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Trastuzumab side effects: what 68,236 FDA adverse event reports show

Trastuzumab · 1,223 reaction terms · 229,862 drug–reaction co-reports · data 2026-09-14
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Drug class

HER2/neu Receptor Antagonist

FDA label (Established Pharmacologic Class) of the closest related product

Label matched

Ontruzant (Ontruzant)

closest FDA label found for this product string; brand list suppressed because the label is a related product, not an exact match

Who reports

68,236 reports · 86% serious · 8,219 with death outcome · 93% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Ontruzant is a HER2/neu receptor antagonist indicated in adults for: The treatment of HER2-overexpressing breast cancer. ( 1.1 , 1.2 ) The treatment of HER2-overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma. ( 1.3 ) Select patients for therapy based on an FDA-approved companion diagnostic for a trastuzumab product ( 1 , 2.2 ).

FDA label, Indications and Usage

What it is

Trastuzumab-dttb is a humanized IgG1 kappa monoclonal antibody that selectively binds with high affinity to the extracellular domain of the human epidermal growth factor receptor 2 protein, HER2. Trastuzumab-dttb is produced by recombinant DNA technology in a mammalian cell (Chinese Hamster Ovary) culture.

FDA label, Description section

Boxed warning

CARDIOMYOPATHY, INFUSION REACTIONS, EMBRYO-FETAL TOXICITY, and PULMONARY TOXICITY WARNING: CARDIOMYOPATHY, INFUSION REACTIONS, EMBRYO-FETAL TOXICITY, and PULMONARY TOXICITY See full prescribing information for comple.

