From the hematopoiesis: the most common side effect is reversible neutropenia, in some cases accompanied by fever. The number of neutrophils is reduced to the minimum values on average after 7 days (in patients,previously received chemotherapy, this period may be shorter), the average duration of severe neutropenia (<500 / μL) is also 7 days. Possible development of thrombocytopenia and anemia.
Hypersensitivity reactions: usually occur within a few minutes after the start of infusion and are easy to moderate (flushing, rash, in conjunction with itching, tightness in chest, back pain, dyspnoea and drug fever or chills). Very rarely develops bullous rash (Lyell's syndrome or Stevens-Johnson syndrome). Severe reactions characterized by a reduction in blood pressure and / or bronchospasm or generalized rash / erythema usually disappear after discontinuation of the infusion and the appointment of adequate therapy.
From the skin and skin appendages: alopecia, mild to moderate skin reactions. Less common are severe reactions, such as a rash accompanied by itching or limited erythema of the skin of the extremities (palms and feet) with swelling and subsequent desquamation. Hypo-or hyperpigmentation of nails, severe nail lesions (onycholysis) are rare.
Fluid retention: cases of peripheral edema and, less often, pleural and pericardial effusions, ascites and weight gain are described. Peripheral edema initially appears on the lower limbs, and then can become generalized, resulting in an increase in body weight of 3 kg or more. The frequency and severity of fluid retention increases with repeated administration of the drug. Fluid retention is not accompanied by acute episodes of oliguria or a decrease in blood pressure. In rare cases, the development of dehydration and pulmonary edema was reported.
On the part of the digestive system: nausea, vomiting, diarrhea, anorexia, constipation, stomatitis, a taste disorder, esophagitis, pain in the stomach, rarely gastrointestinal bleeding, extremely rarely - intestinal obstruction; increased serum activity ACT, ALT, alkaline phosphatase and serum bilirubin concentration.
From the nervous system: peripheral neuropathy in the form of easy or moderately expressed paresthesia, hyperesthesia, dysesthesia or pain, including burning. Motor disorders are characterized by weakness. These violations usually pass independently on average for 3 months.Very rarely there is a development of seizures and a passing loss of consciousness.
From the side of the cardiovascular system: disorders of the heart rhythm (sinus tachycardia, atrial fibrillation), unstable angina, heart failure, increase or decrease in blood pressure. Very rarely there were cases of venous thromboembolism and myocardial infarction.
From the respiratory system: very rarely there is an acute respiratory distress syndrome and interstitial pneumonia, pulmonary fibrosis.
On the part of the organs of vision: rarely - lacrimation in conjunction with conjunctivitis (or without it), transient visual disorders (flashes of light in the eyes, the appearance of cattle), usually occurring during the administration of the drug and combined with the development of hypersensitivity reactions; very rarely (mainly in patients receiving concomitantly other antitumoral drugs) may develop occlusion of the lacrimal canal.
Local reactions: hyperpigmentation, inflammation, redness or dryness of the skin, phlebitis, hemorrhage or edema of the vein.
Other: asthenia, arthralgia, myalgia, muscle weakness, shortness of breath, generalized or local pain,including pain in the chest, not related to heart and lung diseases, sepsis, increased reactions to irradiation.