Decorative image

Vincristine, doxorubicin and dexamethasone (VAD)

VAD is the name of a cancer drug combination that includes:

  • vincristine
  • doxorubicin (Adriamycin)
  • dexamethasone (a steroid)

It is a treatment for myeloma. 

How it works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have VAD

You have vincristine and doxorubicin as a drip into your bloodstream (intravenously). Dexamethasone comes as tablets that you swallow whole, with plenty of water. You should take dexamethasone tablets after a meal or with milk as they can irritate your stomach. 

Into your bloodstream

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have VAD

You have VAD in cycles of treatment. Each cycle takes 21 days (3 weeks) or 28 days (4 weeks). Most people have between 4 to 6 cycles of treatment. 

Below is one of the possible ways to have VAD (the 4 week cycle). 

Day 1 to day 4
  • You have vincristine and doxorubicin slowly over the 4 days through an infusion pump
  • You take dexamethasone tablets every day
Day 5 to day 28
  • You have no treatment

You then start a new cycle of treatment. 

You may be able to go home between day 1 and day 4 of each treatment cycle. If you are at home, you have the infusions through a small pump. You can keep the pump in a small bag, or a bag on a belt (like a bum bag). You’ll need to go back to the hospital on the last day to have the pump disconnected. Or sometimes a chemotherapy nurse may be able to do this at your home.

During the first treatment cycle, you might need to take more dexamethasone tablets. Your doctor or pharmacist will tell how many tablets you need to take. 

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's 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 treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist 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 doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

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 getting an 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. 

Bruising and bleeding 

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Breathlessness

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

Loss of appetite 

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

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.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

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.

Bowel changes 

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

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Fatigue 

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

High temperature (fever)

If you get a high temperature, let your treatment team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Inflammation around the drip site 

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

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: 

  • loss of fluids in your body (dehydration)
  • difficulty sleeping
  • changes in the levels of minerals in your body
  • heart problems such as changes to your blood pressure and heart rhythm
  • hot flushes
  • shortness of breath
  • pain in different parts of your body such as the chest, back and muscles
  • changes to way your liver works that are usually mild and unlikely to cause symptoms
  • skin rash and nail changes
  • dizziness and headaches
  • weight loss

Rare side effects

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

  • changes in blood sugar levels
  • anxiety and mood changes
  • a severe allergic reaction that can cause dizziness, high temperature and shivering
  • tummy (abdominal) pain
  • bleeding in your digestive system
  • eye problems such as watery eyes and inflammation of the eyes (conjunctivitis)
  • pain when passing urine and a decrease or increase in the amount of urine you make

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, foods and drinks 

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.

Loss of fertility 

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Pregnancy and contraception 

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding 

Don’t breastfeed during this treatment because the drugs may come through in 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.

Immunisations 

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 the 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 have had live vaccines as injections

Avoid close contact with people who have 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. You should do so for 2 weeks following their vaccination if you have a severely weakened immune system.

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.

Last reviewed: 
20 May 2019
  • Electronic Medicines Compendium 

    Accessed February 2019

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott, Williams and Wilkins, 2012

Information and help