Decorative image

Raltitrexed (Tomudex)

Raltitrexed is a chemotherapy drug and is also known by its brand name, Tomudex.

It is a treatment for bowel (colorectal) cancer that has spread and is often given with other cancer drugs. 

How it works

Raltitrexed is from a group of drugs known as anti metabolites.

Anti metabolites stop cells making and repairing DNA. Cancer cells need to make and repair DNA so they can grow and form more cells.

How you have it

You have raltitrexed into your bloodstream (intravenously) over 15 minutes.

Into your bloodstream

You might have the treatment through a drip into your arm. Your nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

Or you might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in the whole time you are having treatment.

When you have treatment

You have raltitrexed every 3 weeks (21 days). Each 3 week period is a cycle of treatment. Your doctor will tell you how many cycles you need.

Tests

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

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

Common side effects

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

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Tiredness and weakness during and after treatment

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Diarrhoea or constipation

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

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They may give you medicine to help. 

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the levels of chemicals produced by the liver.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Dehydration

Dehydration means there isn't enough fluid in your body. You might find you aren't passing much urine and the colour is a very dark yellow. Your skin might be very dry and you might feel dizzy. So make sure you drink around 2 litres of fluids every day. Tell your nurse or doctor if you are not able to drink this much fluid. 

Occasional side effects

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

  • bruising, bleeding gums and nosebleeds due to a drop in platelets (blood cells that help the blood clot)
  • flu like symptoms such as high temperature, chills and headache
  • a severe infection
  • headaches
  • indigestion
  • swelling of the hands and feet
  • increased sweating
  • changes to taste
  • sore red, itchy, watery eyes - conjunctivitis
  • hair loss
  • aching joints
  • muscle cramps
  • yellow skin and eyes this is jaundice, tell your doctor or nurse if you notice it
  • cellulitis - a skin infection that can appear as redness of the skin that might be tender and swollen

Rare side effects

This can happen to fewer than 1 in 100 people (1%). Let your doctor or nurse know straight away if your skin becomes very red, painful, swollen and starts to peel.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

In particular tell your doctor, nurse or pharmacist if you are taking:

  • vitamins or vitamin supplements
  • medication to thin your blood and stop it clotting such as warfarin and heparin

Loss of fertility

Raltitrexed can affect the production of sperm. But it should go back to normal 3 months after finishing treatment. 

Contraception and pregnancy

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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

Dangoor sponsorship

About Cancer generously supported by Dangoor Education since 2010.