FDA 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 — boxed warning 2Labeled adverse reaction 2Labeled (related wording) 6Likely indication confounding 2Not in label — unassessed 28
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). 1,183 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
Computerised tomogram thorax38522.0
308.8–882.5ROR 522.3 · calibrated p 1e-12 ✓
175.3 EB05 133.3 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=38 · 100% cliniciannot reported in cached trials
Her2 positive breast cancer229512.7
414.5–634.1ROR 514.4 · calibrated p 8e-14 ✓
187.8 EB05 168.3 · IC025 +6.9
3/3 methods agree
Likely indication confounding
term in indications
serious n=229 · 97% cliniciannot reported in cached trials
Her-2 positive breast cancer69289.6
208.2–402.9ROR 289.9 · calibrated p 4e-11 ✓
142.6 EB05 116.5 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=63not reported in cached trials
Biopsy lung abnormal33148.9
98.1–225.8ROR 148.9 · calibrated p 2e-8 ✓
94.7 EB05 70.6 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=33 · 100% cliniciannot reported in cached trials
Lacrimal structure injury8082.5
64.5–105.7ROR 82.6 · calibrated p 7e-7 ✓
64.1 EB05 53.1 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=32not reported in cached trials
Hair disorder1,37060.4
57.0–64.0ROR 61.6 · calibrated p 4e-6 ✓
50.5 EB05 48.3 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=33not reported in cached trials
Delusion of grandeur6955.9
43.3–72.3ROR 56.0 · calibrated p 9e-6 ✓
46.8 EB05 38.2 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=69 · ♀ 0% (drug 93%)not reported in cached trials
Psychological trauma1,26351.8
48.8–55.0ROR 52.8 · calibrated p 1e-5 ✓
44.4 EB05 42.3 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious PRR 29.9 · 100% consumernot reported in cached trials
Computerised tomogram thorax abnormal9850.2
40.5–62.2ROR 50.3 · calibrated p 2e-5 ✓
42.9 EB05 36.2 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=98 · 92% cliniciannot reported in cached trials
Cardiotoxicity1,20248.1
45.3–51.1ROR 49.0 · calibrated p 2e-5 ✓
41.6 EB05 39.7 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious PRR 25.8 · 92% cliniciannot reported in cached trials
Ejection fraction decreased2,04846.5
44.4–48.7ROR 47.9 · calibrated p 2e-5 ✓
40.4 EB05 39.0 · IC025 +5.3
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 27.0NCT00490139: 1/2,076 (0.0%) on Trastuzumab (serious AE)
Madarosis1,42942.7
40.4–45.1ROR 43.5 · calibrated p 3e-5 ✓
37.5 EB05 35.9 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=182not reported in cached trials
Sarcoid-like reaction2842.1
28.4–62.5ROR 42.1 · calibrated p 7e-5 ✓
36.2 EB05 26.3 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=26 · 100% cliniciannot reported in cached trials
Hair colour changes1,50941.8
39.7–44.1ROR 42.7 · calibrated p 4e-5 ✓
36.8 EB05 35.3 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=164not reported in cached trials
Hair texture abnormal1,50838.6
36.6–40.7ROR 39.4 · calibrated p 6e-5 ✓
34.3 EB05 32.9 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=164not reported in cached trials
Nail dystrophy6137.9
29.0–49.4ROR 37.9 · calibrated p 9e-5 ✓
33.4 EB05 27.0 · IC025 +4.3
3/3 methods agree
Not in label — unassessedserious n=58 · 100% cliniciannot reported in cached trials
Cardiac dysfunction39837.4
33.7–41.5ROR 37.7 · calibrated p 8e-5 ✓
33.4 EB05 30.7 · IC025 +4.8
3/3 methods agree
Labeled — boxed warning
exact term
serious n=365not reported in cached trials
Radiation necrosis6036.1
27.6–47.2ROR 36.2 · calibrated p 1e-4 ✓
32.1 EB05 25.8 · IC025 +4.3
3/3 methods agree
Not in label — unassessedserious n=60 · 100% cliniciannot reported in cached trials
Alopecia totalis3435.0
24.5–49.8ROR 35.0 · calibrated p 2e-4 ✓
30.9 EB05 23.2 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=31not reported in cached trials
Recall phenomenon8132.9
26.2–41.4ROR 32.9 · calibrated p 2e-4 ✓
29.6 EB05 24.6 · IC025 +4.3
3/3 methods agree
Not in label — unassessedserious n=78 · 100% cliniciannot reported in cached trials
Ejection fraction5632.5
24.7–42.8ROR 32.5 · calibrated p 2e-4 ✓
29.2 EB05 23.3 · IC025 +4.1
3/3 methods agree
Labeled — boxed warning
exact term
serious n=52NCT00490139: 1/2,076 (0.0%) on Trastuzumab (serious AE)
Breast cancer metastatic98531.0
29.0–33.1ROR 31.4 · calibrated p 2e-4 ✓
28.2 EB05 26.7 · IC025 +4.7
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 19.1not reported in cached trials
Myelosuppression3,06930.4
29.3–31.5ROR 31.8 · calibrated p 2e-4 ✓
27.7 EB05 26.9 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious PRR 18.4 · 99% clinicianNCT01358877: 2/2,364 (0.1%) on Trastuzumab; 3/2,405 (0.1%) control (serious AE)
Metastases to chest wall3130.1
20.8–43.6ROR 30.1 · calibrated p 4e-4 ✓
27.1 EB05 20.0 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious n=31 · 100% cliniciannot reported in cached trials
Onycholysis13629.4
24.7–35.1ROR 29.5 · calibrated p 3e-4 ✓
26.8 EB05 23.2 · IC025 +4.3
3/3 methods agree
Not in label — unassessedserious n=120not reported in cached trials
Gastrointestinal anastomotic leak3227.2
18.9–39.0ROR 27.2 · calibrated p 7e-4 ✓
24.7 EB05 18.3 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=32 · ♀ 0% (drug 93%) · 100% cliniciannot reported in cached trials
Dacryostenosis acquired10527.0
22.1–33.0ROR 27.0 · calibrated p 5e-4 ✓
24.8 EB05 21.0 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=70not reported in cached trials
Lymphangiosis carcinomatosa8125.8
20.6–32.4ROR 25.9 · calibrated p 7e-4 ✓
23.8 EB05 19.7 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=80 · 100% cliniciannot reported in cached trials
Left ventricular dysfunction51525.7
23.5–28.1ROR 25.9 · calibrated p 6e-4 ✓
23.7 EB05 22.1 · IC025 +4.4
3/3 methods agree
Labeled adverse reaction
exact term
serious n=494 · 91% clinicianNCT00490139: 4/2,076 (0.2%) on Trastuzumab (serious AE)
Nasal mucosal disorder4324.3
17.8–33.2ROR 24.4 · calibrated p 0.001 ✓
22.4 EB05 17.3 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious n=41not reported in cached trials
Onychalgia7324.1
19.0–30.6ROR 24.1 · calibrated p 9e-4 ✓
22.3 EB05 18.3 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=64not reported in cached trials
Metastases to the mediastinum3023.9
16.5–34.6ROR 23.9 · calibrated p 0.001 ✓
21.9 EB05 16.1 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=30not reported in cached trials
Breast neoplasm7423.7
18.7–30.0ROR 23.7 · calibrated p 0.001 ✓
22.0 EB05 18.1 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=72NCT00490139: 1/2,076 (0.0%) on Trastuzumab (serious AE)
Radiation skin injury8123.0
18.3–28.8ROR 23.0 · calibrated p 0.001 ✓
21.3 EB05 17.7 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=78 · 91% clinicianNCT00490139: 1/2,076 (0.0%) on Trastuzumab (serious AE)

