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Gemcitabine Hydrochloride side effects: what 52,745 FDA adverse event reports show

Gemcitabine Hydrochloride · 1,189 reaction terms · 159,588 drug–reaction co-reports · data 2026-09-14
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Drug class

Nucleoside metabolic inhibitor

FDA label, Indications wording

Who reports

52,745 reports · 97% serious · 9,969 with death outcome · 49% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Gemcitabine is a nucleoside metabolic inhibitor indicated: • in combination with carboplatin, for the treatment of advanced ovarian cancer that has relapsed at least 6 months after completion of platinum-based therapy. ( 1.1 ) • in combination with pac.

FDA label, Indications and Usage

What it is

Gemcitabine is a nucleoside metabolic inhibitor. Gemcitabine hydrochloride is 2´-deoxy-2´,2´-difluorocytidine monohydrochloride (β-isomer) with the following structural formula:

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled adverse reaction 4Labeled (related wording) 5Likely indication confounding 7Lab value / disease marker 1Not in label — unassessed 23
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,149 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Desmoplastic small round cell tumour38303.4
198.7–463.5ROR 303.7 · calibrated p 6e-11 ✓
157.9 EB05 120.1 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=38 · ♀ 100% (drug 49%) · 100% cliniciannot reported in cached trials
Pseudocellulitis73210.0
158.1–279.1ROR 210.3 · calibrated p 5e-10 ✓
132.3 EB05 108.8 · IC025 +5.8
3/3 methods agree
Labeled adverse reaction
exact term
serious n=69 · 90% cliniciannot reported in cached trials
Refractory cancer56138.7
102.3–188.1ROR 138.8 · calibrated p 2e-8 ✓
99.3 EB05 79.3 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=56not reported in cached trials
Pseudocirrhosis76119.9
92.7–155.0ROR 120.1 · calibrated p 4e-8 ✓
90.0 EB05 74.3 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=76 · ♀ 100% (drug 49%) · 100% cliniciannot reported in cached trials
Diffuse large b-cell lymphoma recurrent37383.5
74.7–93.4ROR 84.1 · calibrated p 4e-7 ✓
68.8 EB05 63.1 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=371 · 94% cliniciannot reported in cached trials
Recall phenomenon13979.3
66.1–95.1ROR 79.5 · calibrated p 7e-7 ✓
65.5 EB05 56.9 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=136 · ♀ 69% (drug 49%) · 97% cliniciannot reported in cached trials
Diffuse large b-cell lymphoma refractory15076.4
64.2–91.0ROR 76.6 · calibrated p 9e-7 ✓
63.6 EB05 55.5 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=149not reported in cached trials
Ductal adenocarcinoma of pancreas4169.4
49.8–96.8ROR 69.5 · calibrated p 3e-6 ✓
57.6 EB05 44.3 · IC025 +4.6
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=41 · 100% cliniciannot reported in cached trials
Cholangitis infective3561.1
42.8–87.3ROR 61.2 · calibrated p 7e-6 ✓
51.6 EB05 38.8 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=35 · 100% cliniciannot reported in cached trials
Pik3ca-activated mutation4360.3
43.7–83.1ROR 60.4 · calibrated p 7e-6 ✓
51.3 EB05 39.6 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=43 · ♀ 100% (drug 49%) · 91% cliniciannot reported in cached trials
Pancreatic fistula1955.9
34.6–90.4ROR 55.9 · calibrated p 2e-5 ✓
46.9 EB05 31.7 · IC025 +3.7
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=19not reported in cached trials
Pancreatic abscess2351.7
33.5–79.9ROR 51.7 · calibrated p 3e-5 ✓
44.2 EB05 31.0 · IC025 +3.9
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=23 · ♀ 0% (drug 49%) · 100% cliniciannot reported in cached trials
Pancreatic carcinoma recurrent2751.0
34.2–76.2ROR 51.1 · calibrated p 2e-5 ✓
44.0 EB05 31.7 · IC025 +4.0
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=27 · 100% cliniciannot reported in cached trials
