Medical Oncologist
Bevacizumab (Avastin)
Bevacizumab Side Effects: — Timeline and When to Call
Bevacizumab's side effects follow a different pattern from chemotherapy because it targets blood vessels, not cells. High blood pressure, nosebleeds and protein in the urine are common and monitored before every cycle. A small number of serious risks need immediate care if they appear.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Blood pressure rises in many patients — This is a direct effect of how the drug works, not a sign of harm, and your team checks it before every cycle.
- Serious risks are rare but urgent — Bowel perforation, blood clots and a rare neurological syndrome need emergency care if they happen.
- Surgery timing matters — Bevacizumab must be paused around any operation because it slows wound healing throughout the body.
- Most effects settle after stopping — Blood pressure and nosebleeds typically improve once treatment ends, though wound healing takes longer to recover.
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Bevacizumab's most common side effects are high blood pressure, nosebleeds and protein in the urine. These are monitored before each cycle. Rarer but serious risks include blood clots, bowel perforation and a neurological syndrome that needs immediate attention. Most side effects are manageable when reported early. Your team checks for the serious ones before every dose.
Why are bevacizumab's side effects different from chemotherapy?
Bevacizumab works by blocking a protein called VEGF, which tumours use to grow new blood vessels. Without that blood supply, tumours find it harder to grow.
The same mechanism affects blood vessels throughout your body — not only in the tumour. This is why its signature side effects are high blood pressure, nosebleeds and slow wound healing, rather than the hair loss and nausea more often linked to chemotherapy.
Many of its risks are detected through monitoring rather than through symptoms appearing. Your team takes blood pressure readings and checks your urine before every cycle for this reason. Telling them about changes between cycles is equally important.
Side effects, how common they are, and what to do
| Side effect | How often | When it may start | Action needed |
|---|---|---|---|
| Nosebleeds (epistaxis) | Common | Often in early cycles | Manage at home; call if heavy, lasting, or more frequent than before |
| High blood pressure | Common | Within the first weeks, and throughout treatment | Checked before every cycle; call for severe headache, vision change or confusion |
| Protein in urine (proteinuria) | Common | Can appear at any cycle | Tested by dipstick before each dose — no action unless your team asks you to act |
| Fatigue | Common | Any time during treatment | Tell your team; it can usually be managed |
| Headache | Fairly common | Any time | Call if sudden, severe or accompanied by visual changes |
| Blood clots (DVT or pulmonary embolism) | Less common but serious | Any time during treatment | Call today if a leg is swollen or you have chest pain or breathlessness |
| Wound healing problems | Important risk near surgery | Around any operation during treatment | Tell both your surgeon and your oncologist before any planned procedure |
| Bowel or gut perforation | Rare | Any time during treatment | Emergency — severe sudden abdominal pain: go to hospital now |
| Neurological syndrome (RPLS/PRES) | Rare | Any time | Emergency — seizure, sudden vision loss or confusion: go to hospital now |
| Typically starts (common effects) | — | Within the first few treatment cycles; monitoring continues throughout | Report any new or changed symptom to your team between cycles, not only at appointments |
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Tell your team before each cycle
- Any new or worsening headache, especially one that is severe or sudden.
- Any nosebleed that took longer than usual to stop, or that you are having more often.
- Any leg swelling, pain or warmth on one side of the body.
- Any breathlessness or chest pain since your last cycle.
- Any wound from a previous operation that has not healed fully.
- Any surgery, dental extraction or biopsy you are planning or have been referred for.
- Every medicine and supplement you are taking, including herbal remedies and over-the-counter painkillers.
- Any change in how often or how much you are urinating.
Why must bevacizumab be stopped before surgery?
Bevacizumab slows the growth of new blood vessels — the same process the body relies on to heal a wound. This means that operations carried out while the drug is active carry a higher risk of wounds breaking down or not closing properly.
NCCN and ASCO guidance recommends a gap between your last bevacizumab dose and any elective operation, and a further gap before restarting after surgery. Your oncologist and surgeon need to agree that timing together — do not schedule an operation without telling both.
Minor procedures count too. Dental extractions, biopsies and any procedure that breaks the skin should be discussed with your oncology team before you book them.
Did you know?
Bevacizumab was among the first treatments designed specifically to cut off a tumour's blood supply — an approach called anti-angiogenesis.
NCCN and ASCO guidelines include blood pressure monitoring before every cycle precisely because blocking VEGF affects vessels throughout the body, not only inside the tumour.
Source: NCCN Clinical Practice Guidelines in Oncology; ASCO Clinical Practice Guidelines
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Common questions
Frequently asked questions
Will I lose my hair on bevacizumab?
Hair loss is not a typical side effect of bevacizumab. It works by targeting blood vessels rather than rapidly dividing cells, which is why hair follicles are not the main tissue affected. If you are on a combination regimen that includes a chemotherapy drug, the chemotherapy partner may cause hair loss — ask your oncologist which drugs are in your regimen and which side effect comes from which one, so you are not worrying about something that may not apply to you.
My blood pressure was normal before. Why does bevacizumab cause it to rise?
Bevacizumab reduces VEGF, a protein that normally helps blood vessels relax and stay dilated. When VEGF is blocked, blood vessels become narrower and pressure inside them rises. This is a direct pharmacological effect of how the drug works — it is not a sign that the treatment is damaging you. In most cases it is managed with standard blood pressure medicine, and your team monitors it before every cycle so that any increase is caught and treated before it becomes a problem.
Is a nosebleed on bevacizumab serious?
Minor nosebleeds are common and usually settle on their own. Bevacizumab affects the small blood vessels that line the inside of the nose, and brief bleeds are one of the most frequently reported effects of treatment. Call your team if a nosebleed lasts longer than usual, if the bleeding is heavy, or if you are having them more often than before. Any bleeding from a site other than the nose — coughing up blood, blood in the urine, or unusual bruising anywhere — needs same-day review, not a wait until your next appointment.
Can I take aspirin or anti-inflammatory medicines while on bevacizumab?
Only if your oncologist has confirmed they are safe for you. Medicines that affect bleeding — including aspirin, ibuprofen and similar anti-inflammatory drugs — can interact with bevacizumab's effects on blood vessels and increase the risk of serious bleeding. Some herbal supplements carry the same risk. Tell your team everything you are taking before your first cycle, and check before adding anything new, even medicines you have taken for years without a problem.
How long do bevacizumab's side effects last after treatment ends?
Blood pressure often normalises within weeks of stopping, and nosebleeds typically settle. The timing varies between individuals and depends on how long treatment was given. Wound healing improves once the drug has cleared from your system, but your surgeon should know that some effects persist for a period after the last dose. NCCN recommends a specific interval between the last dose and elective surgery — your oncologist will advise on the right timing for your situation rather than a fixed number of weeks.