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Trastuzumab 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 (7 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
Diarrhoea (diarrhea)6,7713.3
3.2–3.3ROR 3.5 · calibrated p 0.483
3.2 EB05 3.2 · IC025 +1.7
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.3NCT00490139: 9/2,076 (0.4%) on Trastuzumab (serious AE)
Alopecia (hair loss)5,0078.0
7.8–8.2ROR 8.6 · calibrated p 0.054
7.8 EB05 7.6 · IC025 +2.9
3/3 methods agree
Not in label — unassessedserious PRR 7.4NCT00490139: 151/2,076 (7.3%) on Trastuzumab
Nausea4,5901.8
1.7–1.8ROR 1.8 · calibrated p 0.859
1.8 EB05 1.7 · IC025 +0.8Labeled adverse reaction
exact term
serious PRR 2.0NCT00490139: 6/2,076 (0.3%) on Trastuzumab (serious AE)
Fatigue (tiredness)4,3701.7
1.7–1.8ROR 1.8 · calibrated p 0.820
1.7 EB05 1.7 · IC025 +0.7Labeled adverse reaction
exact term
serious PRR 1.9NCT00490139: 1/2,056 (0.0%) on Trastuzumab (serious AE)
Off label use (used outside approved label)4,3161.5
1.5–1.6ROR 1.6 · calibrated p 0.685
1.5 EB05 1.5 · IC025 +0.6Reporting / coding artifactserious PRR 1.6not reported in cached trials
Death3,6141.3
1.3–1.3ROR 1.3 · calibrated p 0.513
1.3 EB05 1.3 · IC025 +0.3Outcome field, not a reaction
boxed warning mentions mortality
serious PRR 0.9NCT00490139: 1/2,056 (0.0%) on Trastuzumab (serious AE)
Disease progression3,5499.5
9.2–9.8ROR 10.0 · calibrated p 0.033 ✓
9.2 EB05 9.0 · IC025 +3.2
3/3 methods agree
Reporting / coding artifactserious PRR 6.4not reported in cached trials
Vomiting3,0702.0
2.0–2.1ROR 2.1 · calibrated p 0.980
2.0 EB05 2.0 · IC025 +0.9Labeled adverse reaction
exact term
serious PRR 1.9NCT00490139: 8/2,076 (0.4%) on Trastuzumab (serious AE)
Myelosuppression3,06930.4
29.3–31.5ROR 31.8 · calibrated p 2e-4 ✓
27.7 EB05 26.9 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious PRR 18.4 · 99% clinicianNCT01358877: 2/2,364 (0.1%) on Trastuzumab; 3/2,405 (0.1%) control (serious AE)
Dyspnoea (shortness of breath)2,8291.5
1.5–1.6ROR 1.6 · calibrated p 0.683
1.5 EB05 1.5 · IC025 +0.6Labeled — boxed warning
exact term
serious PRR 1.4NCT00490139: 6/2,076 (0.3%) on Trastuzumab (serious AE)
Pyrexia (fever)2,6022.3
2.2–2.4ROR 2.4 · calibrated p 0.870
2.3 EB05 2.2 · IC025 +1.1
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 1.8NCT00490139: 5/2,076 (0.2%) on Trastuzumab (serious AE)
Asthenia (weakness)2,3321.9
1.8–2.0ROR 1.9 · calibrated p 0.913
1.9 EB05 1.8 · IC025 +0.9Labeled adverse reaction
exact term
serious PRR 1.7NCT00490139: 1/2,076 (0.0%) on Trastuzumab (serious AE)
Neutropenia (low neutrophils (infection-fighting cells))2,2385.1
4.9–5.4ROR 5.3 · calibrated p 0.206
5.1 EB05 4.9 · IC025 +2.3
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 3.5 · 94% clinicianNCT00490139: 3/2,076 (0.1%) on Trastuzumab (serious AE)
Pain2,0651.0
1.0–1.1ROR 1.0 · calibrated p 0.328
1.0 EB05 1.0 · IC025 -0.0
PRR-only: not supported by EBGM or IC
Labeled adverse reaction
exact term
serious PRR 1.0NCT00490139: 2/2,076 (0.1%) on Trastuzumab (serious AE)

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: Trastuzumab ↔ Cardiotoxicity / heart failure.

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 Trastuzumab?

In FDA FAERS, the most frequently co-reported reaction terms for Trastuzumab are diarrhoea, alopecia, nausea, fatigue, vomiting, myelosuppression. 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 Trastuzumab have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: CARDIOMYOPATHY, INFUSION REACTIONS, EMBRYO-FETAL TOXICITY, and PULMONARY TOXICITY WARNING: CARDIOMYOPATHY, INFUSION REACTIONS, EMBRYO-FETAL TOXICITY, and PULMONARY TOXICITY See full prescribing information for comple.

Do FAERS signals prove that Trastuzumab 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.