FOLFOX
Folinic Acid, Fluorouracil, and Oxaliplatin
FOLFOX is one of the most common chemotherapy regimens for colorectal cancer. It combines three drugs given over 2 days every 2 weeks.
14 days
Cycle length
12 cycles
Typical course
6
Side effects tracked
Common Side Effects
Neuropathy (tingling/numbness)
during and after infusion, cumulative
Tip: Avoid cold foods and drinks during and for a few days after infusion. Wear gloves in cold weather.
Nausea and vomiting
days 1–3
Tip: Take anti-nausea medication as prescribed before meals. Small, frequent meals work better than large ones.
Fatigue
days 3–7, peaks around day 5
Tip: Plan rest on days 4–6. Light walks when energy allows can help with fatigue.
Mouth sores
days 3–10
Tip: Rinse with salt water or baking soda solution 4–6 times daily. Avoid alcohol-based mouthwash.
Diarrhea
days 2–5
Tip: BRAT diet (bananas, rice, applesauce, toast). Call doctor if more than 4 loose stools per day.
Low blood counts
days 7–14 (nadir)
Tip: Wash hands frequently, avoid crowds, and take temperature if feeling unwell.
Critical Days in the Cycle
Day 1 — Infusion Day
Watch for
- •Allergic reaction to oxaliplatin (flushing, hives, difficulty breathing)
When to call:
Any signs of allergic reaction during infusion — tell nursing staff immediately.
Day 7 — Nadir Approaching
Watch for
- •Increased fatigue
- •Fever
- •Signs of infection
When to call:
Fever over 100.4°F (38°C) — this is a medical emergency with low counts.
Day 10 — Nadir (Lowest Blood Counts)
Watch for
- •Fever
- •Chills
- •Unusual bruising or bleeding
- •Extreme fatigue
When to call:
Any fever ≥100.4°F — go to the ER immediately, do not wait for a callback. Bleeding that won't stop or feeling very unwell — call the oncology team.
Day 14 — Recovery / Next Cycle
Watch for
- •Counts recovering
- •Energy returning
When to call:
If you feel worse instead of better approaching cycle day.
Frequently Asked Questions
Is nausea normal on day 3 of FOLFOX?
Yes. Days 2–4 are typically when nausea peaks after FOLFOX infusion. Make sure to take prescribed anti-nausea medications proactively, not just when nausea hits. Small frequent meals and ginger tea can also help.
Why does cold feel painful after FOLFOX?
Oxaliplatin causes cold sensitivity — a tingling or burning sensation when touching cold objects or drinking cold liquids. This is one of FOLFOX's most common side effects. Avoid cold drinks, use gloves to handle refrigerator items, and protect your face in cold weather.
What blood counts should I watch?
The most important are ANC (absolute neutrophil count) for infection risk, platelets for bleeding risk, and hemoglobin for anemia/fatigue. Your oncologist will tell you target ranges. Generally, ANC below 1.0 means high infection risk.
When should I call the oncology team?
For fever ≥100.4°F (38°C) during nadir — go to the ER immediately, do not wait for a callback. Call the team immediately for: severe vomiting (can't keep fluids down for 24 hours), signs of allergic reaction, severe diarrhea (more than 6 episodes per day), or any bleeding that won't stop.
How long does FOLFOX fatigue last?
Fatigue typically peaks around days 4–6 of each cycle and gradually improves toward cycle day 10–12. Cumulative fatigue may build over multiple cycles. It usually improves significantly after completing treatment.
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