Gemcitabine Hydrochloride side effects: what 52,745 FDA adverse event reports show
Drug class
Nucleoside metabolic inhibitor
Who reports
52,745 reports · 97% serious · 9,969 with death outcome · 49% female
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.
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:
Boxed warning
None in the current label
Causality screen of the 40 strongest signals
What the badges mean
- Labeled adverse reaction The exact term appears in the label's warnings or adverse-reactions sections: a known, expected effect. The FAERS signal confirms the label rather than discovering anything.
- Labeled (related wording) The label describes this effect under different wording (e.g. 'neutropenia' for 'neutrophil count decreased'). Treated as known.
- Likely indication confounding The term appears in the label's indications: reports probably describe the disease being treated (or its progression), not a drug effect. Classic confounding by indication.
- Lab value / disease marker A laboratory result, investigation or disease-activity marker (antibody positive, CRP abnormal, swollen joint count) not described in the label. These usually mirror the monitored disease or testing protocol rather than a drug effect; not screened further.
- Not in label — unassessed Not found in the label text, not an artifact pattern. This is a genuine candidate for a formal causality assessment (Bradford Hill / WHO-UMC); it has NOT had one here.
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.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Desmoplastic small round cell tumour | 38 | 303.4 198.7–463.5ROR 303.7 · calibrated p 6e-11 ✓ | 157.9 EB05 120.1 · IC025 +5.2 3/3 methods agree | Not in label — unassessed | serious n=38 · ♀ 100% (drug 49%) · 100% clinician | not reported in cached trials |
| Pseudocellulitis | 73 | 210.0 158.1–279.1ROR 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% clinician | not reported in cached trials |
| Refractory cancer | 56 | 138.7 102.3–188.1ROR 138.8 · calibrated p 2e-8 ✓ | 99.3 EB05 79.3 · IC025 +5.3 3/3 methods agree | Not in label — unassessed | serious n=56 | not reported in cached trials |
| Platelet toxicity | 23 | 132.3 82.5–212.3ROR 132.4 · calibrated p 7e-8 ✓ | 91.8 EB05 64.4 · IC025 +4.3 3/3 methods agree | Labeled (related wording) related wording | serious n=23 · 100% clinician | not reported in cached trials |
| Pseudocirrhosis | 76 | 119.9 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 — unassessed | serious n=76 · ♀ 100% (drug 49%) · 100% clinician | not reported in cached trials |
| Biliary tract infection | 128 | 105.4 86.8–128.1ROR 105.7 · calibrated p 1e-7 ✓ | 82.3 EB05 71.0 · IC025 +5.7 3/3 methods agree | Labeled (related wording) related wording | serious n=127 | not reported in cached trials |
| Diffuse large b-cell lymphoma recurrent | 373 | 83.5 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 — unassessed | serious n=371 · 94% clinician | not reported in cached trials |
| Recall phenomenon | 139 | 79.3 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 — unassessed | serious n=136 · ♀ 69% (drug 49%) · 97% clinician | not reported in cached trials |
| Diffuse large b-cell lymphoma refractory | 150 | 76.4 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 — unassessed | serious n=149 | not reported in cached trials |
| Ductal adenocarcinoma of pancreas | 41 | 69.4 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% clinician | not reported in cached trials |
| Cholangitis infective | 35 | 61.1 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 — unassessed | serious n=35 · 100% clinician | not reported in cached trials |
| Renal-limited thrombotic microangiopathy | 30 | 60.8 41.4–89.3ROR 60.9 · calibrated p 8e-6 ✓ | 51.2 EB05 37.6 · IC025 +4.2 3/3 methods agree | Labeled (related wording) related wording | serious n=30 · 100% clinician | not reported in cached trials |
| Pik3ca-activated mutation | 43 | 60.3 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 — unassessed | serious n=43 · ♀ 100% (drug 49%) · 91% clinician | not reported in cached trials |
| Biliary sepsis | 58 | 57.0 43.3–75.1ROR 57.1 · calibrated p 8e-6 ✓ | 49.1 EB05 39.4 · IC025 +4.7 3/3 methods agree | Labeled (related wording) related wording | serious n=58 · 93% clinician | not reported in cached trials |
| Pancreatic fistula | 19 | 55.9 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=19 | not reported in cached trials |
