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Side effects of ABVD

Find out about the side effects of the chemotherapy combination ABVD.

ABVD is the name of a chemotherapy combination. It includes the drugs:

  • A – doxorubicin (Adriamycin)
  • B – bleomycin
  • V – vinblastine
  • D – dacarbazine (DTIC)

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 37.5C.

The side effects may be different if you are having ABVD with other cancer treatments.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38C. Severe infections can be life threatening.

Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You'll have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

A hypersensitivity reaction happens to up to half the people having bleomycin. This causes a high temperature (fever) and chills while you have the drug.

If you have a high temperature the night after your treatment, tell your doctor or nurse when you go for your next dose.

Skin reactions include reddening, darkening or thickening of the skin or nails or dry, peeling skin at the fingertips. You are most likely to develop these side effects 2 to 3 weeks after you start your treatment.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

Feeling or being sick can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid foods that are fried, fatty, or have a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they’re feeling sick.

Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.

Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently every morning and evening and after each meal.
  • Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

This is caused by the doxorubicin. It won't harm you.  

This is particularly common in children.

Don't use sunbeds or sit in the sun. Cover up or use sunscreen if you go out in the sun. 

Remember to put sun cream on your head or wear a hat if you have lost hair there.

Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). It may be due to a blockage in the drainage system of the eye, caused by swelling of the nearby tissues. Or your eyes may make too many tears.

Tell your doctor or nurse if this is a problem. They can prescribe medicines to help reduce swelling.

Some irritants can make the watering worse. These can include dust, pollen or animal hairs. Try to avoid them or wear protective goggles.

Watery eyes occur in about 1 in 4 people with doxorubicin (25%). This may last for several days after the beginning of each treatment.

Women might stop having periods (amenorrhoea) but this may be temporary.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

Tell your nurse straight away if you notice any signs of redness, swelling or leaking at your drip site.

An allergic reaction happens to 3 out of every 100 people (3%) who have doxorubicin. You may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins. It should clear up within a few days.

You might get reddening of the skin in areas where you have had radiotherapy in the past. The skin in the area may also get dry and flaky and feel sore and hot. This goes away on its own.

Changes to the heart muscle may happen in some people. This is usually temporary but for a small number of people might be permanent. Your doctor will check your heart before and after your treatment.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Food may taste metallic.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

Your nails may become darker and white lines may appear on them.

You might get a high temperature and chills. 

Contact your doctor or nurse straight away if you feel unwell or have a temperature of 38C or more.

Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.

Tips

  • Keep your hands and feet warm.
  • Wear well fitting, protective shoes.
  • Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Moisturise your skin at least a couple of times a day.
  • Take care when cutting your nails.

Inflammation of the lungs occurs in about 1 in 10 people (10%) but is more common in people over 70. You will have lung tests before and during treatment. Tell your doctor or nurse if you develop a dry cough or breathlessness, especially in cold weather.

Flu like symptoms may occur for a week after treatment in about 1 in 10 people (10%). You may have a high temperature (fever), chills, and muscle and joint aches, or weakness.

Your eyes might be sore because the drugs cause a reaction on the inside of your eyelids. Or you may not be making enough tears. Your eyes can feel sore and gritty and might be red. Tell your doctor or nurse if you have this. They can prescribe eye drops, ointments or artificial tears for you.

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

Tell your doctor or nurse if you’re feeling depressed. They can arrange for you to talk to someone and give treatment if necessary.

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Vinblastine can cause jaw pain. Let your doctor or nurse know. Painkillers can help.

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse checks your blood pressure regularly. 

A fast heart rate might feel as though your heart is pounding in your chest (palpitations). Talk to your doctor or nurse if you have this.

You might find it hard to pass urine. Let your doctor or nurse know if that happens.

Don’t drive or operate machinery if you have this.

This may happen soon after having vinblastine.

Tell your doctor or nurse straight away if you have a sudden cough, wheezing or difficulty breathing.

About ABVD chemotherapy

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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