Raltitrexed (Tomudex)

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Your doctor has explained that you have colorectal cancer and has recommended treatment with chemotherapy called Tomudex which is given every three weeks as an infusion (drip) into a vein in your arm for approximately 15 minutes.

Before each course of chemotherapy you will see a doctor and have a blood count. If the blood count is low then chemotherapy may be delayed a few days.  The side-effects described below will not affect everyone.  It is important that you feel free to ask questions so that you understand what is happening, what to do and what to expect. Occasionally people have rare side-effects which are not expected and mentioned on this sheet. If in doubt ask.  You may also be given a separate information sheet which tells you what to do and who to contact if needed.

Side effects

Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different  tablets can be prescribed for the next cycle. Some self help tips may also be useful.

Diarrhoea can usually start 5-10 days after the chemotherapy - it is usually mild but occasionally it can be pronounced - it is very important to control the diarrhoea if it develops by taking anti-diarrhoea tablets such as loperamide or codeine. If these have not been given to you at the clinic they can be obtained from the GP. If your diarrhoea persists despite taking the anti-diarrhoea medication, it is very important that you contact the hospital. It is important that you take plenty of fluids if you have diarrhoea so that you do not become dehydrated.


If your blood counts falls you may experience the following:

Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but are otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.

Hair loss; This chemotherapy does not usually cause hair loss. Thinning may occur following 4-6 cycles. This is very rarely enough to need a wig but advice on hair care can be arranged for you during treatment. 

Fatigue;  All chemotherapy can cause fatigue but particularly Tomudex. It usually starts 6-8 days following chemotherapy and can last 7-10 days. It is often relieved by a low dose of steroids. As your treatment progresses you will experience this. You may find that gentle exercise such as a short walk each day (if you are not working) may help. 

Steroids; Before each dose of chemotherapy  you need to take some steroids (Dexamethasone)  to prevent a reaction to chemotherapy and help sickness. Steroids do have some side effects, including weight gain, wakefulness and sometimes agitation. If you normally have indigestion you may be given tablets to prevent indigestion. If patients are prone to "spots" or acne this can be made worse. Likewise they can temporarily upset diabetes or high blood pressure. 

Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash. If you develop mouth ulcers you should contact your clinic and they can prescribe special mouthwashes to help.   

Weight gain; Over the entire course of chemotherapy many patients complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake.

Weight loss may also be experienced by some patients during their course of chemotherapy particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.

Fertility may be affected by chemotherapy, in both men and women.  It is important to discuss fertility with your doctor before starting treatment.  For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent, causing menopausal symptoms. You should not become pregnant during chemotherapy, as it will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant.  Men must also use a barrier contraceptive whilst receiving chemotherapy as sperm is damaged  by chemotherapy.  

Constipation: Some patients experience constipation which may be due to the anti-sickness tablets. You should drink plenty of fluids, eat a high fibre diet and take gentle exercise. If this is severe you should contact your clinic or GP. 

Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team. 

Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally.

There is always someone to contact here and your GP will receive information about your treatment. If in doubt ask.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.



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