The peripheral neuropathy caused by oxaliplatin can continue to worsen for several weeks after the last FOLFOX cycle — a pattern sometimes called coasting — before it begins to improve.
FOLFOX Chemotherapy: — Drugs, the 46-Hour Pump and What to Expect
FOLFOX is a chemotherapy regimen most often used for colorectal cancer. It uses three medicines given in a specific sequence every two weeks, including a 46-hour infusion pump you take home after each clinic visit. If this name has appeared on your chart and nobody has explained it, this page works through each part.
- Three medicines, one name — FOLFOX stands for the three medicines it combines: oxaliplatin, leucovorin and fluorouracil (5-FU).
- Every two weeks — Each cycle starts at the day-care unit and includes a 46-hour pump you carry home while the medicine continues.
- Cold sensitivity is expected — Touching cold surfaces or drinking cold liquids can cause an unusual, painful sensation in the first few days of each cycle — this is a known effect of oxaliplatin.
- Nerve changes are monitored closely — Tingling or numbness in the hands and feet can build across cycles and must be reported to your team at every visit.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026
FOLFOX combines three medicines — oxaliplatin, leucovorin and fluorouracil (5-FU) — given every two weeks for colorectal cancer. The 46-hour pump delivers a slow, continuous 5-FU infusion you take home after your clinic visit. The number of cycles is decided by your oncologist based on your situation.
What happens at each FOLFOX appointment?
Blood test before treatment
A blood sample is taken to check that your counts are safe to proceed. Treatment may be delayed if your blood results need more time to recover.
Oxaliplatin and leucovorin by drip
Both medicines are given as an intravenous drip through your central line or PICC line. Your nurse will tell you how long this takes on the day.
Fluorouracil bolus
A concentrated dose of fluorouracil (5-FU) is injected through your line at the end of the drip.
Pump connected before you leave
A small portable pump loaded with a further dose of 5-FU is attached to your line before you leave the day-care unit.
Home with the pump for 46 hours
You carry the pump in a small bag for the next 46 hours while the medicine is delivered slowly and continuously into your bloodstream.
Return to disconnect the pump
After approximately 46 hours, you return to the unit for the pump to be removed. The next cycle then begins 14 days from the start of the previous one.
Why do you go home with a pump for 46 hours?
Fluorouracil reaches more cancer cells when delivered slowly and continuously over a long period than when given all at once. A sustained infusion exposes dividing cells to the medicine across a wider window. This approach is part of the standard FOLFOX regimen as set out in ESMO and ASCO guidance for colorectal cancer.
The pump is small enough to carry in a bag and runs accurately without any adjustment from you. Your central line or port delivers the medicine directly into a large vein throughout the 46 hours.
If the pump alarms, or if you notice redness, swelling or discomfort around your line site, call the number your team gave you. Do not try to adjust or remove the pump yourself.
Who is FOLFOX not suitable for?
FOLFOX is not given in certain situations. Eligibility is always decided by an oncologist based on the individual's full medical picture.
- Pre-existing severe peripheral neuropathy, because oxaliplatin adds to nerve damage that is already present.
- Known allergy or hypersensitivity to oxaliplatin or to platinum-containing medicines.
- Deficiency of the enzyme dihydropyrimidine dehydrogenase (DPD), which can make fluorouracil severely toxic at standard doses.
- Significantly reduced kidney function, which affects how oxaliplatin is cleared from the body.
- Severe liver impairment.
- Pregnancy, as the medicines carry risk to the developing baby.
- Certain active cardiac conditions, because fluorouracil can affect heart rhythm in susceptible individuals.
Being in one of these groups does not rule out all treatment. Your oncologist will assess what is appropriate for your specific situation.
How do you manage cold sensitivity during FOLFOX?
- Wear gloves before touching cold surfaces — the refrigerator, metal handles, air-conditioned surfaces and cold taps can all trigger the sensation.
- Drink water and other liquids at room temperature or slightly warm during the first few days of each cycle.
- Cover your hands, feet and face when outdoors, even if the temperature does not feel cold to others around you.
- Wrap a cloth around cold glasses or bottles before holding them.
- Tell your team if tingling or numbness in your hands or feet is not settling between cycles — cumulative nerve effects need to be monitored at each visit.
- Do not use ice or cold packs on any part of your body during treatment without asking your team first.
What other side effects does FOLFOX cause?
Fatigue is common, especially in the days immediately after each cycle. Most people can manage daily activities but need to rest more than usual in that first week.
Nausea, mouth soreness and changes in appetite can occur. Your team will prescribe medicines to help manage these. If you develop a fever at any point during your FOLFOX course, call your team the same day — do not wait for your next appointment, as this can become urgent quickly.
Peripheral neuropathy — tingling, numbness or a cramping sensation in the hands and feet — is the side effect most closely monitored over time. It can build with each cycle. Your oncologist will ask about it at every visit because it shapes decisions about whether and how to continue.
Did you know?
This is one reason your oncologist monitors nerve symptoms carefully throughout your course rather than waiting until treatment ends.
Source: ESMO Clinical Practice Guidelines — Colon Cancer
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Frequently asked questions
How many cycles of FOLFOX will I need?
The number is not fixed in advance and depends on your specific situation — the stage and location of your cancer, how you are responding, and how your body is tolerating the treatment. FOLFOX is typically given over several months. Your oncologist will review the plan at regular intervals, and it is reasonable to ask at each visit how many cycles are planned and what the decision points are.
Can I shower or bathe while wearing the FOLFOX pump?
Most portable chemotherapy pumps are not waterproof, and you should ask your nurse for specific instructions before your first cycle. Many units provide a waterproof cover or pouch for bathing. The pump itself should not be submerged or exposed to water. Follow the guidance your team gives you for the specific device you are wearing, and call them if you are unsure about anything.
Is the cold sensitivity from FOLFOX permanent?
The acute cold sensitivity that appears in the first few days of each cycle typically settles before the next one begins. The longer-term concern is cumulative peripheral neuropathy — tingling and numbness that builds across cycles and may not fully resolve after treatment finishes. This is why your team asks about nerve symptoms at every visit. Reporting any lasting or worsening symptoms between cycles is important, because it shapes decisions about continuing treatment.
Will FOLFOX cause hair loss?
Significant hair loss is not a typical side effect of FOLFOX. Some thinning can occur in a proportion of people, but the pronounced hair loss associated with certain other chemotherapy regimens is not expected with this one. If you notice any significant change in your hair during or after treatment, mention it at your next appointment.
What should I do if I get a fever during FOLFOX?
Call your oncology team the same day — do not wait for your next scheduled appointment. FOLFOX can lower your neutrophil count, and a fever may be the first sign that your body is struggling to fight infection. This can become serious quickly and needs same-day assessment. If you cannot reach your team, go to the nearest emergency department and tell them you are on chemotherapy.
Can I eat normally during FOLFOX?
Most people can eat normally for most of the cycle, although appetite and taste often change in the days immediately after each treatment. Avoiding very cold food and drinks in the first few days helps with the cold sensitivity caused by oxaliplatin. Small, frequent meals tend to be better tolerated than large ones in the days after each infusion. If managing appetite or weight becomes difficult, ask your team about a referral to a dietitian.
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