Cold Drinks Suddenly Hurt: Oxaliplatin Cold Sensitivity

You reach for a glass of ice water, and the first sip feels wrong. Not cold — sharp. A prickling across your lips and tongue, or a tight, buzzing ache in your throat. You pull a carton from the refrigerator and your fingertips sting, almost as if you had grabbed something hot. Nothing looks injured. The feeling fades after a minute, then returns with the next cold thing you touch.

If you are being treated with oxaliplatin, this is a recognized effect of the drug. It is documented clearly enough that the official patient drug information for oxaliplatin includes specific instructions about cold.

This page is about living with it day to day. A companion page on this site covers the underlying nerve effect, what is known about how long it lasts, and the symptoms that need a call right away.

MedlinePlus, the patient drug information service of the U.S. National Library of Medicine, states plainly that "exposure to cold air or objects may make some of the side effects of oxaliplatin worse."

MedlinePlus lists several side effects. They include "numbness, burning, or tingling in the fingers, toes, hands, feet, mouth, or throat," pain in the hands or feet, and a decreased sense of touch. MedlinePlus also lists "increased sensitivity, especially to cold" as a side effect. The FDA label says cold temperature or cold objects can bring on or worsen nerve symptoms.

That is why the problem tends to announce itself in ordinary moments rather than during your infusion. It might be a drink, a door handle, or a trip to the mailbox.

MedlinePlus gives a specific instruction for the days immediately after treatment:

"You should not eat or drink anything colder than room temperature, touch any cold objects, go near air conditioners or freezers, wash your hands in cold water, or go outside in cold weather unless absolutely necessary for five days after you receive each dose of oxaliplatin."

Note that this is a window after each dose, not a one-time precaution at the start of treatment. It resets with every cycle.

Drinks and food. Let water sit until it reaches room temperature, and skip ice. Warm drinks are fine — the instruction is about anything colder than room temperature, not about avoiding liquid. Take chilled leftovers out ahead of time, or heat them. The FDA label also advises avoiding cold drinks, ice, and cold objects on the skin. It says not to use ice for mouth sores.

The refrigerator and freezer. MedlinePlus advises against touching cold objects and going near freezers. If someone can hand you things from the fridge during those five days, take the help. Otherwise, put gloves on first.

The sink. Do not wash your hands in cold water. Use warm water — but be careful at the other extreme too, since oxaliplatin can reduce your sense of touch. The National Cancer Institute's guidance on nerve problems suggests checking water temperature and using potholders for exactly this reason.

Air conditioning. MedlinePlus says to stay away from air conditioners and freezers for five days after each dose.

Going outside. MedlinePlus says to avoid going out in cold weather unless it is absolutely necessary during those five days. When you do go out, MedlinePlus says to wear a hat, gloves, and a scarf, and to cover your mouth and nose.

• Call 911 or go to an emergency department if a severe allergic reaction starts during or soon after an infusion. MedlinePlus lists rash, hives, difficulty breathing or swallowing, hoarseness, a feeling that your throat is closing, swelling of the lips and tongue, dizziness, and fainting. These reactions can happen within minutes of a dose and can be life-threatening.
• Call 911 or go to an emergency department if you have chest pain or pressure, shortness of breath, black and tarry stools, or vomit that is bloody or looks like coffee grounds. Also call 911 for heavy bleeding that will not stop.
• Call your care team right away, day or night, if you have any of the effects MedlinePlus lists as serious. It says to call your doctor immediately about these:
  • Tightening of the jaw.
  • A strange feeling in the tongue.
  • Difficulty speaking.
  • Stumbling or loss of balance when walking.
  • Difficulty with everyday activities such as writing or fastening buttons.
  • Sore throat, fever, chills, and other signs of infection. A normal temperature is not a reason to wait.
  • Pain when urinating, or pain, redness, or swelling where oxaliplatin was injected.
  • Unusual bruising or bleeding, a nosebleed, blood in urine, or bright red blood in stool.
• Call your care team within a day or two if the cold sensitivity is stopping you drinking or eating enough. Call, too, if the numbness and tingling are reaching beyond your hands, feet and mouth.

CDC says to call your doctor immediately for a temperature of 100.4°F (38°C) or higher during chemotherapy. Cannot reach your team? Go to the nearest emergency department.

The National Cancer Institute's advice on nerve problems is direct: "If you start to notice any of the problems listed above, talk with your doctor or nurse."

Bring specifics:

• Which day of the cycle it started.
• How long episodes last.
• Whether it is spreading beyond your hands and mouth.
• Whether it is keeping you from eating or drinking enough.

Those details inform decisions about dose and timing.

Neither MedlinePlus nor NCI says how many people develop cold sensitivity, how severe it usually gets, or how long it persists after treatment ends. The FDA label says to warn patients of the risk of nerve effects that may be reversible or may persist. Ask your oncology team what they expect in your situation.

The MedlinePlus oxaliplatin page was last reviewed in 2010. The FDA label is newer and gives the same cold advice.

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• MedlinePlus, U.S. National Library of Medicine — Oxaliplatin Injection: https://medlineplus.gov/druginfo/meds/a607035.html
• National Cancer Institute — Nerve Problems (Peripheral Neuropathy) and Cancer Treatment: https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems
• FDA — oxaliplatin prescribing information (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=oxaliplatin
• CDC — Watch Out for Fever: https://www.cdc.gov/cancer-preventing-infections/patients/fever.html