VAD is the name of a cancer drug combination that includes:
- 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 might 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
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
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).
- You have vincristine and doxorubicin slowly over the 4 days through an infusion pump.
- You take dexamethasone tablets every day.
- 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.
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.
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.
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 petechiae).
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.
Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help.
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.
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 health care 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 have any pain, redness, swelling or leaking around 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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
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.
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.
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).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can 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 the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
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.