nilotinib (Oral route)
Prolongation of the QT interval and sudden death have been reported. Do not use nilotinib in the presence of hypokalemia, hypomagnesemia, or long QT syndrome. Hypokalemia or hypomagnesemia must be corrected prior to nilotinib administration and monitored during treatment. Avoid drugs that prolong the QT interval and strong CYP3A4 inhibitors. Avoid food 2 hours before and 1 hour after taking nilotinib. ECGs should be obtained to monitor the QTc .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antineoplastic Agent
Pharmacologic Class: Tyrosine Kinase Inhibitor
Uses For nilotinib
Nilotinib is used to treat Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in adults who are newly diagnosed. It is also given to adults with Ph+ CML in chronic phase (CP) or accelerated phase (AP) who have taken other medicines (eg, imatinib) or treatments but did not work well. Leukemia is a type of cancer where the body makes too many abnormal white blood cells.
Nilotinib belongs to the general group of medicines known as antineoplastics or cancer medicines. It interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells may also be affected by nilotinib, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects may not be serious but may cause concern.
Before you begin treatment with nilotinib, you and your doctor should talk about the benefits nilotinib will do as well as the possible risks of using it.
nilotinib is available only with your doctor's prescription.
Before Using nilotinib
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 nilotinib, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to nilotinib 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.
Appropriate studies have not been performed on the relationship of age to the effects of nilotinib in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nilotinib in the elderly.
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 nilotinib, 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 nilotinib 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.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine
Using nilotinib 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.
- Adenovirus Vaccine
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Eslicarbazepine Acetate
- Influenza Virus Vaccine, Live
- Inotuzumab Ozogamicin
- Morphine Sulfate Liposome
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- St John's Wort
- Typhoid Vaccine
- Vincristine Sulfate Liposome
- Yellow Fever Vaccine
Using nilotinib with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
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. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using nilotinib with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use nilotinib, or give you special instructions about the use of food, alcohol, or tobacco.
- Grapefruit Juice
Other Medical Problems
The presence of other medical problems may affect the use of nilotinib. Make sure you tell your doctor if you have any other medical problems, especially:
- Ascites (abnormal build-up of water in the stomach) or
- Bleeding problems or
- Blood or bone marrow problems (eg, anemia, neutropenia, thrombocytopenia) or
- Fluid retention or
- Heart or blood vessel problems (eg, congestive heart failure, heart attack, ischemic heart disease, pericardial effusion, peripheral arterial occlusive disease, slow heartbeat, stroke), or history of or
- Hyperkalemia (high potassium in the blood) or
- Hypocalcemia (low calcium in the blood) or
- Hyponatremia (low sodium in the blood) or
- Hypophosphatemia (low phosphate in the blood) or
- Lung disease (eg, pleural effusion, pulmonary edema) or
- Pancreatitis (inflammation of the pancreas), history of—Use with caution. May make these conditions worse.
- Heart rhythm problems (eg, long QT syndrome) or
- Hypokalemia (low potassium in the blood) or
- Hypomagnesemia (low magnesium in the blood)—Should not be used in patients with these conditions.
- Lactose intolerance—Use with caution. nilotinib contains lactose.
- Liver disease—Use with caution. The effects may be increased because of slower removal of nilotinib from the body.
- Total gastrectomy (surgery that involves the removal of the entire stomach)—The effects of nilotinib may be decreased in patients who had this procedure.
Proper Use of nilotinib
Take nilotinib exactly 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. Do not change the dose or stop using nilotinib without checking first with your doctor.
nilotinib should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the medication guide if you do not have one.
It is best to take nilotinib on an empty stomach (at least 1 hour before or 2 hours after a meal).
Swallow the capsule whole with water. If you have trouble swallowing the capsule, they can be opened and the contents can be sprinkled in one teaspoon of applesauce (puréed apple). Do not sprinkle Tasigna® on other foods. This mixture must be taken right away within 15 minutes and should not be stored for later use.
If you are taking an H2 blocker medicine (eg, famotidine), take it at least 10 hours before or 2 hours after taking nilotinib.
If you are taking an antacid that contains aluminum, magnesium, or simethicone, take it at least 2 hours before or 2 hours after taking nilotinib.
Do not eat grapefruit or drink grapefruit juice while you are using nilotinib. Grapefruit and grapefruit juice may change the amount of the medicine that is absorbed in the body.
