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Trastuzumab Side Effects

In Summary

Commonly reported side effects of trastuzumab include: febrile neutropenia, infection, asthenia, dizziness, fever, headache, nausea, pain, skin rash, vomiting, abdominal pain, back pain, diarrhea, flu-like symptoms, insomnia, neutropenia, pharyngitis, rhinitis, chills, and anorexia. Other side effects include: urinary tract infection, anemia, arthralgia, depression, edema, ostealgia, paresthesia, sinusitis, and tachycardia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to trastuzumab: intravenous powder for solution

Along with its needed effects, trastuzumab may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking trastuzumab:

More common
  • Black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • chest pain
  • chills
  • cough
  • cracked lips
  • decreased frequency or amount of urine
  • diarrhea
  • difficult or labored breathing
  • difficulty in swallowing
  • dry mouth
  • fever
  • headache
  • hoarseness
  • increased blood pressure
  • increased thirst
  • irregular heartbeat
  • loss of appetite
  • lower back or side pain
  • mood changes
  • muscle aches, pain, or cramps
  • nausea
  • numbness or tingling in the hands, feet, or lips
  • painful or difficult urination
  • pale skin
  • peeling of the skin
  • pinpoint red spots on the skin
  • seizures
  • sore throat
  • sores, ulcers, or white spots on the lips, tongue, or inside the mouth
  • stuffy or runny nose
  • swelling of the face, fingers, or lower legs
  • swollen glands
  • tightness in the chest
  • troubled breathing
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting
  • weight gain
Less common
  • Bladder pain
  • bloody nose
  • blurred vision
  • body aches or pain
  • burning or stinging of the skin
  • cloudy urine
  • dilated neck veins
  • dizziness
  • ear congestion
  • extreme tiredness or weakness
  • fainting
  • fast, irregular, pounding, or racing heartbeat or pulse
  • frequent urge to urinate
  • general feeling of discomfort or illness
  • irregular breathing
  • joint pain
  • loss of voice
  • nasal congestion
  • nervousness
  • pain or tenderness around the eyes and cheekbones
  • painful cold sores or blisters on the lips, nose, eyes, or genitals
  • pounding in the ears
  • shivering
  • sneezing
  • sweating
  • trouble sleeping
  • Chest discomfort
  • hives, itching, skin rash
  • joint stiffness or swelling
  • neck tenderness or swelling
  • redness of the skin
  • tightness in the chest

Some side effects of trastuzumab may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • difficulty in moving
  • feeling of warmth
  • muscle stiffness
  • redness of the face, neck, arms and occasionally, upper chest
  • sudden sweating
Less common

For Healthcare Professionals

Applies to trastuzumab: intravenous powder for injection


The most common adverse events were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, dyspnea, rash, neutropenia, anemia, stomatitis, weight loss, thrombocytopenia, mucosal inflammation, nasopharyngitis, dysgeusia, and myalgia.[Ref]


Very common (10% or more): Neutropenia (78%), leukopenia (52%), anemia (36%), febrile neutropenia (23%), thrombocytopenia (16%)
Frequency not reported: Hypoprothrombinemia[Ref]


Very common (10% or more): LVEF decrease (44%), congestive heart failure (28%), cardiomyopathy (15%), peripheral edema (10%), tachycardia (10%)
Common (1% to 10%): Hypertension, hypotension, asymptomatic cardiac dysfunction, ejection fraction decreased, palpitation, cardiac arrhythmia, cardiac failure, heart beat irregular, cardiac flutter, lymphedema, hot flush, thrombotic adverse event, supraventricular tachyarrhythmia, vasodilation
Uncommon (0.1% to 1%): Ventricular dysfunction, pericardial effusion
Frequency not reported: Cardiogenic shock, pericarditis, bradycardia, gallop rhythm present, S3 gallop[Ref]


Very common (10% or more): Infusion-related reactions (54%)
Common (1% to 10%): Hypersensitivity, allergic reaction
Frequency not reported: Anaphylactic reaction, anaphylactic shock[Ref]


