Side effects of bendamustine (Levact)

Find out about the side effects of the chemotherapy drug bendamustine for non-Hodgkin lymphoma, chronic lymphocytic leukaemia and myeloma.

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 1 in 10 people (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.

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 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. 

Sickness is most likely to start within 24 hours of the treatment. It is usually well controlled with anti sickness tablets and injections. Tell your doctor or nurse if you still have sickness as there are other medicines you can have.

Feeling or being sick affects about about 7 in 10 people (70%).

A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.

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.

Tiredness during and after treatment affects about 4 out of 10 people (40%)

Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men

You may be able to store sperm before starting treatment.

It can take a few months or sometimes years for fertility to return to normal. You can have sperm counts to check your fertility when your treatment is over. Ask your doctor about it.

Women

Chemotherapy can cause an early menopause. This stops you from being able to become pregnant in the future. Talk to your doctor about this before your treatment. It’s sometimes possible to store eggs or embryos before treatment.

Your mouth might get sore. 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.

Tell your doctor or nurse if your mouth is sore.

Occasional side effects

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

Your hair may thin. It usually begins falling out gradually within 2 to 3 weeks after treatment starts.

Your hair grows back once your treatment has finished. This can take several months and your hair is likely to be softer.

Tips

  • Use gentle hair products such as baby shampoos.
  • Don't use perms or hair colours on thinning hair.
  • Use a soft baby brush and comb thinning hair gently.
  • Pat your hair dry gently rather than rubbing.
  • Avoid using hair dryers, curling tongs and curlers.

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.

You might have heart palpitations or chest pain.

If you have any chest pain, contact your doctor or nurse as soon as possible. 

During treatment, your blood pressure may be lower or higher than usual. Your nurse will check this regularly. Your blood pressure usually goes back to normal either during treatment or when your treatment ends. 

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.

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

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 way your liver is working.

A small number of people have an allergic reaction, usually during the first or second treatment.

Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.

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

Your nurse will keep a close eye on you and give you treatment straight away if this happens. They might slow your drip down.

Women might stop having periods (amenorrhoea) but this may be temporary.

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

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.

Some drugs can affect the way your kidneys work. You'll have regular blood tests to check how well your kidneys are working.

You are unlikely to notice any symptoms from this and any changes will almost certainly go back to normal after treatment. 

High uric acid levels in the blood are due to the breakdown of tumour cells (tumour lysis syndrome). You will have regular blood tests to check your uric acid levels and may have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid.

Tell your doctor or nurse if you develop a dry cough or breathlessness, especially in cold weather.

Rare side effects

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

Changes in taste can make you go off certain foods. Many people go off tea and coffee, for example. You might also find that some foods taste different. Some people find that they prefer to eat spicier foods.

Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

Let your doctor or nurse know straight away if you have any blood in your spit.

Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.

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.
  • Moisturise your skin at least a couple of times a day.
  • Take care when cutting your nails.

About bendamustine

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.

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