Medical Oncologist
Enhertu infusion day
Trastuzumab Deruxtecan Infusion Day: — Premedication, Duration and What to Expect
Your first trastuzumab deruxtecan infusion runs for about 90 minutes. Later infusions can be shorter if the first went well. Here is what the whole visit looks like, from the pre-treatment check to going home.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Day care, not hospital admission — You go home the same day. No overnight stay is needed for the infusion itself.
- Your first session runs longer — The first infusion takes longer than later ones. This is normal — the team watches more closely the first time.
- Premedication comes first — You receive medicines to reduce the chance of a reaction before the main drip starts.
- Plan for a full half-day — Between checks, premedication, the infusion and observation, allow several hours for the visit.
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Trastuzumab deruxtecan is given as a drip in day care every three weeks. The prescribing information sets the first infusion at 90 minutes; if you tolerate it well, later infusions can shorten to 30 minutes. Premedication is given before each infusion, and you are observed for a period after the drip ends before you go home.
How long does a trastuzumab deruxtecan infusion take?
| First infusion | Later infusions | |
|---|---|---|
| Duration | Around 90 minutes | Can shorten to around 30 minutes if the first was well tolerated |
| Observation after | Longer — at least an hour is standard | Shorter if previous infusions were uneventful |
| Premedication | Yes — antihistamine and corticosteroid before the drip | Yes — same premedication each time |
| Monitoring during | Vital signs checked throughout and after | Vital signs checked throughout and after |
| Typically starts | Cycle 1, Day 1 — your first treatment day | Every 3 weeks from Cycle 2 onwards |
What should you do before your infusion day?
- Arrange transport homeDo not plan to drive yourself. The premedication can cause drowsiness. Book a family member, auto or cab in advance.
- Eat a light meal beforehandArrive having eaten unless your team has told you to fast. An empty stomach can make nausea more likely.
- List every medicine and supplement you are takingInclude vitamins, herbal preparations and anything Ayurvedic. Your team needs the full picture before each cycle.
- Wear loose, comfortable clothingThe nurse will need clear access to your arm for the cannula. Avoid tight or fitted sleeves.
- Bring something to occupy youA book, headphones or a charged phone — the whole visit can run several hours.
- Tell your team about any new symptomsA cough, fever or shortness of breath that has appeared since your last visit must be mentioned before the drip begins.
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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)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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What happens on infusion day, step by step?
Arrival and pre-treatment check
A nurse records your blood pressure, temperature, pulse and oxygen level and reviews your recent blood results before anything is given.
Premedication
You receive an antihistamine and a corticosteroid — through a drip or by mouth — around 30 minutes before the main infusion starts. These reduce the chance of a reaction.
Cannula placed
A nurse inserts a small cannula into a vein in your arm. If you have a port or PICC line, tell them — they will use that instead.
Infusion begins
Trastuzumab deruxtecan is given slowly. The rate is more cautious for the first infusion. Tell your nurse immediately if you notice flushing, chills, chest tightness or breathlessness.
Infusion ends and cannula removed
Once the drip is complete the nurse flushes the line and removes the cannula.
Observation period
You stay in the day care area for a period after the infusion ends. Your team watches for any delayed reaction before you leave. Do not plan to leave the moment the drip finishes.
Going home
Your nurse will tell you which symptoms to watch for and give you a contact number. Use it the same day if anything concerns you.
What should you watch for after you get home?
Infusion reactions can occasionally happen in the hours after you leave, not only during the drip. Report the same day if you notice new shortness of breath, chest tightness, a fever, or a rash that appears or spreads after you are home.
Mild tiredness on infusion day and the following day is common. Most people feel well enough for light activity within a day or two, though this varies from person to person.
You will be given a contact number before you leave. Use it if anything worries you rather than waiting for your next scheduled appointment — your concern is always worth a call.
Did you know?
Trastuzumab deruxtecan is an antibody-drug conjugate — an antibody that targets HER2 on cancer cells, linked to a chemotherapy payload it releases directly inside them.
It carries a higher number of chemotherapy molecules per antibody than earlier conjugates in its class. This higher drug-to-antibody ratio is part of why ASCO described its results in HER2-low breast cancer as practice-changing — a group where earlier HER2-targeted therapies were not effective.
Source: ASCO 2022 – DESTINY-Breast04; Daiichi Sankyo / AstraZeneca prescribing information for trastuzumab deruxtecan
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Common questions
Frequently asked questions
Can I eat before my infusion?
Yes, unless your team has told you to fast. A light meal before you arrive is better than an empty stomach — fasting can make you feel faint and may make nausea more likely during the infusion. A very heavy meal is also worth avoiding if you tend to feel queasy during treatment. If you are unsure what your team recommends, ask at your pre-treatment appointment.
What should I do if I feel unwell during the infusion?
Tell your nurse immediately and do not wait to see if it passes. If you notice flushing, chills, chest tightness, breathlessness, heat in the face, headache or simply a sense that something is wrong, call out or use your call button straight away. The drip can be slowed or stopped quickly, and reactions caught early are much easier to manage. There is always a nurse present in the day care area.
Can I drive myself home after the infusion?
No, not on infusion day — especially not after your first infusion. The premedication includes an antihistamine that commonly causes drowsiness, and you will have been sitting still for several hours. Arrange for someone to drive you, or book an auto or cab before you come in. Do not plan to ride a two-wheeler home either. If arranging transport is difficult, tell the clinic team in advance so they can help you plan.
How long will I be at the clinic altogether?
Plan for longer than the infusion itself. You arrive for a pre-treatment check, wait while premedication is given, sit through the infusion, then stay for an observation period before leaving. On your first infusion day, allow most of a morning or afternoon — four to five hours from arrival to leaving is a reasonable estimate, though the timing depends on your clinic's schedule. Later visits are usually shorter once the team knows how you tolerate the drug.
Will the premedication make me drowsy?
It may. The antihistamine given before trastuzumab deruxtecan commonly causes drowsiness, and most people feel groggy for a few hours after the infusion rather than for the whole day. Avoid driving or making important decisions until the following morning. If the drowsiness is bothering you significantly, mention it to your team — there may be options to adjust the timing or choice of antihistamine used.