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Cabozantinib Dosage

Medically reviewed by Drugs.com. Last updated on Mar 30, 2020.

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

Capsules: 140 mg orally once a day until patient no longer experiences clinical benefit or unacceptable toxicity occurs

Use: For progressive metastatic medullary thyroid cancer (MTC)

Usual Adult Dose for Renal Cell Carcinoma

Tablets: 60 mg orally once a day until patient no longer experiences clinical benefit or unacceptable toxicity occurs

Use: For patients with advanced renal cell carcinoma (RCC)

Usual Adult Dose for Hepatocellular Carcinoma

Tablets: 60 mg orally once a day until patient no longer experiences clinical benefit or unacceptable toxicity occurs

Use: For patients with hepatocellular carcinoma (HCC) who have been previously
treated with sorafenib

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

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:
-Tablets and capsules are not interchangeable.
-This drug should be taken on an empty stomach at least 2 hours before or 1 hour after a meal.
-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 therapy)
-Musculoskeletal: Oral exam (prior to and periodically during therapy due to ONJ risk)
-Renal: Urine protein (regularly during therapy)

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.

Frequently Asked Questions