Amifostine: what it protects, how it is given, side effects
Last updated September 7, 2026.
**Amifostine (brand name Ethyol) is a cytoprotective agent, an organic thiophosphate given by vein to protect healthy kidney and salivary gland tissue during certain cancer treatments.** Alkaline phosphatase on normal cells converts amifostine into an active thiol that mops up the reactive byproducts of cisplatin and radiation, so healthy tissue absorbs less of the damage while your cancer treatment continues. It is not a cancer drug itself and does not shrink tumors. The single most important safety point is blood pressure: it can fall during the infusion, so you lie flat and your pressure is checked every 5 minutes, and the infusion is stopped if the drop is large enough.
What does it treat?
Amifostine has two labeled uses. The first is reducing the cumulative kidney toxicity that builds up when cisplatin is given repeatedly for advanced ovarian cancer, which shows up as rising creatinine, falling magnesium, and dose delays. The second is reducing moderate to severe xerostomia, meaning long-term dry mouth, in people getting radiation after surgery for head and neck cancer when the radiation field covers a substantial part of the parotid glands. That dryness pattern is thick saliva, trouble swallowing dry food, waking at night to sip water, and more dental decay. Amifostine is sold as Ethyol and as generic amifostine for injection, and it is not combined into any oral or fixed-dose combination product. The label says it should not be used with chemotherapy or radiation given for cure, such as treatment of germ cell tumors, outside a clinical trial, since protection of tumor tissue has not been ruled out in those settings.
How do you take it?
Amifostine comes as a single-dose vial of powder (500 mg) that a pharmacist reconstitutes with 0.9% sodium chloride, and a nurse infuses it in a clinic or infusion center, never at home. With cisplatin, the adult dose is 910 mg/m2 once daily as a 15-minute infusion started 30 minutes before chemotherapy; the 15-minute infusion is used because longer infusions are tolerated poorly. With radiation for head and neck cancer, the dose is 200 mg/m2 once daily as a 3-minute infusion given 15 to 30 minutes before each daily fraction. Those daily doses are the labeled ceilings; there is no additional dose to take later in the day. Blood pressure medicines are held for 24 hours before the infusion, you should be well hydrated beforehand, and antiemetics, typically dexamethasone 20 mg IV plus a 5-HT3 blocker, are given before and along with the chemotherapy dose. There are no food restrictions, though a light meal and steady fluids beforehand help with nausea. If your blood pressure falls enough that the nurse has to interrupt the infusion and it does not recover within 5 minutes, the rest of that dose is not given and the next cycle is dropped to 740 mg/m2. There is no missed-dose rule to manage yourself: if you miss an appointment, call the clinic and let them reschedule, and do not ask for a double dose. Call your oncology team before the next dose if you develop any rash away from the injection site, mouth or eye sores, fever, fainting, or vomiting that keeps you from drinking.
Side effects to know
- Common: Most people feel nausea, and often vomiting, along with a warm flushed feeling, chills, sneezing, hiccups, dizziness, sleepiness, and a temporary drop in blood pressure during or shortly after the infusion, and these usually settle within minutes to hours after the dose ends.
- Serious: Stop treatment and get medical help right away for signs of a severe skin reaction, including a rash that spreads beyond the injection site, blisters, peeling skin, sores in the mouth or eyes, or rash with fever, since erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and exfoliative dermatitis have been reported and some cases were fatal. Also urgent: anaphylaxis with hives, throat tightness, or trouble breathing; fainting or blood pressure that does not come back up; seizure or loss of consciousness; and symptoms of low calcium such as numbness around the mouth, muscle cramps, or twitching.
Who should not take it?
You should not get amifostine if you are dehydrated or your blood pressure is already low, if you cannot safely hold antihypertensive medicines for 24 hours before the infusion, or if you have had a serious reaction to amifostine or another aminothiol. Tell your team first if you have heart disease such as arrhythmias, ischemic heart disease, heart failure, or a history of stroke or transient ischemic attack, since a blood pressure drop is riskier for you; if you have had a severe drug rash before; or if you have nephrotic syndrome or low calcium, because amifostine can lower serum calcium and levels may need checking. The main interactions are with anything else that lowers blood pressure, including diuretics, alpha blockers, nitrates, and some antidepressants and prostate medicines, so bring a full list of prescriptions and supplements. On pregnancy, the FDA label states amifostine can cause fetal harm based on animal studies and there are no adequate studies in pregnant women, so it is used in pregnancy only if clearly needed, and effective contraception is advised; it is not known whether amifostine passes into breast milk, and the label advises deciding whether to stop nursing or stop the drug. Skip alcohol the day before and the day of an infusion, since it dehydrates you, adds to the blood pressure drop, and worsens nausea and dry mouth.
