Cold Sensitivity During Oxaliplatin Chemotherapy

This page is for people getting the chemotherapy drug oxaliplatin who find that cold now hurts, and for the people helping them.

Cold sensitivity during oxaliplatin treatment is part of a nerve effect. The FDA label calls it peripheral sensory neuropathy. Knowing that changes what you watch for and what you report.

You may want the practical side: how to manage drinks, the refrigerator, and going outdoors. See the companion page on this site about cold drinks suddenly hurting. This page is about the nerve effect. It also covers what is known about duration, and the symptoms that should prompt a call.

The National Cancer Institute explains that "some cancer treatments cause peripheral neuropathy, a result of damage to the peripheral nerves." Peripheral nerves run out from your brain and spinal cord to the rest of your body. NCI groups the damage by which type of nerve is affected.

Sensory nerves carry sensation. When they are damaged, NCI describes "tingling, numbness, or a pins-and-needles feeling in your feet and hands." You may also lose the ability to feel temperature or pain normally. The FDA label for oxaliplatin lists cold-triggered symptoms under peripheral sensory neuropathy. It says the symptoms can be brought on or made worse by cold temperature or cold objects.

Motor nerves control muscles. NCI describes "weak or achy muscles that may cause you to lose your balance, trip easily." It also lists muscle twitching, cramping or wasting, and trouble swallowing or breathing.

Autonomic nerves control functions you do not think about. Damage here can show up as digestive changes, dizziness, sexual problems, sweating changes, and urination problems.

This is worth stating plainly. You may go looking and come up empty.

NCI's patient page on nerve problems from cancer treatment does not name which drugs cause peripheral neuropathy. It does not name cold as a trigger either. The clearest patient-facing federal statement linking oxaliplatin to cold comes from MedlinePlus. That is the U.S. National Library of Medicine's drug information service. It says that "exposure to cold air or objects may make some of the side effects of oxaliplatin worse."

MedlinePlus lists the relevant common effects. They are "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.

Neither document explains why cold in particular sets this off. Neither names other chemotherapy drugs as causes of cold sensitivity. Maybe you are on a combination regimen and want to know which part is responsible for what. Ask your oncologist or pharmacist.

MedlinePlus gives a defined precaution window. Avoid anything colder than room temperature "for five days after you receive each dose of oxaliplatin." That window resets with each cycle.

These sources do not give a duration for the sensitivity itself. They do not say whether it fades between cycles, builds over treatment, or lasts after the final dose. NCI's page does not state how long treatment-related peripheral neuropathy lasts. The FDA label says to warn patients of the risk of nerve effects that may be reversible or may persist. Your oncology team can tell you what they see with your regimen and dose.

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

• Call 911 or go to an emergency department if signs of a severe allergic reaction begin. 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. They may start within minutes of a dose, and they can be fatal.
• 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 notice any of the effects MedlinePlus separates out as serious. It says to call your doctor immediately about any of these:
  • Stumbling or loss of balance when walking.
  • Difficulty with everyday activities such as writing or fastening buttons.
  • Difficulty speaking.
  • Tightening of the jaw.
  • A strange feeling in the tongue.
  • 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 any of the other nerve symptoms described above are new or worsening. NCI's instruction covers all of them: "If you start to notice any of the problems listed above, talk with your doctor or nurse."

CDC says to call your doctor immediately for a temperature of 100.4°F (38°C) or higher during chemotherapy. If your team does not call back quickly, go to the nearest emergency department.

The top group of effects matters for a reason. They suggest the nerve problem may be affecting how your body works. Your oncologist needs that information, because dose and schedule can be adjusted.

• Which drug in my regimen is responsible for the cold sensitivity?
• What would make you consider changing my dose or schedule because of it?
• What should I do between cycles if the numbness does not fully go away?
• Who do I call, and at what number, if the jaw tightening or speech changes happen at night or on a weekend?

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• National Cancer Institute — Nerve Problems (Peripheral Neuropathy) and Cancer Treatment: https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems
• MedlinePlus, U.S. National Library of Medicine — Oxaliplatin Injection: https://medlineplus.gov/druginfo/meds/a607035.html
• 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