Oxaliplatin

Oxaliplatin is a type of chemotherapy drug. It’s a treatment for a number of different cancer types.

You pronounce oxaliplatin as ox-ali-pla-tin.

You usually have oxaliplatin in combination with other cancer drugs. It depends on the type of cancer you have as to which drugs you have it with. 

You might also have oxaliplatin as part of a clinical trial.

How does oxaliplatin work?

Oxaliplatin is one of a group of drugs called alkylating agents, which is a type of chemotherapy.

Oxaliplatin works by sticking to one of the cancer cell's DNA  strands. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything the cell does. The cell cannot then grow and divide into 2 new cells.

How do you have oxaliplatin?

You have oxaliplatin as a drip into your bloodstream (intravenously).

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
• 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. You have a new cannula each time you have treatment.

How often do you have oxaliplatin?

You have oxaliplatin as cycles of treatment . Each cycle varies depending on what type of cancer you have.

Each treatment of oxaliplatin takes between 2 to 6 hours to go into your bloodstream. The amount of time you have oxaliplatin over will depend on your treatment plan.

Your healthcare team can tell you more about the details of your treatment plan.

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.

What are the side effects of oxaliplatin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 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. 

Breathlessness and looking pale

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

Bruising, bleeding gums or nosebleeds

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).

Less commonly you might also bleed from other areas of the body for other reasons. For instance, some people might notice their poo is quite dark or they might pass fresh blood.

Allergic reaction

A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Increased sensitivity to the cold

Oxaliplatin can make you more sensitive to the cold. It can affect your throat causing it to feel as though it is difficult to breathe and swallow. This can happen whilst you have oxaliplatin or within 2 hours of it finishing. It’s only temporary but can feel quite frightening.

Opening and closing the fridge or freezer, touching metal, eating or drinking cold foods and changes in temperature from the weather can trigger this.

It can help wearing gloves and avoid very cold food and drink for 24 hours before and after oxaliplatin.

Let your team know straight away if it's affecting your breathing and swallowing.

Numbness and tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. This is due to its effects on the nerves. The medical name for this is peripheral neuropathy.

Peripheral neuropathy can make it difficult to do fiddly things such as doing up buttons. It might be triggered and get worse with cold temperatures: for example, cold air, cold drinks, or touching anything cold.

Other nerve problems might include having abnormal sensation to different parts of the body. This can feel like a shock-like sensation passing down your arms.

Tiredness and weakness

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.

Loss of appetite

You might lose your appetite for various reasons while 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. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Mouth sores and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. 

Inflammation and pain at your drip site

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

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Changes to the way your liver works

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.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Difficulty breathing or a cough

You may develop a cough or breathing problems. Let your healthcare team know straight away if you suddenly become breathless or develop a cough.

Skin changes

You might notice skin changes which are red and itchy. Less commonly your skin might peel.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your healthcare team before using any creams or lotions.

Pain

This treatment can cause pain in different parts of your body such as your back and tummy (abdomen). Less commonly you might have pain in your bones and stiffness in your joints.

Let your healthcare team know if you are in pain so that they can give you painkillers.

Changes to the level of substances in the blood

The level of glucose and sodium in your blood might go up and the level of potassium might go down. Less commonly you may also have low levels of calcium.

It’s unlikely you will have symptoms from this as they are usually picked up on blood tests. You have regular blood tests during treatment to check this.   

Fever and rigors

You might get a high temperature (fever) with a sudden feeling of being cold, shivering and sweating (rigor). Contact your healthcare team straight away. Ask them if you can take paracetamol to help lower your temperature.

Weight changes

You may gain weight while having this treatment. Or less commonly you may lose weight.

You may be able to control it with diet and exercise. Tell your healthcare team if you are finding it difficult to control your weight. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include

• indigestion symptoms include heartburn, bloating and burping
• high blood pressure symptoms might include headaches, confusion, vision problems or chest pain
• feeling very low in mood (depressed)
• difficulty sleeping (insomnia)
• eye problems - this includes problems with your vision and watery, red and itchy eyes (conjunctivitis)
• dizziness
• brittle, chipped and ridged nails
• runny nose
• problems passing urine such as burning or stinging when going, passing blood and changes to how often you go
• damage to the nerves that control your muscles causing symptoms such as weakness, cramping or twitching
• hiccups
• inflammation of the membranes covering the brain and spinal cord (meninges). Symptoms are similar to meningitis (stiff neck, unable to look at bright light and headache)
• not enough fluid in your body (dehydration)
• sweating more than usual
• reddening of the skin (flushing)
• blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• a risk of falling

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• hearing problems such as hearing loss
• blockage or slow movement of the gut
• feeling nervous
• an imbalance of substances in your blood (metabolic acidosis). It can cause confusion, tiredness, shortness of breath and headaches

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 medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. 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 may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Women must not become pregnant for at least 9 months after the end of treatment. Men should not father a child for at least 6 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment. 

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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