The Chemotherapy Drugs for Cancer That Cause Hair Loss

The Most and Least Likely Drugs to Cause Hair Loss

Female with cancer looking outside the window
Which chemotherapy drugs are most likely to cause hair loss?. FatCamera/E+/Getty Images

Chemotherapy is a systemic treatment that your doctor may prescribe to fight your cancer. While there are several potential side effects of chemotherapy, one of the most dreaded is hair loss. Which medications are most likely and least likely to make you lose your hair?

Side Effects of Chemotherapy

Chemotherapy drugs work by interfering with the division and growth of rapidly growing cells. While these drugs can be effective on cancer cells, they also damage normal cells in our bodies which divide rapidly.

This includes hair follicles (leading to hair loss), cells in the digestive tract (leading to nausea and vomiting), and cells in your bone marrow (leading to fewer red blood cells, white blood cells, and platelets).

Hair Loss From Chemotherapy

Hair loss is very common during chemotherapy for breast cancer as well as other cancers, though some drugs and methods of administration are more likely than others to disrupt hair follicles.

Whether or not you develop hair loss and the degree of your hair loss depends on a number of factors including:

  • Dose of chemotherapy
  • How often the chemotherapy is given
  • The route of administration
  • The drugs or combination of drugs you receive

The good news is that chemotherapy-induced hair loss is almost always reversible.

Hair loss often begins around the time of your second chemotherapy infusion, though this varies widely. Some people do not lose all of their hair until they have nearly completed chemotherapy.

Hair re-growth typically begins within 3 months of concluding chemotherapy. When your hair does grow back, many people find they have what's been coined chemo curls. If your hair was straight prior to chemotherapy it will likely become straight again, but this process can take up to several years.

Some techniques have been tried to prevent or reduce hair loss (see below).

Which Chemotherapy Drugs Cause Hair Loss?

There are a number of chemotherapy agents used in breast cancer—many of them used in combination. Common regimens for adjuvant treatment such as Cytoxan and Adriamycin followed by Taxol are usually associated with hair loss.

Here is a list of chemotherapy drugs—not exclusive to breast cancer—that are most and least likely to cause hair loss.

Chemotherapy Drugs Most Likely to Cause Hair Loss

Chemotherapy medications which cause hair loss in the majority of people include:

  • Adriamycin (doxorubicin)
  • Cytoxan or Neosar (cyclophosphamide)
  • Taxol (paclitaxel)
  • Taxotere (docetaxel)
  • Cerubine (daunorubicin)
  • Ellence (epirubicin)
  • VePesid (etoposide)
  • Idamycin (idarubicin)
  • Ifex (ifosfamide)
  • Ixempra (exabepilone)
  • Camptosar (irinotecan)
  • Hycamtin (topotecan)
  • Navelbine (vinorelbine)
  • Ixempra (Ixabepilone)

Chemotherapy Drugs That Sometimes Cause Hair Loss

Chemotherapy medications which cause hair loss for some but not all people include:

  • Blenoxane (bleomycin)
  • Myleran or Busulfex (busulphan)
  • Cytosar-U (cytarabine)
  • 5-FU, Fluorouracil, Adrucil (5-fluorouracil)
  • Gemzar (gemcitabine)
  • Gleostine (lomustine)
  • Alkeran (melphalan)
  • Thioplex (thiootepa)
  • Velban (vinblastine)
  • Oncovin (vincristine)

Chemotherapy Drugs That Rarely Cause Hair Loss

Some chemotherapy drugs result in only minimal hair loss, though these are often combined with drugs that cause more hair loss.

These include:

  • Paraplatin (carboplatin)
  • Xeloda (capecitabine)
  • Gliadel (carmustine)
  • Platinol (cisplatin)
  • Fludara or Oforta (vludarabine)
  • Trexall, Otrexup, Rasuvo (methotrexate)
  • Mutamicin (mitomycin C)
  • Novantrone (mitroxantrone)
  • Procarbazine (sold by generic name in US)
  • Purinethol (6-mercaptopurine)
  • Zanosar (streptozotocin)

Preventing Chemotherapy-Induced Hair Loss

For those who are interested, it may sometimes be possible to prevent hair loss from chemotherapy. Scalp cooling units can reduce roughly 50 percent of hair loss, but come with a price. Many infusion centers do not have these units and therefore you may have to rent a cooling device.

Scalp cooling works by narrowing the blood vessels in the scalp so that chemotherapy drugs are less able to reach hair follicles. With some cancers, especially blood-related cancers like leukemia and lymphomas, there has been concern that cooling could reduce the effectiveness of chemotherapy. While it's not likely to be a problem with breast cancer, scalp cooling can be very uncomfortable, similar to the symptoms of brain freeze you may remember while eating ice cream in the past.

Medications such as Rogaine (minoxidil) have also been tried, but are not very effective in reducing hair loss.

Permanent vs Temporary Hair Loss

Unlike hair loss related to radiation therapy, the loss of hair which occurs with chemotherapy is most often temporary. That said, there have been a few cases of permanent hair loss reported on some chemotherapy drugs. The combination of FEC (fluorouracil/epirubicin/cyclophosphamide) with docetaxel has been reported to result in permanent and severe hair loss for some people who have had this regimen for breast cancer treatment.

Handling Hair Loss From Chemotherapy

It can be very emotional coping with the hair loss you experience during chemotherapy. Even though this complication is more of a nuisance, it remains one of the most feared side effects. Many oncologists recommend that you purchase a wig, hats, or scarves before beginning chemotherapy. All or a portion of the cost of a wig may be covered by your insurance. To have it covered, however, you will need to have your oncologist write a prescription for a "hair prosthesis."

Before you go, you may want to check out the basics for buying a chemotherapy wig. There are also organizations that provide free wigs, hats, or scarves for people living with cancer.

It's important to keep in mind that hair loss may occur all over your body. This includes eyelashes, eyebrows, pubic hair, and more. While women may appreciate a reprieve from shaving their legs (and men, their faces), our eyelashes perform a protective function you may not realize until you open an oven door or are outside on a dusty day. Check out these 6 ways to prepare for hair loss from chemotherapy.

A Word From Verywell on Hair Loss During Chemotherapy

Many chemotherapy drugs result in hair loss, including those used for breast cancer. Some people choose scalp cooling as a way to reduce hair loss whereas others prefer the comfort of a warm head and planning ahead with a scarf or wig. The preference is very personal and it's important that you do what is best for you alone. Fortunately, most hair loss is temporary and many women find that their hair grows back even healthier than before.

Sources:

Dunnill, C., Al-Tameemi, W., Collett, A., Haslam, I., and N. Georgopoulos. A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and Its Prevention. Oncologist. 2017 Sep 26. (Epub ahead of print).

Kluger, N., Jacot, W., Frouin, E. et al. Permanent Scalp Alopecia Related to Breast Cancer Chemotherapy by Sequential Fluorouracil/Epirubicin/Cyclophosphamide (FEC) and Docetaxel: A Prospective Study of 20 Patients. Annals of Oncology. 2012. 23(11):2879-84.

Nangia, J., Wang, T., Osborne, C. et al. Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial. JAMA. 2017. 317(6):596-605.

West, H. Chemotherapy-Induced Hair Loss (Alopecia). JAMA Oncology. 2017. 3(8):1147.

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