Raltitrexed (Tomudex)

Raltitrexed is also known by its brand name, Tomudex. It 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. Anti metabolites also stop normal cells working properly, which is why they cause side effects. Raltitrexed is used to treat bowel (colorectal) cancer.

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 just before your course of treatment starts and it stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. How many cycles of treatment you have depends on your treatment plan. There is detailed information about the way doctors plan chemotherapy in the planning chemotherapy section.

Raltitrexed side effects are listed below. You can use the links to find out more about each side effect or look in our cancer drug side effects section. Side effects may be worse in people with kidney damage. You may need to have the drug dose reduced.

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 doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Diarrhoea affects about 1 in 3 people (30%) and can start a few days after the chemotherapy – occasionally diarrhoea can become severe so contact your doctor straight away if you have diarrhoea
• 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, as you can try other types
• Mouth sores and ulcers, including a sore throat and difficulty in swallowing
• Mild loss of appetite
• Liver changes that are mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but your doctor will check your liver with regular blood tests
• Skin rashes affect about 1 in 10 (10%) people and may be itchy
• Raltitrexed can harm a baby developing in the womb so it is not advisable to become pregnant or father a child while having this drug – talk to your doctor about contraception before beginning treatment if there is any chance you or your partner could become pregnant
• 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 this drug, so if having a baby is important to you it is important to talk to your doctor about fertility before starting treatment
• You should not breastfeed while having this drug as it may come through in the breast milk

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

• Constipation
• Hair thinning

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 that they can help you manage them. Your chemotherapy nurse, clinic or ward 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, these 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.