Metastases to muscle1947.1
29.2–75.7ROR 47.1 · calibrated p 5e-5 ✓
40.5 EB05 27.4 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=19not reported in cached trials
Pancreatic carcinoma metastatic29946.4
41.2–52.3ROR 46.7 · calibrated p 2e-5 ✓
41.5 EB05 37.7 · IC025 +5.1
3/3 methods agree
Likely indication confounding
term in indications
serious n=298 · 93% cliniciannot reported in cached trials
Haemolytic uraemic syndrome23945.0
39.4–51.5ROR 45.2 · calibrated p 3e-5 ✓
40.4 EB05 36.3 · IC025 +5.0
3/3 methods agree
Labeled adverse reaction
exact term
serious n=239 · 95% cliniciannot reported in cached trials
Toxic erythema of chemotherapy2342.5
27.6–65.3ROR 42.5 · calibrated p 8e-5 ✓
37.3 EB05 26.2 · IC025 +3.7
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=22 · 100% cliniciannot reported in cached trials
Thrombotic microangiopathy93442.4
39.6–45.3ROR 43.1 · calibrated p 3e-5 ✓
38.3 EB05 36.3 · IC025 +5.1
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 22.7 · 95% cliniciannot reported in cached trials
Cholangitis57340.7
37.3–44.3ROR 41.1 · calibrated p 5e-5 ✓
36.9 EB05 34.4 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=573 · 94% cliniciannot reported in cached trials
Thrombophlebitis migrans2837.5
25.5–55.3ROR 37.5 · calibrated p 1e-4 ✓
33.6 EB05 24.4 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=27not reported in cached trials
Capillary leak syndrome17236.3
31.1–42.4ROR 36.4 · calibrated p 1e-4 ✓
33.2 EB05 29.2 · IC025 +4.7
3/3 methods agree
Labeled adverse reaction
exact term
serious n=172 · 97% cliniciannot reported in cached trials
Metastases to bone marrow4034.2
24.8–47.3ROR 34.3 · calibrated p 2e-4 ✓
31.2 EB05 23.9 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=40 · ♀ 71% (drug 49%)not reported in cached trials
Metastases to chest wall2733.5
22.6–49.7ROR 33.6 · calibrated p 2e-4 ✓
30.4 EB05 21.9 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious n=27not reported in cached trials
Adenocarcinoma pancreas9832.7
26.6–40.2ROR 32.7 · calibrated p 2e-4 ✓
30.1 EB05 25.4 · IC025 +4.4
3/3 methods agree
Likely indication confounding
term in indications
serious n=98 · 97% cliniciannot reported in cached trials
Follicular lymphoma6432.2
24.9–41.5ROR 32.2 · calibrated p 2e-4 ✓
29.6 EB05 24.0 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=64not reported in cached trials
Carbohydrate antigen 19-9 increased3730.5
21.8–42.6ROR 30.5 · calibrated p 3e-4 ✓
28.0 EB05 21.2 · IC025 +3.8
3/3 methods agree
Lab value / disease markerserious n=35not reported in cached trials
Duodenal obstruction2130.0
19.2–46.7ROR 30.0 · calibrated p 5e-4 ✓
27.3 EB05 18.8 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=21not reported in cached trials
Hypercalcaemia of malignancy1929.9
18.7–47.6ROR 29.9 · calibrated p 5e-4 ✓
27.1 EB05 18.3 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=19not reported in cached trials
Atypical haemolytic uraemic syndrome5529.0
22.1–38.2ROR 29.1 · calibrated p 4e-4 ✓
26.9 EB05 21.4 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=55not reported in cached trials
Metastases to spleen2828.6
19.5–42.0ROR 28.6 · calibrated p 5e-4 ✓
26.3 EB05 19.1 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=28not reported in cached trials
Metastases to peritoneum16828.5
24.4–33.4ROR 28.6 · calibrated p 4e-4 ✓
26.6 EB05 23.4 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=168 · 91% cliniciannot reported in cached trials
Egfr gene mutation2426.9
17.8–40.7ROR 26.9 · calibrated p 8e-4 ✓
24.8 EB05 17.5 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=24 · 100% cliniciannot reported in cached trials
Haematotoxicity58326.6
24.5–28.9ROR 26.9 · calibrated p 5e-4 ✓
25.0 EB05 23.3 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious PRR 15.2 · 96% cliniciannot reported in cached trials
Tumour associated fever2526.4
17.6–39.6ROR 26.4 · calibrated p 8e-4 ✓
