Side effects of erlotinib (Tarceva)

Find out about the side effects of the cancer treatment drug erlotinib.

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 38C.

The side effects may be different if you are having erlotinib 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.

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, smoothing in unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

More than 7 out of every 10 people (75%) have skin problems.

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.

Around 5 out of 10 people (50%) get diarrhoea. Most will have mild diarrhoea.

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 37.5C. Severe infections can be life threatening.

Cancer drugs can reduce the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

Your white blood cell level begins to fall after each treatment. Then it gradually goes up again.

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.

Around 2 out of every 10 people (20%) develop an infection.

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.

Around 5 out of 10 people (50%) have this effect.

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

Your 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, use a soft bristled toothbrush.
  • Avoid mouthwashes that contain alcohol.
  • 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.
  • Eating fresh or tinned pineapple can keep your mouth fresh and moist.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

Around 2 out of 10 people (20%) have a sore mouth.

Tell your doctor or nurse if you are short of breath or you have a cough. This could be due to infection. It can also be due to changes to the lung tissue, making the lung tissue less flexible.

Contact your doctor straight away if you have sudden difficulty in breathing and a cough or high temperature.

The changes are usually very mild and unlikely to cause symptoms. They will almost certainly go back to normal when treatment is finished. 

You have regular blood tests throughout your treatment so your doctor can check this.

Feeling or being sick can be severe. It 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 may 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 fried foods, fatty foods or foods with 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 are feeling sick.

Up to 3 out of 10 people (30%) have this effect.

You might have tingling or numbness in your arms, legs, fingers or toes. It can make it difficult to do fiddly things such as doing up buttons.

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.
  • Take care when cutting your nails.

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

The hair on your head could become thinner or you may gradually lose your hair. 

Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

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

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.

Speak to your doctor or nurse if any of these are a problem for you.

Occasional side effects

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

Speak to your doctor or nurse if this is a problem for you. 

Let your doctor or nurse know straight away if you have sudden, sharp tummy (abdominal) pain, vomiting, or blood in your poo (faeces) or vomit.

This is more likely to happen if you have had stomach ulcers or diverticular disease in the past.

Cracks in the skin can happen when your skin is very dry, particularly in the finger tips, palms, knuckles or soles of feet. They can develop about a month after treatment starts. Cracked skin can be very painful and may become infected.

Using unperfumed thick moisturising cream may help if your skin gets dry or cracked. Check with your doctor or nurse before using any creams or moisturisers.

Swelling and redness (inflammation) around the fingernails or toenails can happen at least 1 month after starting treatment. Tell your doctor or nurse if you have this as you may need steroids and antibiotics.

Tips to prevent this from happening:

  • Moisturise your skin regularly
  • Do not soak your hands and feet in water for long periods of time
  • Use cotton-lined rubber gloves when washing up
  • Do not bite your fingernails and be careful when cutting your finger and toenails
  • Dry your feet carefully before putting on shoes

This treatment might cause:

  • dry eyes
  • watery eyes
  • red eyes
  • blurred vision
  • an eye infection 

Tell your doctor if you have any problems with your eyes.

Don't drive if you have blurred vision. 

Rare side effects

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

Your doctor or nurse will regularly check how well your liver is working during treatment.

Tell your doctor straight away if your urine looks much darker than usual or your skin or eyes look yellow.

Very rarely this drug can make a hole in your stomach, food pipe (oesophagus) or bowel. This is called gastrointestinal perforation. 

Let your doctor or nurse know straight away if you have sudden severe abdominal pain or pain that doesn't go away. Or if you notice blood in your stool or vomit.

You might have:

  • ingrowing eyelashes or longer, thicker eyelashes
  • increased eyebrow growth
  • increased hair on the face or body

Talk to your doctor or nurse if this happens. 

About erlotinib

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.

Last reviewed: 
03 Apr 2018
  • Electronic Medicines Compendium (eMC)
    Accessed April 2018

  • Erlotinib in NSCLC
    South East London NHS Cancer Network, 2012

  • Determinants of Tumor Response and Survival With Erlotinib in Patients With Non—Small-Cell Lung Cancer
    R Perez-Soler and others
    Journal of Clinical Oncology, 2004. Vol 22, Number 16, Pages 3238-3247

  • Erlotinib in Previously Treated Non–Small-Cell Lung Cancer
    F Shepherd and others
    The New England Journal of Medicine, 2005. Vol 353, Pages 123-132​

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