FOLFIRINOX
Folinic Acid, Fluorouracil, Irinotecan, and Oxaliplatin
FOLFIRINOX is an aggressive four-drug regimen used for pancreatic cancer and some colorectal cancers. It is highly effective but has significant side effects.
14 days
Cycle length
12 cycles
Typical course
6
Side effects tracked
Common Side Effects
Severe fatigue
throughout treatment, cumulative
Tip: This is one of the most demanding regimens. Plan for significant rest days 2–6. Reduce activity expectations significantly during treatment weeks.
Neuropathy
cumulative, worsens over cycles
Tip: Avoid cold. Report worsening numbness to your oncologist — dose adjustments may be needed.
Diarrhea
acute and delayed
Tip: Aggressive loperamide management for late diarrhea. Have electrolyte drinks (Pedialyte) on hand.
Neutropenia
days 7–14
Tip: G-CSF injections (Neupogen/Neulasta) are often prescribed. Fever is an emergency.
Nausea and vomiting
days 1–5
Tip: Multiple anti-nausea medications are typically prescribed. Take them on schedule, not just when symptoms hit.
Hair loss
weeks 2–4
Tip: Expected with this regimen. Temporary — grows back after treatment.
Critical Days in the Cycle
Day 1 — Infusion (46-hour pump)
Watch for
- •Nausea
- •Reaction to oxaliplatin or irinotecan
- •Pump site issues
When to call:
Any reaction during infusion, pump malfunction, or disconnection site problems.
Day 3 — Pump Disconnect + Diarrhea Watch
Watch for
- •Late diarrhea onset
- •Dehydration
When to call:
More than 3 loose stools per day — start loperamide immediately and call team.
Day 8 — Nadir
Watch for
- •Fever
- •Infection signs
- •Severe fatigue
When to call:
Any fever ≥100.4°F — go to the ER immediately, do not wait for a callback. FOLFIRINOX nadir is often severe.
Frequently Asked Questions
Is FOLFIRINOX the most intense chemo regimen?
It's among the most intensive outpatient regimens. It uses four drugs and requires a 46-hour take-home pump. Patients generally need more support at home during FOLFIRINOX than other regimens.
How do I handle the at-home pump?
The pump delivers fluorouracil for 46 hours after the infusion center visit. The nursing team will show you how to handle it, what to do if the tube comes out, and when to return for disconnection. Keep the disconnect instructions on your fridge.
When should I call the oncology team during FOLFIRINOX?
For fever ≥100.4°F during nadir — go to the ER immediately, do not wait for a callback. Call the team immediately for: severe vomiting (unable to keep any fluids down for 12 hours), more than 4 loose stools per day, pump problems, or any new severe symptoms.
Have a question about FOLFIRINOX that's not answered here?
CareCompanion's AI assistant can answer questions about symptoms, what medications to expect, and when to contact the care team — any time, no signup needed.
Full access includes medication tracking, appointment reminders, and AI-powered visit prep sheets.