Skip to Content

Cabozantinib Dosage

Medically reviewed on February 7, 2018.

Applies to the following strengths: 140 mg daily-dose; 100 mg daily-dose; 60 mg daily-dose; 60 mg; 20 mg; 40 mg

Usual Adult Dose for Thyroid Cancer

Capsule Formulation: 140 mg orally once a day
Duration of therapy: Until patient no longer experiences clinical benefit or unacceptable toxicity occurs.

Comments:
-This drug should be taken on an empty stomach, at least 2 hours before and at least 1 hour after a meal.
-The capsule form of this drug cannot be substituted with the tablet form.
-Swallow capsules whole; do not divide or crush.
-Do not take a missed dose within 12 hours of the next dose.
-Do not ingest foods (e.g., grapefruit, grapefruit juice) or nutritional supplements that are known to inhibit cytochrome P450 while taking this drug.

Use: For metastatic medullary thyroid cancer (MTC)

Usual Adult Dose for Renal Cell Carcinoma

Tablet Formulation: 60 mg orally once a day
Duration of therapy: Until patient no longer experiences clinical benefit or unacceptable toxicity occurs.

Comments:
-This drug should be taken on an empty stomach, at least 2 hours before and at least 1 hour after a meal.
-The tablet form of this drug cannot be substituted with the capsule form.
-Swallow tablets whole; do not crush.
-Do not take a missed dose within 12 hours of the next dose.
-Do not ingest foods (e.g., grapefruit, grapefruit juice) or nutritional supplements that are known to inhibit cytochrome P450 while taking this drug.

Use: For patients with advanced renal cell carcinoma (RCC) who have received at least 1 prior anti-angiogenic therapy

Renal Dose Adjustments

Capsules/Tablets:
-Mild to moderate renal dysfunction: No adjustment recommended.
-Severe renal dysfunction: Data not available

Liver Dose Adjustments

Capsule formulation (MTC):
-Mild to moderate hepatic impairment: 80 mg orally once a day
-Severe hepatic impairment: Use is not recommended.

Tablet formulation (RCC):
-Mild to moderate hepatic impairment: 40 mg orally once a day
-Severe hepatic impairment: Use is not recommended.

Dose Adjustments

CAPSULE FORMULATION (MTC):
-Adverse Reactions (Grade 4, Grade 3, or Intolerable Grade 2): Withhold therapy until improvement to baseline or resolution to Grade 1; then adjust the dose as follows:
---If previous dose 140 mg/day: Reduce dose to 100 mg/day
---If previous dose 100 mg/day: Reduce dose to 60 mg/day
---If previous dose 60 mg/day: Do not dose reduce; resume at 60 mg/day if tolerated or discontinue therapy.
-Concomitant Use of Strong CYP450 3A4 Inhibitors: Use is not recommended. If concomitant use is necessary, reduce the dose of this drug by 40 mg (e.g., from 140 mg/day to 100 mg/day). Resume the dose used prior to initiation of the strong CYP450 3A4 inhibitor 2 to 3 days after discontinuation of the CYP450 3A4 inhibitor.
-Concomitant Use of Strong CYP450 3A4 Inducers: Use is not recommended. If concomitant use is necessary, increase the dose of this drug by 40 mg (e.g., from 140 mg/day to 180 mg/day) as tolerated. Resume the dose used prior to initiation of the strong CYP450 3A4 inducer 2 to 3 days after discontinuation of the CYP450 3A4 inducer. Do not exceed 180 mg/day.
-Permanently discontinue therapy for development of perforation or fistula formation, severe hemorrhage; serious arterial thromboembolic event (e.g., myocardial infarction, cerebral infarction), nephrotic syndrome, malignant hypertension, hypertensive crisis, severe hypertension despite optimal medical management, osteonecrosis of the jaw, or reversible posterior leukoencephalopathy syndrome.

TABLET FORMULATION (RCC):
-Scheduled Surgery: Stop treatment at least 28 days prior to scheduled surgery, including dental surgery.
-Adverse Reactions (Grade 4, Grade 3, or Intolerable Grade 2): Withhold therapy until improvement to baseline or resolution to Grade 1; then adjust the dose as follows:
---If previous dose 60 mg/day: Reduce dose to 40 mg/day
---If previous dose 40 mg/day: Reduce dose to 20 mg/day
---If previous dose 20 mg/day: Do not dose reduce; resume at 20 mg/day if tolerated or discontinue therapy
-Concomitant Use of Strong CYP450 3A4 Inhibitors: Use is not recommended. If concomitant use is necessary, reduce the dose of this drug by 20 mg (e.g., from 60 mg/day to 40 mg/day). Resume the dose used prior to initiation of the strong CYP450 3A4 inhibitor 2 to 3 days after discontinuation of the CYP450 3A4 inhibitor.
-Concomitant Use of Strong CYP450 3A4 Inducers: Use is not recommended if alternative therapy is available. If concomitant use is necessary, increase the dose of this drug by 20 mg (e.g., from 60 mg/day to 80 mg/day) as tolerated. Resume the dose used prior to initiation of the strong CYP450 3A4 inducer 2 to 3 days after discontinuation of the 3A4 inducer. Do not exceed 80 mg/day.
-Permanently discontinue therapy for development of unmanageable fistula or GI perforation, severe hemorrhage, arterial thromboembolic event (e.g., myocardial infarction, cerebral infarction), hypertensive crisis or severe hypertension despite optimal medical management, nephrotic syndrome, or reversible posterior leukoencephalopathy syndrome.

Precautions

US BOXED WARNINGS:
PERFORATIONS/FISTULAS/HEMORRHAGE:
-GI perforations occurred in 3% and fistula formation in 1% of patients. Discontinue therapy for perforation or for fistula formation.
-Severe, sometimes fatal, hemorrhage including hemoptysis and GI hemorrhage occurred in 3% of patients. Monitor patients for bleeding. Do not administer this drug to patients with severe hemorrhage.

CONTRAINDICATIONS:
-None

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration Advice:
-Do not open/break/crush/chew tablets or capsules; swallow whole with a full glass of water.
-Do not take a missed dose if it is less than 12 hours before the next dose.
-Do not ingest foods (e.g., grapefruit) or nutritional supplements (e.g., St. John's Wort) that are known to inhibit or induce CYP450 activity while taking this drug.

Storage Requirements:
-Store at 20C to 25C (68F to 77F).
-Keep in the original package to protect from moisture.

Monitoring:
-Cardiovascular: Blood pressure (prior to and regularly during treatment)
-Musculoskeletal: Oral exam (prior to and periodically during treatment due to ONJ risk)
-Renal: Urine protein (regularly during treatment)

Patient Advice:
-This drug may cause side effects such as dizziness that can affect your ability to perform certain activities; avoid driving and activities such as operating machinery until you know how this drug affects you.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide