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gemcitabine

Generic Gemzar
Used for Lung Cancer, Breast Cancer, Ovarian Cancer, Pancreatic Cancer
Used for Lung Cancer, Breast Cancer, Ovarian Cancer, Pancreatic Cancer

Gemcitabine is a chemotherapy medication that’s used for many different cancers, including pancreatic cancer, non-small cell lung cancer (NSCLC), ovarian cancer, and breast cancer. It’s commonly taken together with other anticancer medications, but can also be taken by itself for certain cancers. Gemcitabine is given as an infusion through the vein (IV), and the dose and treatment schedule depends on your specific treatment plan. It can often lower your blood cell counts, which can put you at risk for feeling very tired, bleeding, and getting infections.

Reviewed by:
reviewer
Julia Lee, PharmD, BCOP
reviewer
Cydnee Ng, PharmD
Last reviewed on October 9, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Gemcitabine?

What is Gemcitabine used for?

How Gemcitabine works

Gemcitabine is a type of chemotherapy called an antimetabolite. It interferes with the cancer cells’ ability to make genetic material. This kills cancer cells and stops cancer growth.

Are you looking for information on decitabine (Dacogen) instead?

Drug Facts

Common BrandsGemzar, Infugem (brand names no longer available)
Drug ClassAntimetabolite
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Gemcitabine?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea and vomiting (69%)
  • Anemia (low red blood cell count; 63%)
  • Low white blood cell count (63%)
  • Signs of stress to the liver on blood tests (up to 68%)
  • Signs of kidney injury (protein or blood in the urine; up to 45%)
  • Fever (41%)
  • Rash (30%)
  • Low platelet count (24%)
  • Feeling short of breath (23%)

Other Side Effects

  • Diarrhea
  • Bleeding
  • Infection
  • Hair loss
Note: Side effects were reported by people with different cancers who took gemcitabine by itself. Side effects might differ depending on your cancer, the dosing schedule, and the other medications included in your treatment plan.

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Low blood cell counts: fever, chills, feeling very tired, unusual bleeding or bruising
  • Lung injury: cough, wheezing, trouble catching your breath
  • Serious kidney injury: making little or no urine, dark urine, unusual bleeding or bruising
  • Liver injury: pain in the right side of the stomach, yellowing of the eyes or skin, dark or brown urine
  • Capillary leak syndrome: rapid weight gain, swelling, trouble breathing, dizziness
  • Posterior reversible encephalopathy syndrome (PRES): headache, feeling sluggish or confused, vision loss, seizure

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Black, tarry stools

bleeding gums

bloating or swelling of the face, arms, hands, lower legs, or feet

blood in the urine or stools

blurred vision

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

chest pain

chills

cloudy urine

confusion

cough

coughing up blood

diarrhea

difficult or labored breathing

difficulty in moving

difficulty in swallowing

dizziness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

fever

general feeling of discomfort or illness

headache

hoarseness

increased menstrual flow or vaginal bleeding

joint pain

lack or loss of strength

loss of appetite

lower back or side pain

muscle ache, cramps, pain, or stiffness

nausea

nosebleeds

painful or difficult urination

pale skin

paralysis

pinpoint red spots on the skin

prolonged bleeding from cuts

rapid weight gain

red or black, tarry stools

red or dark brown urine

runny nose

shivering

sores, ulcers, or white spots on the lips or in the mouth

sore throat

sweating

swelling of the hands, ankles, feet, or lower legs

swelling or inflammation of the mouth

swollen glands

swollen joints

tightness in the chest

trouble sleeping

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

unusual weight gain or loss

vomiting

Less common

Chest discomfort

fast, slow, or irregular heartbeat

headache (sudden and severe)

hives, itching, skin rash

inability to speak

nervousness

noisy breathing

pain or discomfort in the arms, jaw, back, or neck

pounding in the ears

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

seizures

slurred speech

temporary blindness

weakness in the arm or leg or on one side of the body (sudden and severe)

Rare

Rapid, shallow breathing

Incidence not known

Blue lips and fingernails

cloudy urine

coughing that sometimes produces a pink frothy sputum

dark urine

decrease or increase in the amount of urine

decreased urine output

difficult, fast, noisy breathing

dilated neck veins

extreme tiredness or weakness

fast, slow, or irregular heartbeat

general feeling of tiredness or weakness

increased sweating

irregular breathing

itching, pain, redness, swelling, tenderness, or warmth on the skin

light-colored stools

sores on the skin, especially on the thighs, breasts, penis, or buttocks

sores, welts, or blisters

stomach pain, continuing

sudden weakness in the arms or legs

sudden, severe chest pain

swelling of the face, fingers, feet, or lower legs

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Difficulty having a bowel movement

hair loss

sleepiness or unusual drowsiness

thinning of hair

Less common

Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Gemcitabine

thumbs-up

Pros

Given as a short infusion (usually takes 30 minutes)

Part of recommended treatment plans for a variety of cancers, including pancreatic cancer and non-small cell lung cancer

thumbs-down

Cons

Often given once a week

Can lower your blood cell counts, which can put you at risk of bleeding and infection

pharmacist-tips

Pharmacist tips for Gemcitabine

pharmacist

  • Gemcitabine is given as an infusion through the vein (IV). Even though the infusion takes about 30 minutes, it’s a good idea to plan to spend a few hours at the infusion center. You might have to do blood tests during your visit.

    • Gemcitabine can lower your blood cell counts, which can put you at risk for infection. Make sure to practice good hand hygiene (wash your hands often) and avoid people who are sick. Let your healthcare team know if you develop any signs of an infection, like fever, chills, or tiredness.

      • Gemcitabine commonly causes nausea and vomiting. Tell your healthcare team if it starts negatively impacting your daily life. Your provider might've prescribed anti-nausea medications that you can try taking. Your providers can also recommend other ways to manage nausea and vomiting, such as eating smaller, more frequent meals and avoiding foods with strong smells.

        • Tell your provider if you have a new or worsening cough, if you start wheezing, or if you feel like you’re having trouble catching your breath. Though rare, gemcitabine can cause serious lung problems. Sometimes, this can happen up to 2 weeks after you’ve stopped treatment.

          • If you’re able to become pregnant, use effective birth control during treatment with gemcitabine and for 6 months after your last dose. If you’re male and have a partner who could become pregnant, also use birth control (e.g., condoms) while you’re taking this medication and for 3 months after your last dose. This is important because gemcitabine might harm an unborn baby.

            • Avoid breastfeeding while you’re getting treated with gemcitabine and for at least a week after your last dose. It’s not known whether gemcitabine can be found in breast milk and whether it can cause side effects in breastfed children.

              faqs

              Frequently asked questions about Gemcitabine

              What other cancers can gemcitabine be used for?
              Gemcitabine is FDA-approved to treat pancreatic cancer, non-small cell lung cancer, ovarian cancer, and breast cancer. But it’s frequently used by itself or together with other anticancer treatments off-label for other cancers, like bladder cancer, bile duct cancer, and certain types of lymphoma. These off-label uses are recommended by the National Comprehensive Cancer Network (NCCN). NCCN guidelines are based on reviews of clinical studies that suggest that treatments like gemcitabine have clinical benefits for those specific cancers. Talk with your provider about whether gemcitabine can be used for your cancer.
              Will I lose my hair with gemcitabine?
              Gemcitabine by itself can sometimes cause hair loss. You're more likely to lose your hair if you’re taking gemcitabine along with other chemotherapy that can also cause hair loss, like paclitaxel. If you experience hair loss during treatment, you can use wigs, scarves, or turbans. Some insurance plans and nonprofit organizations can help you afford your wig. Talk to your healthcare team about hair loss during treatment.
              Is gemcitabine palliative care?
              Gemcitabine helps fight and treat the actual cancer; it’s not a palliative care treatment. Palliative treatments for people with cancer are treatments that focus on managing cancer symptoms, side effects, pain, and stress. The overall goal of palliative care is to support people with cancer throughout their treatment journey so they can continue to live as best they can. It’s a good idea to talk with your healthcare team about how gemcitabine fits into your treatment plan and overall treatment goals.
              How can I manage nausea and vomiting while I’m taking gemcitabine?
              It's common to have nausea or vomiting while you’re taking gemcitabine. Before each infusion, your provider might give you medication to prevent nausea and vomiting. Your provider might also prescribe anti-nausea medications that you can take at home as needed to relieve any nausea or vomiting. It’s also a good idea to try to eat smaller, more frequent meals to avoid stomach upset. Drinking plenty of fluids throughout the day can also help prevent your nausea from getting worse and help prevent dehydration if you vomit. Speak with your healthcare team if these side effects are disrupting your daily routine. Your providers can suggest other medications and strategies to help manage nausea and vomiting.
              What happens if I have low blood cell counts with gemcitabine?
              Gemcitabine often lowers the amount of blood cells in your body, which can put you at risk for anemia, bleeding, and infections. Before each infusion, your provider will check your blood cell counts from your blood test results to make sure it’s safe for you to get treatment. In general, your provider will probably hold off your gemcitabine treatment if your blood cell counts are low. After chemotherapy, your provider might give you an injection of a medication that helps boost your white blood cell counts if they’re low. Once your blood cell counts recover and your provider has determined it’s safe to restart gemcitabine, your provider might modify your treatment schedule or lower your gemcitabine dose.
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              warings-icon

              What are the risks and warnings for Gemcitabine?

              Gemcitabine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Low blood cell counts (bone marrow suppression)

              Gemcitabine lowers your bone marrow’s ability to make blood cells. Low amounts of blood cells can raise your chance of bleeding and make you more likely to get infections. To prevent further complications, you might need to get transfusions if your red blood cell counts are too low. Your provider might also lower your gemcitabine dose if your blood cell counts drop too much from treatment. Talk to your healthcare provider right away if you suddenly have unusual bleeding or bruising, muscle weakness, extreme tiredness, or a fever.

              risk-warning

              Lung injury

              Gemcitabine can cause very rare, but serious and potentially life-threatening, lung inflammation or fluid buildup in the lungs. Tell your healthcare provider right away if you have a new or worsened cough, trouble breathing, or wheezing. You’ll probably need to stop taking gemcitabine while your provider does scans of your lungs and if the scans show signs of lung damage.

              risk-warning

              Serious kidney injury (hemolytic uremic syndrome)

              In very rare situations, gemcitabine can cause a serious kidney problem called hemolytic uremic syndrome. Let your provider know if you have little or no urine, dark urine, or more bruising or bleeding than usual. Those might be signs of kidney injury, and you might have to stop taking gemcitabine so your kidneys can recover.

              risk-warning

              Liver injury

              • Risk factors: Taking other medications that could harm the liver | Cancer that’s spread to the liver | History of liver problems

                Gemcitabine might cause damage to your liver. Let your healthcare team know if you notice signs of liver damage, such as pain in the right side of the stomach, yellowing of the eyes or skin, or dark or brown urine. Sometimes, people don’t feel any symptoms when their liver is having problems, so you’ll need to get blood tests done during treatment to track how well your liver is working. You might need to take a break from gemcitabine if your provider suspects that you have liver damage.

                risk-warning

                Toxicity based on dosing schedule

                • Risk factors: Infusion given over a longer period of time (more than 1 hour) | Infusion given more often than once per week

                  You can have more side effects from gemcitabine, like low blood pressure, low blood cell counts, or fatigue, when certain dosing schedules are used. These situations include infusions that are given over a longer period of time (longer than 1 hour) and infusions that are given more often than once per week. Your healthcare team will help set up your treatment schedule to make sure gemcitabine is safe for you.

                  risk-warning

                  Worsening side effects from radiation therapy

                  • Risk factors: Previous radiation therapy

                    Let your healthcare team know if you’ve had radiation therapy in the past. While you’re getting treated with gemcitabine, you might develop a rash in the area where you had radiation; this is called radiation recall. Contact your providers if you notice a new or worsening rash so they can monitor and help manage your symptoms.

                    Gemcitabine shouldn’t be used while you’re getting radiation therapy. Studies showed that people who received gemcitabine along with radiation had severe side effects from the radiation.

                    risk-warning

                    Capillary leak syndrome

                    In some situations, people receiving gemcitabine by itself or together with other treatments had a serious side effect called capillary leak syndrome. This side effect happens when fluid leaks out of blood vessels and into other parts of your body. This can cause swelling, breathing problems, low blood pressure, and kidney damage. Tell your healthcare team right away if you notice rapid weight gain, swelling, trouble breathing, or dizziness so your providers can examine you.

                    risk-warning

                    Posterior reversible encephalopathy syndrome (PRES)

                    Posterior reversible encephalopathy syndrome (PRES) is a very rare side effect of gemcitabine that can be fatal. This side effect typically affects your nervous system, and symptoms can appear anytime during treatment. Let your provider know if you have any symptoms of PRES, like headache, feeling sluggish or confused, or vision loss.

                    If you develop symptoms, your provider will confirm whether you have PRES by ordering a brain scan called an MRI (magnetic resonance imaging). You’ll need to stop gemcitabine if it’s confirmed that you have PRES. If recognized and treated early, symptoms of PRES typically go away within days.

                    risk-warning

                    Harm to the unborn baby

                    Let your provider know if you’re pregnant or planning to become pregnant. Gemcitabine can harm unborn babies. If you’re able to have children, you’ll need to confirm that you’re not pregnant with a pregnancy test before you start treatment to make sure it's safe for you. Use reliable birth control while you’re taking this medication and for at least 6 months after your last dose. If you’re male and have a partner who’s able to become pregnant, use effective birth control (e.g., condoms) while you’re taking gemcitabine until at least 3 months after the last dose.

                    dosage

                    Gemcitabine dosage forms

                    Typical dosing for Gemcitabine

                    This medication is given as an infusion through the vein (intravenously or IV) and is given by a healthcare provider at an infusion center.

