Gemcitabine (Specialist drug)

How it works

As a pyrimidine (nucleoside) analogue it is incorporated into DNA and inhibits ribonucleotide reductase, halting DNA synthesis and causing apoptosis of dividing cells.

Prescribing in practice

• Myelosuppression is the main dose-limiting toxicity, so withhold or modify treatment according to blood counts and counsel on infection and bleeding risk.
• Prolonging the infusion beyond the recommended duration increases toxicity, so administer over the specified short infusion time.
• Rare but serious haemolytic uraemic syndrome, capillary leak syndrome and pulmonary toxicity can occur and require prompt recognition and discontinuation.

Monitoring

Monitor full blood count before each dose and check renal and hepatic function, with vigilance for pulmonary symptoms and signs of haemolytic uraemic syndrome.

Counselling the patient

• Seek urgent help for fever, sore throat or unusual bruising or bleeding.
• Mild flu-like symptoms are common shortly after an infusion.
• Report new breathlessness, reduced urine output or marked swelling.

Evidence & guidelines

Gemcitabine is a long-established antimetabolite chemotherapy with efficacy across several solid tumours demonstrated in randomised trials and embedded in oncology treatment protocols.