24.4 EB05 17.4 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=25not reported in cached trials
Duodenal stenosis2925.4
17.5–37.0ROR 25.5 · calibrated p 9e-4 ✓
23.6 EB05 17.2 · IC025 +3.5
3/3 methods agree
Not in label — unassessedserious n=28not reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Gemcitabine as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (0 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Disease progression4,85117.0
16.6–17.5ROR 18.6 · calibrated p 0.003 ✓
16.4 EB05 16.0 · IC025 +4.0
3/3 methods agree
Reporting / coding artifactserious PRR 11.0 · 96% cliniciannot reported in cached trials
Off label use (used outside approved label)4,1091.9
1.8–1.9ROR 2.0 · calibrated p 0.923
1.9 EB05 1.8 · IC025 +0.9Reporting / coding artifactserious PRR 2.0not reported in cached trials
Thrombocytopenia (low platelets)3,70513.6
13.2–14.1ROR 14.6 · calibrated p 0.008 ✓
13.2 EB05 12.9 · IC025 +3.7
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 8.0 · 92% clinicianNCT00011986: 645/851 (75.8%) on Gemcitabine
Neutropenia (low neutrophils (infection-fighting cells))3,2949.9
9.6–10.2ROR 10.5 · calibrated p 0.027 ✓
9.7 EB05 9.4 · IC025 +3.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 5.9 · 92% clinicianNCT00011986: 1/766 (0.1%) on Gemcitabine (serious AE)
Anaemia (low red blood cells)3,0846.5
6.3–6.7ROR 6.9 · calibrated p 0.105
6.4 EB05 6.2 · IC025 +2.6
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 4.2NCT00011986: 685/851 (80.5%) on Gemcitabine
Malignant neoplasm progression2,91211.7
11.3–12.1ROR 12.3 · calibrated p 0.015 ✓
11.4 EB05 11.0 · IC025 +3.4
3/3 methods agree
Reporting / coding artifactserious PRR 6.9not reported in cached trials
Drug ineffective (drug did not work)2,7770.8
0.8–0.9ROR 0.8 · calibrated p 0.200
0.8 EB05 0.8 · IC025 -0.3
PRR-only: not supported by EBGM or IC
Reporting / coding artifactserious PRR 1.4 · 95% cliniciannot reported in cached trials
Nausea2,6051.3
1.3–1.4ROR 1.3 · calibrated p 0.528
1.3 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
serious PRR 1.5NCT00011986: 1/767 (0.1%) on Gemcitabine (serious AE)
Diarrhoea (diarrhea)2,1201.3
1.3–1.4ROR 1.3 · calibrated p 0.524
1.3 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
serious PRR 1.3 · 90% clinicianNCT00011986: 2/767 (0.3%) on Gemcitabine (serious AE)
Vomiting2,0971.8
1.7–1.9ROR 1.8 · calibrated p 0.838
1.8 EB05 1.7 · IC025 +0.8Labeled adverse reaction
exact term
serious PRR 1.5NCT00011986: 1/767 (0.1%) on Gemcitabine (serious AE)
Fatigue (tiredness)2,0941.1
1.0–1.1ROR 1.1 · calibrated p 0.356
1.1 EB05 1.0 · IC025 +0.0Labeled adverse reaction
exact term
serious PRR 1.2NCT00011986: 3/774 (0.4%) on Gemcitabine (serious AE)
Death1,9880.9
0.9–1.0ROR 0.9 · calibrated p 0.252
0.9 EB05 0.9 · IC025 -0.2
PRR-only: not supported by EBGM or IC
Outcome field, not a reactionserious PRR 0.5not reported in cached trials
Febrile neutropenia1,83511.3
10.8–11.8ROR 11.7 · calibrated p 0.019 ✓
11.0 EB05 10.6 · IC025 +3.4
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 6.5 · 92% clinicianNCT00011986: 7/767 (0.9%) on Gemcitabine (serious AE)
Myelosuppression1,65720.3
19.3–21.3ROR 20.9 · calibrated p 0.002 ✓
19.4 EB05 18.6 · IC025 +4.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 11.5 · 94% cliniciannot reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Oxycodone Hydrochloride ↔ Drug Dependence.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Gemcitabine?

In FDA FAERS, the most frequently co-reported reaction terms for Gemcitabine are thrombocytopenia, neutropenia, anaemia, nausea, pyrexia, diarrhoea. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Gemcitabine have an FDA boxed warning?

No. The FDA label retrieved for Gemcitabine has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Gemcitabine causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.