What is trifluridine-tipiracil hydrochloride (Lonsurf®)?

Trifluridine-tipiracil hydrochloride (Lonsurf®) is a chemotherapy drug. It is used to treat bowel cancer (colorectal cancer) that has spread to other parts of the body.

This information should ideally be read with our general information about chemotherapy and the type of cancer you have.

Lonsurf may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial.

When and how is Lonsurf given?

Lonsurf is usually given after other chemotherapy drugs or biological therapies to treat cancer of the bowel have been used. Or it may be given if these other drugs aren’t suitable.

Lonsurf is given as tablets, so you can have it at home. During treatment, you will regularly see a cancer doctor or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.

Before or on the day of treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. This is to check that it is okay for you to have chemotherapy.

Taking Lonsurf tablets

You have Lonsurf as tablets which you can take at home. The tablets come in two strengths – 15mg and 20mg. Your doctor, nurse or pharmacist will tell you how many of each tablet to take. Always take Lonsurf exactly as explained. This is important to make sure they work as well as possible for you.

Take your tablets twice a day, in the morning and evening. Swallow them with a glass of water within an hour of eating your morning and evening meals (or after a snack).

  • If you forget to take your tablets, contact your doctor or nurse. Do not take an extra dose.
  • Keep them in the original package at room temperature and away from heat and direct sunlight.
  • Keep this medicine safe and out of the reach of children.
  • Wash your hands after handling the tablets.
  • Return any remaining capsules to the pharmacist if your treatment is stopped.

Your course of chemotherapy

You have Lonsurf as a course of several sessions (cycles) of treatment for as long as it is working well for you. A cycle of Lonsurf lasts 28 days (four weeks). You usually take the tablets for set days on each cycle:

Week 1

  • Days 1 to 5 – take the tablets twice a day.
  • Days 6 to 7 – don’t take the tablets on these days.

Week 2

  • Days 1 to 5 – take the tablets twice a day.
  • Days 6 to 7 – don’t take the tablets on these days.

Weeks 3 and 4

  • Don’t take any tablets during these weeks.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection.

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. 

Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Feeling sick

You may feel sick in the first few days after this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24-hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Diarrhoea

This treatment may cause severe diarrhoea. Your nurse or doctor may give you anti-diarrhoea drugs to take at home.

If you have diarrhoea:

  • follow any advice you have been given about taking anti-diarrhoea drugs
  • drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Contact the hospital straight away if:

  • you have diarrhoea at night
  • you have diarrhoea more than 6 times in a day
  • the anti-diarrhoea drugs do not work within 24 hours.

Some people may need to go to hospital to have fluids through a drip. You may need to take antibiotics.

Difficulty sleeping

This treatment can cause sleeplessness (insomnia) in some people. If you are finding it difficult to sleep, talk to your doctor or specialist nurse.

Skin changes

Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream. You may get a rash, which may be itchy.

Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Less common side effects

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Tummy pain

You may get pain or discomfort in your tummy (abdomen), feel bloated or have indigestion or wind. Your doctor can give you drugs to help improve these symptoms. Tell them if the pain does not improve or if it gets worse.

Breathlessness

You may feel short of breath after taking Lonsurf. Tell your doctor if this happens or if any existing breathing problems get worse.

Soreness and redness of palms of hands and soles of feet

This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.

Hair loss

It is not common to lose your hair after taking Lonsurf. It is almost always temporary and your hair will grow back after treatment ends. Your nurse can give you advice about coping with hair loss.

Other information

Lactose

If you have a severe intolerance to lactose, tell your cancer doctor before taking Lonsurf.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Heart problems

In a small number of people, Lonsurf can affect the heart. If you have chest pain or chest tightness, or if your heartbeat becomes less regular or feels too fast or too slow, contact a doctor straight away.

Effects on the kidneys and liver

This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys and liver are working.

It is important to drink at least 2 litres (3½ pints) of fluids each day to help protect your kidneys.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Fertility

Doctors do not know if Lonsurf can affect your fertility (being able to get pregnant or father a child). If you are worried about this, talk to your doctor or nurse before treatment starts.

Contraception

Your doctor will advise you not to become pregnant or father a child while taking Lonsurf. This is because the drugs may harm a developing baby. It is important to use contraception during chemotherapy and for six months after. You can discuss this with your doctor or specialist nurse.

Lonsurf may make the contraceptive pill less effective. So it’s usually best to use ‘barrier’ methods of contraception during treatment. For example, condoms or the cap.

Sex

If you have sex during this course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

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