                    Your healthcare team will determine your gemcitabine dose and treatment schedule based on the type of cancer that’s getting treated. Your dose will be calculated based on your body surface area (BSA), which takes into account your weight and height.

                    • Pancreatic cancer

                      • Weeks 1 to 8: The typical dose is 1,000 mg/m2 of BSA given IV once a week for the first 7 weeks, and then a one-week break.

                      • Week 8 and beyond: The typical dose is 1,000 mg/m2 given IV on days 1, 8, and 15 of each 28-day treatment cycle.

                    • Non-small cell lung cancer

                      • For 28-day treatment cycles: The typical dose is 1,000 mg/m2 given IV on days 1, 8, and 15 of each treatment cycle.

                      • For 21-day treatment cycles: The typical dose is 1,250 mg/m2 of BSA given IV on days 1 and 8 of each treatment cycle.

                    • Ovarian cancer: The typical dose is 1,000 mg/m2 of BSA given IV on day 1 and 8 of each 21-day treatment cycle.

                    • Breast cancer: The typical dose is 1,250 mg/m2 of BSA given IV on day 1 and 8 of each 21-day treatment cycle.

                    Note: This list only includes recommended dosages from the manufacturer for the FDA-approved uses of gemcitabine. Your provider might include this medication as part of your treatment plan for a cancer that’s not listed here. Your provider might also use a different dosing schedule from what’s listed here. These situations are considered off-label uses of gemcitabine.

                    interactions

                    Interactions between Gemcitabine and other drugs

                    Gemcitabine may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Gemcitabine. Please note that only the generic name of each medication is listed below.

                    Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                    Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                    alternatives

                    What are alternatives to Gemcitabine?

                    There are a number of medications that your doctor can prescribe in place of Gemcitabine. Compare a few possible alternatives below.
                    Gemcitabine
                    Used for:
                    View Prices
                    Docetaxel (Taxotere)
                    Used for:

                    • Breast cancer

                    • Non-small cell lung cancer

                    • Prostate cancer

                    • Stomach cancer

                    • Head and neck cancer

                    View Prices
                    Paclitaxel (Taxol)
                    Used for:
                    View Prices

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                    References

                    Best studies we found

                    American Cancer Society. (2020). Coping with hair loss.

                    American Cancer Society. (2021). Choosing and wearing a wig.

                    American Cancer Society. (2023). What is palliative care?

                    View All References (16)

                    American Cancer Society. (2024). Preventing infections in people with cancer.

                    Burris, H. A., III, et al. (2010). Radiation recall with anticancer agents. The Oncologist.

                    Ciccolini, J., et al. (2016). Pharmacokinetics and pharmacogenetics of gemcitabine as a mainstay in adult and pediatric oncology: An EORTC-PAMM perspective. Cancer Chemotherapy and Pharmacology.

                    Ingenus Pharmaceuticals, LLC. (2022). Gemcitabine injection, solution [package insert]. DailyMed.

                    Izzedine, H., et al. (2022). Anticancer drug-induced capillary leak syndrome. Kidney International Reports.

                    National Cancer Institute. (2022). Off-label drug use in cancer treatment.

                    National Comprehensive Cancer Network. (2023). Bladder cancer.

                    National Comprehensive Cancer Network. (2023). Early and locally advanced non-small cell lung cancer.

                    National Comprehensive Cancer Network. (2023). Gallbladder and bile duct cancers.

                    National Comprehensive Cancer Network. (2023). Metastatic non-small cell lung cancer.

                    National Comprehensive Cancer Network. (2023). Ovarian cancer.

                    National Comprehensive Cancer Network. (2023). Pancreatic cancer.

                    National Comprehensive Cancer Network. (2024). Diffuse large B-cell lymphomas.

                    National Kidney Foundation. (2015). Hemolytic uremic syndrome (HUS).

                    Sudulagunta, S. R., et al. (2017). Posterior reversible encephalopathy syndrome (PRES). Oxford Medical Case Reports.

                    Zarkavelis, G., et al. (2023). Off-label despite high-level evidence: A clinical practice review of commonly used off-patent cancer medicines. European Society for Medical Oncology Open.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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