Procarbazine is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat Hodgkin lymphoma and brain tumours. This information describes procarbazine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer or lymphoma.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Procarbazine is available as 50mg cream-coloured capsules.

The capsules should be swallowed whole with plenty of water.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described on this information will not affect everyone who is given procarbazine and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and rarer ones, so you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you.

If you notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Procarbazine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Procarbazine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with procarbazine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin soon after the treatment is given and last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

A flu-like effect This can occur after you have had procarbazine. You may have headaches, aching joints or muscles, a temperature, lethargy (a lack of energy) and chills. If this happens it is important to drink lots of fluids and get plenty of rest.

Possible interaction with alcohol and some foods While taking this drug it is best to avoid alcohol and alcohol-free beers and wines, as the combination can cause sickness, headaches, sweating, drowsiness and breathing problems. Some foods can also cause problems, so you may need to avoid foods such as mature cheeses, salami, and yeast or beef extracts (Oxo®, Bovril® and Marmite®). The pharmacist at the hospital, or the nurse or doctor looking after you, will advise you on which foods to avoid if this is necessary.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Skin changes Procarbazine can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Numbness or tingling in hands or feet This is due to the effect of procarbazine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after the treatment has finished.

Emotional changes Procarbazine may cause depression, bad dreams, sleeplessness, nervousness and feelings of fear. However, this is very rare. Discuss these symptoms with your doctor if they occur.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking procarbazine, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug and for at least a few months afterwards. Again, discuss this with your doctor.

• It is important to take your capsules at the right times. You must take them as directed by your doctor.
• Keep the capsules in the original packaging and store them at room temperature, away from heat and direct sunlight.
• Keep the capsules in a safe place where children cannot reach them, as procarbazine could harm them.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the capsules let your doctor know as you may need to take another dose. Do not take another capsule without first informing your doctor.
• If you forget to take a capsule do not take a double dose. Tell your doctor and keep to your regular dose schedule.

This section is based upon our Procarbazine factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott Williams and Wilkins, 2001.

For further references, please see general bibliography.