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Side effects of Z-DEX

Find out about the side effects of the combination chemotherapy Z-DEX. 

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.

Common side effects

Each of these effects happens in more than 10 in every 100 people (more than 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 advice line or doctor straight away if you have any of these signs, or your temperature goes above 37.5C or below 36C. 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.

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. 

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 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.

You might feel sick or be sick. 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.

Tips 

  • Avoid eating or preparing food when you feel sick.
  • Avoid hot fried foods, fatty foods or foods with a strong smell.
  • Eat several small meals and snacks each day.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Try fizzy drinks.
  • Sip high calorie drinks if you can’t eat.

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.

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

Your hair will grow back once your 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.

Your mouth might get sore. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

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.

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.

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

Occasional side effects

Each of these effects happens in 1 to 10 in every 100 people (1 to 10%). You might have one or more of them.

Your skin is more sensitive to sunlight during your treatment and for several months afterwards. You need to cover up and stay in the shade. Use a high factor sunscreen if you go out in the sun.

You might have soreness, a burning feeling, and dry skin in the areas treated with radiotherapy in the past. Keep affect areas out of the sun. Tell your doctor or nurse if you have a skin reaction. It usually goes away on its own. 

You might have nail changes such as ridges or darkening. Tell your doctor or nurse if you have any nail changes. They can recommend how best to care for them.

You might notice that your skin becomes darker with this treatment. 

You may get black or brown discoloration in the creases of your skin. 

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.

Changes to the heart muscle may happen in some people. This is usually temporary but for a small number of people might be permanent. 

For a small number of people the damage may lead to angina (chest pain) or a heart attack. Your doctor will check your heart before and after your treatment.

Let your doctor or nurse know straight away if you have sudden sharp pains in your tummy, or blood in your vomit or poo.

Your skin may become red and sore or you may have an itchy rash.

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.

Indigestion is pain or discomfort in your chest or stomach.

Symptoms can also include:

  • heartburn, a burning sensation in the lower chest
  • feeling sick
  • feeling bloated
  • belching
Speak to your doctor or nurse if you have indigestion or stomach pain.

Tips

  • Stop smoking.
  • Limit your caffeine intake found in coffee and tea, canned drinks and chocolate.
  • Avoid foods and drinks that can cause heartburn, such as citrus fruits and alcohol.
  • Raise the head of your bed when sleeping or lying down.
  • Don't eat for 2 or 3 hours before going to bed.
  • Reduce fatty foods in your diet, such as deep fried foods.

You have regular blood and urine tests to check this. If you have diabetes you may need to check your blood sugar levels more often than usual. 

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Feeling hungrier can make it difficult to keep your weight down. Your appetite will go back to normal when you stop the treatment but some people need to diet to lose the extra weight.

Talk to your nurse or your dietitian about how to safely control your weight.

Talk to your doctor or nurse if you’re having problems sleeping. It can help to change a few things about when and where you sleep.

Tips

  • Go to bed and get up at the same time each day.
  • Make sure the temperature is right.
  • Spend time relaxing before you go to bed - have a bath, read or listen to music.
  • Do some light exercise each day to help tire yourself out.
  • Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon.
  • Have a light snack before you go to bed to stop hunger waking you up.

This treatment might cause mood changes. Speak to your doctor or nurse if you have this. They can give you advice. 

This drug may make you feel drowsy or dizzy. Don’t drive or operate machinery if you have this.

Rare side effects

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

A small number of people have an allergic reaction while having this treatment. 

Tell your doctor or nurse immediately if you have any of these symptoms: 

  • a rash
  • shortness of breath
  • redness or swelling of the face
  • feeling hot
  • dizziness
  • a sudden need to pass urine

You may not be able to become pregnant or father a child after treatment with this 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.    

High levels of uric acid in your blood can lead to a build up of crystals in body tissues and kidneys. This can cause kidney changes and swollen or inflamed joints (gout). Tell your doctor if you have pain and swelling in your joints.

You have regular blood tests to check your levels of uric acid. You might have medicines to control the levels.

Drinking plenty of fluids helps to flush out the excess uric acid. 

There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.

About Z-DEX

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