| Pancreatic abscess | 23 | 51.7 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% clinician | not reported in cached trials |
| Pancreatic carcinoma recurrent | 27 | 51.0 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% clinician | not reported in cached trials |
| Metastases to muscle | 19 | 47.1 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 — unassessed | serious n=19 | not reported in cached trials |
| Pancreatic carcinoma metastatic | 299 | 46.4 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% clinician | not reported in cached trials |
| Haemolytic uraemic syndrome | 239 | 45.0 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% clinician | not reported in cached trials |
| Toxic erythema of chemotherapy | 23 | 42.5 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% clinician | not reported in cached trials |
| Thrombotic microangiopathy | 934 | 42.4 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% clinician | not reported in cached trials |
| Cholangitis | 573 | 40.7 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 — unassessed | serious n=573 · 94% clinician | not reported in cached trials |
| Thrombophlebitis migrans | 28 | 37.5 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 — unassessed | serious n=27 | not reported in cached trials |
| Capillary leak syndrome | 172 | 36.3 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% clinician | not reported in cached trials |
| Metastases to bone marrow | 40 | 34.2 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 — unassessed | serious n=40 · ♀ 71% (drug 49%) | not reported in cached trials |
| Metastases to chest wall | 27 | 33.5 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 — unassessed | serious n=27 | not reported in cached trials |
| Adenocarcinoma pancreas | 98 | 32.7 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% clinician | not reported in cached trials |
| Follicular lymphoma | 64 | 32.2 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 — unassessed | serious n=64 | not reported in cached trials |
| Carbohydrate antigen 19-9 increased | 37 | 30.5 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 marker | serious n=35 | not reported in cached trials |
| Duodenal obstruction | 21 | 30.0 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 — unassessed | serious n=21 | not reported in cached trials |
| Hypercalcaemia of malignancy | 19 | 29.9 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 — unassessed | serious n=19 | not reported in cached trials |
| Atypical haemolytic uraemic syndrome | 55 | 29.0 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 — unassessed | serious n=55 | not reported in cached trials |
| Metastases to spleen | 28 | 28.6 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 — unassessed | serious n=28 | not reported in cached trials |
| Metastases to peritoneum | 168 | 28.5 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 — unassessed | serious n=168 · 91% clinician | not reported in cached trials |
| Post thrombotic syndrome | 29 | 27.1 18.6–39.5ROR 27.2 · calibrated p 7e-4 ✓ | 25.1 EB05 18.3 · IC025 +3.5 3/3 methods agree | Labeled (related wording) related wording | serious n=29 | not reported in cached trials |
| Egfr gene mutation | 24 | 26.9 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 — unassessed | serious n=24 · 100% clinician | not reported in cached trials |
| Haematotoxicity | 583 | 26.6 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 — unassessed | serious PRR 15.2 · 96% clinician | not reported in cached trials |
| Tumour associated fever | 25 | 26.4 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 — unassessed | serious n=25 | not reported in cached trials |
| Duodenal stenosis | 29 | 25.4 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 — unassessed | serious n=28 | not 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).
- NCT00011986 — Combination Chemotherapy in Treating Patients With Stage III or Stage IV Ovarian Epithelial Cancer or Primary (N=4312, PHASE3; 127 AE terms posted; arms: Carbo/Taxol; Carbo/Taxol/Gemcitabine; Carbo/Taxol/Doxil; Carbo/Topotecan - Carbo/Taxol)
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.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Disease progression | 4,851 | 17.0 16.6–17.5ROR 18.6 · calibrated p 0.003 ✓ | 16.4 EB05 16.0 · IC025 +4.0 3/3 methods agree | Reporting / coding artifact | serious PRR 11.0 · 96% clinician | not reported in cached trials |
