doctor or nurse straight away if you have this
  • 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
  • Painful joints due to raised uric acid levels in the blood. You need to drink plenty of fluids to flush out the uric acid. You may also have a drug called allopurinol
  • A second cancer or leukaemia may develop some years after idarubicin treatment but this is rare

Important points to remember

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


Don’t 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.


Related information


More information about Z-DEX drugs

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/emc.

If you have a side effect we don’t mention here and you think it 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: 14 July 2015