Actinomycin D (dactinomycin)

Actinomycin D is a chemotherapy drug. It works by damaging cancer cells' DNA. When DNA is damaged, a cell cannot divide into 2 new cells, so this helps to stop the cancer growing.

Doctors use actinomycin D to treat sarcomas, Wilm’s tumour, testicular cancer, melanoma and choriocarcinoma.

Actinomycin D is a yellow liquid that you have as a slow injection into a vein or through a drip (an infusion). 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 this type of chemotherapy as a course of several cycles of treatment. The treatment plan for actinomycin D depends on which type of cancer you have. There is detailed information about planning chemotherapy in the main chemotherapy section.

We have listed the side effects associated with actinomycin D below. You can use the links (underlined) to find out more about each side effect. Where there is no link please see our cancer drugs side effects section, or use the search box at the top of the page.

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

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

• 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 treatment centre 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

• Fatigue during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick usually starts within 2 hours of having the drug and can last for up to 24 hours, but is usually well controlled with anti sickness medicines
• Loss of appetite
• Hair loss
• Mouth sores can happen in up to 1 in 3 people (33%)
• Diarrhoea can be severe and happens in up to 1 in 3 people (33%) – it usually begins within a week of having treatment. You should have anti diarrhoea tablets to take. Drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Skin changes – this drug can cause a rash, darkening of your skin (particularly along the vein where you have your injection), or reddening of areas of skin that have had radiotherapy
• Actinomycin D may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant

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

• A high temperature (fever) or chills
• Abdominal cramps
• Depression
• Difficulty swallowing
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately

Fewer than 1 in 100 people have these.

• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you 
• Women may stop having periods (amenorrhoea) but this may only be temporary

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may have more side effects 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 that they can help you manage them. Your nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.