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vandetanib (Oral route)

van-DET-a-nib

Oral route(Tablet)

Vandetanib can prolong the QT interval, and torsades de pointes and sudden death have been reported with its use. Do not use in patients with hypocalcemia, hypokalemia, hypomagnesemia, or long QT syndrome; electrolyte depletion must be corrected prior to starting vandetanib and should be periodically monitored. Avoid drugs that are known to prolong the QT interval. Vandetanib is only available through a restricted distribution program (Vandetanib REMS) .

Commonly used brand name(s)

In the U.S.

  • Caprelsa

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Tyrosine Kinase Inhibitor

Uses For vandetanib

Vandetanib is used to treat medullary thyroid cancer that cannot be treated with surgery or that has already spread to different parts of the body.

vandetanib is available only under a registered distribution program called Vandetanib REMS (Risk Evaluation and Mitigation Strategy) Program. You will be asked to sign a form before you take vandetanib. This form tells you about the benefits and risks of using vandetanib. Make sure you understand what is on the form before you sign it.

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Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, vandetanib is used in certain patients with the following medical conditions:

  • Non-small cell lung cancer, locally advanced or metastatic (cancer that has already spread), after failure of first- or second-line cancer treatment (chemotherapy).

Before Using vandetanib

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 vandetanib, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to vandetanib 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 vandetanib in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of vandetanib in the elderly.

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 vandetanib, 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 vandetanib with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amifampridine
  • Bepridil
  • Cisapride
  • Dronedarone
  • Fluconazole
  • Ketoconazole
  • Mesoridazine
  • Nelfinavir
  • Pimozide
  • Piperaquine
  • Posaconazole
  • Saquinavir
  • Sparfloxacin
  • Thioridazine
  • Ziprasidone

Using vandetanib 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.

  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Anagrelide
  • Apomorphine
  • Aprepitant
  • Arsenic Trioxide
  • Artemether
  • Asenapine
  • Astemizole
  • Atazanavir
  • Azithromycin
  • Bedaquiline
  • Carbamazepine
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Dasatinib
  • Delamanid
  • Desipramine
  • Digoxin
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Doxepin
  • Droperidol
  • Ebastine
  • Enzalutamide
  • Eribulin
  • Erythromycin
  • Escitalopram
  • Eslicarbazepine Acetate
  • Famotidine
  • Felbamate
  • Fingolimod
  • Flecainide
  • Fluoxetine
  • Formoterol
  • Fosaprepitant
  • Foscarnet
  • Fosphenytoin
  • Galantamine
  • Gatifloxacin
  • Gemifloxacin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Hydroquinidine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Itraconazole
  • Ivabradine
  • Lapatinib
  • Levofloxacin
  • Lumefantrine
  • Mefloquine
  • Metformin
  • Methadone
  • Mifepristone
  • Mitotane
  • Mizolastine
  • Moxifloxacin
  • Nilotinib
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Ondansetron
  • Paliperidone
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perflutren Lipid Microsphere
  • Perphenazine
  • Phenobarbital
  • Phenytoin
  • Primidone
  • Probucol
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Sertindole
  • Sertraline
  • Sevoflurane
  • Siltuximab
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • St John's Wort
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Terfenadine
  • Tetrabenazine
  • Tizanidine
  • Tolterodine
  • Topotecan
  • Toremifene
  • Trazodone
  • Trimipramine
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Vilanterol
  • Vinflunine
  • Voriconazole
  • Vorinostat

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 vandetanib. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bleeding problems or
  • Diarrhea or
  • Heart failure or
  • Hypertension (high blood pressure) or
  • Hypothyroidism (an underactive thyroid) or
  • Lung disease (eg, interstitial lung disease, pneumonitis)—Use with caution. May make these conditions worse.
  • Bradyarrhythmia (abnormally slow heartbeat) or
  • Congenital long QT syndrome (heart disorder), or history of or
  • Hemoptysis (spitting or coughing up blood), recent history of or
  • Torsade de pointes (abnormal heart rhythm), history of—Should not be used in patients with these conditions.
  • Hypocalcemia (low calcium in the blood) or
  • Hypokalemia (low potassium in the blood) or
  • Hypomagnesemia (low magnesium in the blood)—Use with caution. May cause side effects to be worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of vandetanib

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

Take vandetanib exactly as directed even if you feel well. 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.

vandetanib comes with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.

Swallow the tablet whole. Do not break, crush, or chew it. You may take the tablet with or without food.

If you have trouble swallowing the tablets:

  • Dissolve the tablet in a glass containing 2 ounces of non-carbonated water. Do not use any other liquid.
  • Stir the mixture for 10 minutes and swallow it right away.
  • Rinse the glass with an additional 4 ounces of non-carbonated water and swallow the mixture to make sure you get the full dose of vandetanib.
  • This mixture may also be given through a nasogastric or gastrostomy tubes.

Be careful not to handle crushed or broken tablets. If you have contact with broken or crushed tablets, wash your hands or skin with soap and water immediately.