The dose of nilotinib 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 nilotinib. 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 Ph+ CML-CP and CML-AP after other treatments have failed:
- Adults—400 milligrams (mg) two times a day, at least 12 hours apart. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
- For the treatment of newly diagnosed Ph+ CML-CP:
- Adults—300 milligrams (mg) two times a day, at least 12 hours apart. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
- For the treatment of Ph+ CML-CP and CML-AP after other treatments have failed:
If you miss a dose of nilotinib, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
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 nilotinib
If you will be taking nilotinib for a long time, it is very important that your doctor check your progress at regular visits to make sure that nilotinib is working properly. Blood tests may be needed to check for unwanted effects.
Using nilotinib while you are pregnant can harm your unborn baby. Use an effective form of birth control during treatment with nilotinib and for at least 14 days after the last dose to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
nilotinib can cause changes in the heart rhythm, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Tell your doctor right away if you have a fast, pounding, or irregular heartbeat. Your doctor will check your heartbeat with an ECG test (electrocardiogram) before, during, and 7 days after starting treatment with nilotinib.
After at least 3 years of treatment with nilotinib, your doctor may do certain tests to check if you continue to show no symptoms of your cancer (remission) and may let you stop taking it. This is called treatment free remission (TFR). However, you may need to restart treatment, at a later time, if you are no longer in remission.
nilotinib may cause heart or blood vessel problems, such as a decreased blood flow to the legs, heart, or brain. Check with your doctor right away if you have chest pain or discomfort, numbness or weakness, change in the color of the legs, leg pain, or problems with walking or speaking.
Nilotinib can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
- If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
- Check with your doctor right away if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
- Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
- Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
- Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
- Avoid contact sports or other situations where bruising or injury could occur.
Pancreatitis and other pancreas problems may occur while you are using nilotinib. Check with your doctor right away if you or your child have sudden and severe stomach pain with nausea and vomiting.
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.
nilotinib may cause a serious type of reaction called tumor lysis syndrome. Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in the amount of your urine, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.
nilotinib may cause fluid retention (edema). Tell your doctor right away if you have bloating or swelling of the face, arms, hands, lower legs, or feet, rapid weight gain, or trouble breathing.
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.
nilotinib 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
- Black, tarry stools
- bleeding gums
- blood in the urine or stools
- blurred vision
- bone pain
- clay-colored stools
- dark urine
- decreased appetite
- difficult or labored breathing
- dry mouth
- flushed, dry skin
- fruit-like breath odor
- increased hunger
- increased thirst
- increased urination
- irregular heartbeat, recurrent
- loss of appetite
- lower back or side pain
- muscle aches, cramps, or pain
- no blood pressure
- no breathing
- no pulse
- numbness, tingling, pain, or weakness in the hands or feet
- painful or difficult urination
- pale skin
- pinpoint red spots on the skin
- skin rash or itching
- sore throat
- stomach pain or tenderness
- stuffy or runny nose
- swelling of the hands, ankles, feet, or lower legs
- tightness in the chest
- troubled breathing with exertion
- ulcers, sores, or white spots in the mouth
- unexplained weight loss
- unusual bleeding or bruising
- unusual tiredness or weakness
- weakness and heaviness of the legs
- yellow eyes or skin
- Decreased urine output
- fast heartbeat
- loss of consciousness
- muscle cramps in the hands, arms, feet, legs, or face
- numbness and tingling around the mouth, fingertips, or lips
- rapid weight gain
- Bladder pain
- bloody or cloudy urine
- body aches or pain
- cough producing mucus
- depressed mood
- dry skin and hair
- ear congestion
- feeling cold
- frequent urge to urinate
- hair loss
- loss of voice
- muscle stiffness
- pain or tenderness around the eyes and cheekbones
- sensitivity to heat
- slowed heartbeat
- swelling or puffiness of the face
- tender, swollen glands in the neck
- trouble sleeping
- trouble swallowing
- weight changes
- white patches in the mouth or throat or on the tongue
- Pain or swelling of the treated skin
- rapid, shallow breathing
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
- Back pain
- burning, itching, and pain in hairy areas
- difficulty with moving
- joint pain or swelling
- lack or loss of strength
- muscle spasms
- pain in the arms or legs
- pus at the root of the hair
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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More about nilotinib
- Side Effects
- During Pregnancy
- Dosage Information
- Drug Interactions
- Support Group
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- Drug class: BCR-ABL tyrosine kinase inhibitors
Other brands: Tasigna