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cabozantinib (Oral route)

ka-boe-ZAN-ti-nib

Oral route(Capsule)

Gastrointestinal (GI) perforations, fistula formation, and severe hemorrhage have occurred in patients treated with cabozantinib malate. Discontinue therapy if GI perforation or fistula develop. Monitor patients for bleeding, and do not administer cabozantinib malate to patients with severe hemorrhage .

Commonly used brand name(s)

In the U.S.

  • Cometriq

Available Dosage Forms:

  • Capsule

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Tyrosine Kinase Inhibitor

Uses For cabozantinib

Cabozantinib is used to treat medullary thyroid cancer that has already spread to different parts of the body. It interferes with the growth of cancer cells, which are eventually destroyed by the body. Cabozantinib is an antineoplastic (cancer) medicine.

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cabozantinib is available only with your doctor's prescription.

Before Using cabozantinib

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For cabozantinib, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to cabozantinib or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of cabozantinib in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies have not been performed on the relationship of age to the effects of cabozantinib in the geriatric population. However, no geriatric-specific problems have been documented to date.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking cabozantinib, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using cabozantinib with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aprepitant
  • Atazanavir
  • Boceprevir
  • Carbamazepine
  • Ceritinib
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Dabrafenib
  • Enzalutamide
  • Eslicarbazepine Acetate
  • Fluconazole
  • Fosaprepitant
  • Fosphenytoin
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Lopinavir
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Phenobarbital
  • Phenytoin
  • Piperaquine
  • Posaconazole
  • Primidone
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Saquinavir
  • Siltuximab
  • St John's Wort
  • Telaprevir
  • Telithromycin
  • Voriconazole

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of cabozantinib. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bleeding problems or
  • Blood clots (eg, heart attack, stroke) or
  • Hypertension (high blood pressure) or
  • Proteinuria (protein in the urine) or
  • Stomach fistula or perforation (a hole from the inside)—Use with caution. May make these conditions worse.
  • Bleeding problems, recent or
  • Hemoptysis (spitting or coughing up blood), recent or
  • Liver disease, moderate and severe—Use is not recommended in patients with these conditions.
  • Dental or tooth problems or
  • Dental procedures or surgery or
  • Poor oral hygiene or
  • Tooth infection—May increase risk for severe jaw problems.

Proper Use of cabozantinib

Medicines used to treat cancer are very strong and can have many side effects. Before taking cabozantinib, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.

Take cabozantinib only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

cabozantinib comes with a patient information insert. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Take cabozantinib on an empty stomach. Do not eat for at least 2 hours before and at least 1 hour after taking cabozantinib.

Swallow the capsule whole with a full glass (at least 8 ounces) of water. Do not crush, break, chew, or open the capsule.

Dosing

The dose of cabozantinib will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of cabozantinib. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (capsules):
    • For the treatment of thyroid cancer:
      • Adults—140 milligrams (mg) per day as a single dose. Your doctor may adjust the dose if needed.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of cabozantinib, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose of cabozantinib and it is less than 12 hours since your regular time, take it as soon as you can and take your next dose at the normal time. If you miss a dose and it is more than 12 hours since your regular time, skip the missed dose and take your next dose at the normal time. Do not use extra medicine to make up for a missed dose.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using cabozantinib

If you will be taking cabozantinib for a long time, it is very important that your doctor check you at regular visits for any problems or unwanted effects. Blood and urine tests may be needed to check for unwanted effects.

Using cabozantinib while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. You should continue to use birth control for at least 4 months after you stop taking cabozantinib. If you think you have become pregnant while using the medicine, tell your doctor right away.

Check with your doctor right away if you have severe stomach pain, or gagging, coughing or choking when you eat or drink. These could be symptoms of a perforation (tear) or fistula (hole) in the bowel.

cabozantinib may increase your chance of bleeding. Tell your doctor right away if you cough up blood or have bleeding gums, difficulty with breathing or swallowing, dizziness, increased menstrual flow or vaginal bleeding, nosebleeds, prolonged bleeding from cuts, red or dark brown urine, or red or black, tarry stools. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

Check with your doctor right away if you have chest pain or discomfort, nausea, pain or discomfort in your arms, jaw, back, or neck, shortness of breath, sweating, or vomiting. These could be symptoms of a heart attack.

Make sure any doctor or dentist who treats you knows that you are using cabozantinib. You may need to stop using cabozantinib before having surgery, including dental procedures.

Your doctor will check your blood pressure on a regular basis while you are taking cabozantinib. You might need to monitor your blood pressure at home. Tell your doctor right away if you have a severe headache, lightheadedness, or changes in your vision.

Tell your doctor right away if you have jaw tightness, swelling, numbness, pain, or a loose tooth. This could be symptoms of a severe jaw problem.

cabozantinib may cause a serious skin problem called hand-foot syndrome or palmar plantar erythrodysesthesia syndrome. Check with your doctor if you have a rash that doesn't go away or redness, pain, swelling, or blisters on the palms of your hands or soles of your feet.

Check with your doctor right away if you have a headache, seizures, confusion, blurred vision or other visual problems. These may be symptoms of a rare and serious brain condition called reversible posterior leukoencephalopathy syndrome.

Do not eat grapefruit or drink grapefruit juice while you are using cabozantinib. Grapefruit and grapefruit juice may increase the amount of cabozantinib in the blood.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

cabozantinib Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Blurred vision
  • burning, numbness, tingling, or painful sensations
  • dehydration
  • difficulty with breathing or swallowing
  • dizziness
  • headache
  • nervousness
  • pain in the chest, groin, or legs, especially the calves
  • pounding in the ears
  • redness, swelling, or pain of the skin
  • scaling of the skin on the hands and feet
  • severe, sudden headache
  • skin ulcers
  • slow or fast heartbeat
  • slurred speech
  • sudden loss of coordination
  • sudden, severe weakness or numbness in the arm or leg
  • sudden, unexplained shortness of breath
  • tingling of the hands and feet
  • unsteadiness or awkwardness
  • vision changes
  • weakness in the arms, hands, legs, or feet
Less common
  • Bleeding gums
  • bloody, black, or tarry stools
  • coughing up blood
  • heartburn
  • heavy jaw feeling
  • increased menstrual flow or vaginal bleeding
  • indigestion
  • loosening of a tooth
  • nausea
  • nosebleeds
  • pain, swelling, or numbness in the mouth or jaw
  • paralysis
  • prolonged bleeding from cuts
  • red or dark brown urine
  • severe abdominal or stomach pain, cramping, or burning
  • trouble breathing
  • vomiting of material that looks like coffee grounds, severe and continuing
Rare
  • Confusion
  • disturbed color perception
  • double vision
  • halos around lights
  • night blindness
  • overbright appearance of lights
  • seizures
  • tunnel vision

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Acid or sour stomach
  • belching
  • bleeding after defecation
  • change in taste
  • changes in hair color
  • decreased appetite
  • decreased weight
  • diarrhea
  • difficulty having a bowel movement (stool)
  • difficulty with moving
  • dry skin
  • fear
  • hair loss or thinning of the hair
  • hoarseness
  • lack or loss of strength
  • loss of taste
  • muscle pain or stiffness
  • muscle spasm
  • pain in the joints
  • rash
  • sore throat
  • stomach discomfort, upset, or pain
  • swelling or inflammation of the mouth
  • uncomfortable swelling around the anus
  • voice changes
  • vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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