Dosing

The dose of vandetanib 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 vandetanib. 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 (tablets):
    • For the treatment of medullary thyroid cancer:
      • Adults—300 milligrams (mg) once a day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of vandetanib, 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 vandetanib 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 vandetanib

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

Using vandetanib 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 at least 4 months after you have stopped taking vandetanib. However, if you think you have become pregnant while using the medicine, tell your doctor right away.

Contact your doctor right away if you have any changes in your heart rhythm. You might feel dizzy, faint, or have a fast, pounding, or uneven heartbeat. Make sure your doctor knows if you or anyone in your family has ever had a heart rhythm problem such as QT prolongation.

Serious skin reactions can occur with vandetanib. Check with your doctor right away if you have blistering, peeling, or loosening of the skin; red skin lesions; severe acne or skin rash; sores or ulcers on the skin; or fever or chills while you are using vandetanib.

Avoid overexposing your skin to sunlight. Always use sunscreen or sun-blocking lotions and wear protective clothing and hats while you are using vandetanib and for 4 months after the last dose.

Call your doctor right away if you have unexplained shortness of breath, cough, and fever that comes on suddenly. These may be symptoms of a serious lung condition.

Stop using vandetanib and call your doctor right away if you have confusion; difficulty with speaking; slow speech; an inability to speak; an inability to move your arms, legs, or facial muscles; double vision; or a headache. These may be symptoms of a stroke.

vandetanib may increase your chance of bleeding. Tell your doctor right away if you have bleeding gums, coughing up blood, difficulty in breathing or swallowing, dizziness, headache, increased menstrual flow or vaginal bleeding, nosebleeds, prolonged bleeding from cuts, red or dark brown urine, red or black, tarry stools, or shortness of breath. To help with this problem, 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.

If you are rapidly gaining weight, having shortness of breath, chest pain or discomfort, extreme tiredness or weakness, irregular breathing, irregular heartbeat, or excessive swelling of the hands, wrist, ankles, or feet, check with your doctor immediately. These may be symptoms of heart problems or your body keeping too much water.

vandetanib may cause diarrhea. This may also increase your risk of having an electrolyte imbalance (e.g., low potassium, magnesium, or calcium in the blood). Tell your doctor right away if you start having muscle cramps or twitching, mood or mental changes, or unusual tiredness or weakness while being treated with vandetanib.

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

Check with your doctor right away if blurred vision, difficulty with reading, eye pain or irritation, or any other vision change occurs during therapy. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

vandetanib may cause blurred vision. Make sure you know how you react to vandetanib before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to see well.

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 (St. John's wort) or vitamin supplements.

vandetanib 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
  • Abdominal or stomach cramps or pain
  • bleeding gums
  • blurred vision
  • body aches or pain
  • chest pain
  • cloudy urine
  • confusion
  • convulsions
  • cough
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness
  • ear congestion
  • fainting
  • fever or chills
  • headache
  • increased menstrual flow or vaginal bleeding
  • irregular heartbeat recurrent
  • loss of voice
  • muscle cramps in the hands, arms, feet, legs, or face
  • nervousness
  • nosebleeds
  • numbness and tingling around the mouth, fingertips, or feet
  • paralysis
  • pounding in the ears
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • slow or fast heartbeat
  • sneezing
  • sore throat
  • stuffy or runny nose
  • tenderness
  • tightness in the chest
  • tremor
  • troubled breathing
  • unusual tiredness or weakness (severe)
  • watery or bloody diarrhea
Less common
  • Blue lips, fingernails, or skin
  • chest pain or discomfort
  • dilated neck veins
  • extreme fatigue
  • foreign substance into the lungs
  • infection from breathing
  • irregular breathing
  • irregular heartbeat
  • irregular, fast or slow, or shallow breathing
  • lightheadedness
  • no breathing
  • swelling of the face, fingers, feet, or lower legs
  • weight gain
Rare
  • Bloating
  • constipation
  • darkened urine
  • decreased urine output
  • indigestion
  • loss of appetite
  • nausea
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • yellow eyes or skin

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
  • blemishes on the skin
  • blindness
  • blistering, crusting, irritation, itching, or reddening of the skin
  • change in taste
  • cracked, dry, or scaly skin
  • cracks in the skin
  • decreased appetite
  • decreased vision
  • decreased weight
  • depression
  • discoloration of the fingernails or toenails
  • dry mouth
  • dry skin
  • hair loss or thinning of the hair
  • heartburn
  • increased sensitivity of the skin to sunlight
  • itching skin
  • lack or loss of strength
  • loosening of the fingernails
  • loss of heat from the body
  • loss of taste
  • muscle aches or spasms
  • pimples
  • rash with flat lesions or small raised lesions on the skin
  • red, swollen skin
  • redness or other discoloration of the skin
  • redness or soreness around the fingernails
  • severe sunburn
  • stomach discomfort or upset
  • swelling
  • trouble sleeping

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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