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Antimetabolite Chemotherapy Pregnancy: Contraindicated — cytotoxic

Gemcitabine

Brand names: Gemzar

Adult dose

Dose: 1000-1250 mg/m2 IV on days 1, 8, 15 of a 28-day cycle
Route: Intravenous infusion (over 30 minutes)
Frequency: Days 1, 8, 15 of each 28-day cycle (with cisplatin or carboplatin on day 1)
Max: 1250 mg/m2 per dose
GC regimen (gemcitabine + cisplatin): standard first-line for metastatic bladder urothelial carcinoma. GCarbo: gemcitabine + carboplatin for cisplatin-ineligible patients

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Use with caution in renal impairment; no specific dose reduction for mild-moderate impairment but monitor closely

Hepatic

Use with caution; hepatotoxicity possible — monitor LFTs

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • GC regimen (von der Maase 2000): established gemcitabine + cisplatin as standard first-line for metastatic bladder cancer — equivalent efficacy to older MVAC with superior tolerability
  • Flu-like syndrome after infusion: paracetamol and adequate hydration; warn patients to expect this on day of infusion
  • Radiation recall: if patient has received prior radiotherapy, gemcitabine can trigger inflammatory reaction in previously irradiated field — often weeks to months after radiotherapy
  • Pulmonary toxicity (rare interstitial pneumonitis) — if progressive dyspnoea develops, stop and investigate; responds to corticosteroids
  • Day 15 dose often omitted or dose-reduced if blood counts insufficient — FBC must be checked before each administration

Contraindications

  • Severe myelosuppression
  • Active serious infection

Side effects

  • Myelosuppression (neutropenia, thrombocytopenia, anaemia)
  • Flu-like syndrome (fever, myalgia — very common, day 1-2 post-infusion)
  • Nausea and vomiting
  • Transient transaminase elevation
  • Peripheral oedema
  • Radiation recall reaction
  • Pulmonary toxicity (rare)

Interactions

  • Warfarin (increased INR — monitor)
  • Live vaccines (contraindicated during chemotherapy)
  • Radiation (radiation recall and enhanced local toxicity)

Monitoring

  • FBC before each dose (day 8 and 15 counts determine whether to proceed)
  • LFTs
  • Renal function
  • Respiratory symptoms

Reference: BNFc; BNF 90; NICE NG2 (Bladder Cancer); Von der Maase et al. (2000) GC vs MVAC trial; EAU Bladder Cancer Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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