Does hydroxyurea cause diarrhea?

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Last updated: June 30, 2025View editorial policy

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From the Guidelines

Hydroxyurea can cause diarrhea as a side effect, as evidenced by the gastrointestinal symptoms listed in the guidelines of care for the management of psoriasis and psoriatic arthritis 1. The incidence of diarrhea with hydroxyurea is generally reported to be less than 10% of patients. If diarrhea occurs, it is typically mild to moderate in severity and often manageable with supportive care. Patients experiencing persistent or severe diarrhea should contact their healthcare provider, as dose adjustments or supportive medications may be needed. The mechanism behind hydroxyurea-induced diarrhea likely relates to its effects on rapidly dividing cells, including those lining the gastrointestinal tract, as hydroxyurea works by inhibiting DNA synthesis in actively dividing cells. Some key points to consider when managing hydroxyurea-induced diarrhea include:

  • Monitoring for signs of dehydration and electrolyte imbalances
  • Adjusting the dose of hydroxyurea as needed to minimize gastrointestinal side effects
  • Considering the use of supportive medications, such as anti-diarrheal agents, to manage symptoms
  • Educating patients on the importance of reporting persistent or severe diarrhea to their healthcare provider. It's also important to note that hydroxyurea has been associated with other gastrointestinal symptoms, including stomatitis, anorexia, nausea, vomiting, and constipation 1. Overall, while hydroxyurea can cause diarrhea, it is generally a manageable side effect, and patients should be educated on how to recognize and report symptoms to their healthcare provider.

From the Research

Hydroxyurea and Diarrhea

  • Hydroxyurea is an antimetabolite drug that is commonly used in many hematological disorders, and its side effects can vary in incidence 2, 3.
  • While the provided studies do not directly address the question of whether hydroxyurea causes diarrhea, they do report cases of gastrointestinal ulcers and other mucocutaneous adverse effects associated with hydroxyurea use 3, 4, 5, 6.
  • One study reports a case of a patient who experienced episodes of mucous diarrhea while being treated with hydroxyurea, suggesting a possible link between the drug and gastrointestinal symptoms 6.
  • However, the studies do not provide conclusive evidence of a direct causal relationship between hydroxyurea and diarrhea.
  • The pathophysiology of non-oral gastrointestinal ulceration in relation to hydroxyurea is unclear, but withdrawal of the drug typically leads to complete resolution of symptoms 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Hydroxyurea-induced oral ulceration.

Oral surgery, oral medicine, oral pathology and oral radiology, 2015

Research

Hydroxyurea and colonic ulcers: a case report.

BMC gastroenterology, 2014

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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