When is it an emergency?
Call 911 in the US for fainting or collapse, trouble breathing, swelling of the lips, tongue, or throat, hives with lightheadedness, chest pain, or a seizure, since these point to anaphylaxis or severe hypotension. Get same-day care, and hold further doses, for any new rash spreading beyond the injection site, blistering, skin peeling, or sores in the mouth or eyes, especially with fever, because severe skin reactions can start days to weeks after a dose. Numbness around the mouth, muscle cramps, or twitching can mean low calcium and needs a blood test that day. Amifostine is given only in a clinic, so overdose is rare, but too much shows up as a marked blood pressure drop with clamminess, blurred vision, and fainting; the nurse lays you flat and runs IV fluids, and for any suspected overdose at home you can reach Poison Control at 1-800-222-1222, free and open 24 hours.
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Common questions
What is the maximum amifostine dose in a day?
The highest labeled dose is 910 mg/m2 once daily, given as a 15-minute infusion 30 minutes before cisplatin. For radiation-related dry mouth in head and neck cancer, the labeled dose is 200 mg/m2 once daily as a 3-minute infusion before each treatment fraction. Both are once-daily doses with no second dose later in the day. Because dosing uses body surface area, the actual milligrams differ from person to person. If a blood pressure drop forces the infusion to be interrupted and pressure does not recover within 5 minutes, the label directs using 740 mg/m2 for later cycles.
Can I drink alcohol while I am getting amifostine?
There is no direct interaction listed on the label, but alcohol works against this drug in practical ways. It dehydrates you, and being dehydrated is one of the situations where amifostine should not be given at all. It also lowers blood pressure, which stacks on top of the drop the infusion itself causes. On top of that, alcohol worsens nausea and dries the mouth further, which is the exact symptom the radiation dose is meant to reduce. Skip alcohol the day before and the day of each infusion, and ask your oncology team about the rest of the week.
Is amifostine safe during pregnancy or breastfeeding?
The FDA label states that amifostine can cause fetal harm based on animal studies and that there are no adequate, well-controlled studies in pregnant women, so it is used during pregnancy only if the benefit clearly outweighs the risk. Effective contraception is advised while you are on treatment. Keep in mind that the cisplatin or radiation given alongside amifostine carries its own risk to a pregnancy, so this is a conversation about the whole regimen. It is not known whether amifostine passes into breast milk, and the label advises choosing between stopping nursing and stopping the drug. Tell your oncology team right away if you are pregnant, might be, or are nursing.
Do I need to eat or fast before an amifostine infusion?
There are no food restrictions with amifostine. What matters more is fluid: you should be well hydrated before the dose, so drink water steadily the evening before and the morning of your appointment unless your team has limited your fluids. A light meal beforehand is usually easier on the stomach than a heavy one, since nausea and vomiting are the most common side effects at the chemotherapy dose. Your team will give antiemetics before and during the infusion, commonly dexamethasone 20 mg IV plus a 5-HT3 blocker. Blood pressure medicines are held for 24 hours before the dose, so confirm with your team which of your pills to skip.
What are the signs of getting too much amifostine?
The clearest sign is a sharp blood pressure drop: lightheadedness, blurred vision, clammy skin, nausea, and fainting. That is why you stay lying flat and your blood pressure is measured every 5 minutes during the infusion. Treatment is straightforward: the infusion is stopped, you are placed head-down with legs raised, and IV normal saline is run. Low calcium is the other overdose-related effect, showing up as tingling around the mouth, muscle cramps, or twitching. Call 911 for fainting, a seizure, or trouble breathing, and reach Poison Control at 1-800-222-1222 for any suspected overdose.
What medicines and conditions interact with amifostine?
The biggest interaction is with anything that lowers blood pressure, which is why antihypertensives are held for 24 hours before each dose. That includes diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, nitrates, and alpha blockers used for prostate symptoms, plus some antidepressants that cause dizziness on standing. If your blood pressure medicine cannot safely be held, amifostine may not be the right choice for you. Heart disease, prior stroke or transient ischemic attack, nephrotic syndrome, and a history of a severe drug rash all need to be flagged before the first dose. Bring a full list of prescriptions, over-the-counter medicines, and supplements to your treatment visit.