| Off label use (used outside approved label) | 4,109 | 1.9 1.8–1.9ROR 2.0 · calibrated p 0.923 | 1.9 EB05 1.8 · IC025 +0.9 | Reporting / coding artifact | serious PRR 2.0 | not reported in cached trials |
| Thrombocytopenia (low platelets) | 3,705 | 13.6 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% clinician | NCT00011986: 645/851 (75.8%) on Gemcitabine |
| Neutropenia (low neutrophils (infection-fighting cells)) | 3,294 | 9.9 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% clinician | NCT00011986: 1/766 (0.1%) on Gemcitabine (serious AE) |
| Anaemia (low red blood cells) | 3,084 | 6.5 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 4.2 | NCT00011986: 685/851 (80.5%) on Gemcitabine |
| Malignant neoplasm progression | 2,912 | 11.7 11.3–12.1ROR 12.3 · calibrated p 0.015 ✓ | 11.4 EB05 11.0 · IC025 +3.4 3/3 methods agree | Reporting / coding artifact | serious PRR 6.9 | not reported in cached trials |
| Drug ineffective (drug did not work) | 2,777 | 0.8 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 artifact | serious PRR 1.4 · 95% clinician | not reported in cached trials |
| Nausea | 2,605 | 1.3 1.3–1.4ROR 1.3 · calibrated p 0.528 | 1.3 EB05 1.3 · IC025 +0.3 | Labeled adverse reaction exact term | serious PRR 1.5 | NCT00011986: 1/767 (0.1%) on Gemcitabine (serious AE) |
| Pyrexia (fever) | 2,593 | 3.0 2.9–3.1ROR 3.1 · calibrated p 0.596 | 3.0 EB05 2.9 · IC025 +1.5 3/3 methods agree | Labeled (related wording) related wording | serious PRR 2.2 | not reported in cached trials |
| Diarrhoea (diarrhea) | 2,120 | 1.3 1.3–1.4ROR 1.3 · calibrated p 0.524 | 1.3 EB05 1.3 · IC025 +0.3 | Labeled adverse reaction exact term | serious PRR 1.3 · 90% clinician | NCT00011986: 2/767 (0.3%) on Gemcitabine (serious AE) |
| Vomiting | 2,097 | 1.8 1.7–1.9ROR 1.8 · calibrated p 0.838 | 1.8 EB05 1.7 · IC025 +0.8 | Labeled adverse reaction exact term | serious PRR 1.5 | NCT00011986: 1/767 (0.1%) on Gemcitabine (serious AE) |
| Fatigue (tiredness) | 2,094 | 1.1 1.0–1.1ROR 1.1 · calibrated p 0.356 | 1.1 EB05 1.0 · IC025 +0.0 | Labeled adverse reaction exact term | serious PRR 1.2 | NCT00011986: 3/774 (0.4%) on Gemcitabine (serious AE) |
| Death | 1,988 | 0.9 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 reaction | serious PRR 0.5 | not reported in cached trials |
| Febrile neutropenia | 1,835 | 11.3 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% clinician | NCT00011986: 7/767 (0.9%) on Gemcitabine (serious AE) |
| Myelosuppression | 1,657 | 20.3 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% clinician | not 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.
- Desmoplastic small round cell tumour — n=38, PRR 303.4
- Refractory cancer — n=56, PRR 138.7
- Pseudocirrhosis — n=76, PRR 119.9
- Diffuse large b-cell lymphoma recurrent — n=373, PRR 83.5
- Recall phenomenon — n=139, PRR 79.3
- Diffuse large b-cell lymphoma refractory — n=150, PRR 76.4
- Cholangitis infective — n=35, PRR 61.1
- Pik3ca-activated mutation — n=43, PRR 60.3
- Cholangitis — n=573, PRR 40.7
- Thrombophlebitis migrans — n=28, PRR 37.5
✓ 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
- FDA label via openFDA (set ID a625c92b-c569-4b98-8d2e-2b3f5e12b34f, effective 20240816; matched on
openfda.generic_name.exact:"GEMCITABINE") - Bayesian shrinkage measures computed offline over all 1,317,300 cached pairs: BCPNN information component (IC, with Norén closed-form IC025) and MGPS empirical-Bayes geometric mean (EBGM, EB05) with a two-component gamma prior fitted by maximum marginal likelihood (α₁=0.57, β₁=0.02, α₂=1.42, β₂=0.70, w=0.17); unstratified
- FAERS pair statistics from the OpenPV build of 2026-09-14 (openFDA
count=aggregation, fieldpatient.drug.openfda.generic_name.exact, 1,189 reaction terms, min 3 co-reports); PRR/ROR with 95% CI, chi-square with Yates correction - Serious-only and stratified counts (serious:1, patient.patientsex, primarysource.qualification) from openFDA count queries; serious-only PRR uses the drug serious report total and the term global serious total (N_serious=11,882,979); strata shown only when n ≥ 20
- Seriousness and sex counts from openFDA
count=serious,patient.patientsex,seriousnessdeath - ClinicalTrials.gov API v2 (query
GEMCITABINE, results-bearing studies sorted by enrollment)
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.