Very common (10% or more): Cough (43%), dyspnea (42%), rhinitis (22%), Grade 2 to 5 pulmonary toxicity (14%), nasopharyngitis (13%), wheezing, epistaxis, rhinorrhea
Common (1% to 10%): Pharyngolaryngeal pain, sinusitis, epistaxis, upper respiratory infection, rhinitis, asthma, lung disorder, pleural effusion
Uncommon (0.1% to 1%): Pulmonary infiltrates, pulmonary hypertension, interstitial pneumonitis
Frequency not reported: Pulmonary insufficiency, pulmonary fibrosis, respiratory distress, respiratory failure, lung infiltration, acute pulmonary edema, acute respiratory distress syndrome, bronchospasm, hypoxia, oxygen saturation decreased, laryngeal edema, pulmonary edema, orthopnea
Postmarketing reports: Bronchospasm, hypoxia, pleural effusions, non-cardiogenic pulmonary edema[Ref]


Very common (10% or more): Infection (47%), herpes simplex (38%), antibody to trastuzumab (15%), flu syndrome (12%)
Common (1% to 10%): Neutropenic sepsis, postoperative wound infection, herpes zoster
Uncommon (0.1% to 1%): Sepsis[Ref]


Very common (10% or more): Renal impairment/failure (18%)
Common (1% to 10%): Grade 3 or 4 renal failure, renal disorder, hyperbilirubinemia
Frequency not reported: Glomerulonephritis membranous, glomerulonephropathy, renal failure
Postmarketing reports: Nephrotic syndrome with pathological evidence of glomerulopathy[Ref]


Very common (10% or more): Nausea (76%), vomiting (53%), diarrhea (45%), abdominal pain (34%), stomatitis (24%), anorexia (14%)
Common (1% to 10%): Constipation, dyspepsia, dysphagia, lip swelling, pancreatitis, hemorrhoids, dry mouth[Ref]

Nervous system

Very common (10% or more): Headache (44%), asthenia (42%), fatigue (35%), insomnia (29%), dizziness (24%), paresthesia (23%), peripheral neuritis (23%), neuropathy (13%), dysgeusia (10%), dizziness (13%), tremor, hypoesthesia
Common (1% to 10%): Hypertonia, somnolence, ataxia
Rare (less than 0.1%): Paresis
Frequency not reported: Brain edema[Ref]


Very common (10% or more): Rash (38%), nail changes (12%), acne (11%), rash/desquamation (11%), erythema, swelling face, palmar-plantar erythrodysesthesia syndrome, alopecia
Common (1% to 10%): Pruritus, dry skin, ecchymosis, hyperhidrosis, maculopapular rash, onychoclasis, dermatitis, contusion, skin infection, erysipelas, cellulitis
Uncommon (0.1% to 1%): Urticaria
Frequency not reported: Angioedema[Ref]


Very common (10% or more): Arthralgia (37%), back pain (34%), bone pain (24%), muscle tightness, myalgia
Common (1% to 10%): Muscle spasm, neck pain, pain in extremity, arthritis[Ref]


Very common (10% or more): Anorexia (31%), hypokalemia (28%), weight loss (23%)
Frequency not reported: Hyperkalemia
Postmarketing reports: Volume overload[Ref]


Very common (10% or more): Asthenia (62%), pain (61%), fever (56%), chills (41%), accidental injury (13%)
Common (1% to 10%): Malaise
Uncommon (0.1% to 1%): Deafness
Rare (less than 0.1%): Sudden death
Postmarketing reports: Oligohydramnios or oligohydramnios sequence (including pulmonary hypoplasia, skeletal abnormalities, and neonatal death)[Ref]


Common (1% to 10%): Hepatocellular injury, hepatitis, liver tenderness
Rare (less than 0.1%): Jaundice
Frequency not reported: Hepatic failure[Ref]


Very common (10% or more): Conjunctivitis, lacrimation increased
Common (1% to 10%): Dry eye
Frequency not reported: Papilledema, retinal hemorrhage[Ref]


Common (1% to 10%): Breast inflammation/mastitis, urinary tract infection, cystitis[Ref]


Very common (10% or more): Depression (20%), insomnia (14%)
Common (1% to 10%): Anxiety, thinking abnormal
Uncommon (0.1% to 1%): Depression[Ref]


Uncommon (0.1% to 1%): Autoimmune thyroiditis[Ref]


Frequency not reported: Malignant neoplasm progression, neoplasm progression[Ref]


1. Cerner Multum, Inc. "Australian Product Information." O 0

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

3. "Product Information. Ogivri (trastuzumab)." Mylan GmbH, Morgantown, WV.

4. "Product Information. Herceptin (trastuzumab)." Genentech, South San Francisco, CA.

Some side effects of trastuzumab may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.