Drug Interactions between cabozantinib and nintedanib

Cabozantinib should be taken on an empty stomach, one hour before or two hours after a meal. Do not consume grapefruit, grapefruit juice, or any supplements that contain grapefruit extract during treatment with cabozantinib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of cabozantinib. You may be more likely to experience side effects such as nausea; vomiting; diarrhea; loss of appetite; weight loss; mouth sores; abdominal pain; skin rash (primarily on the palms of the hands and soles of the feet); delayed wound healing; high blood pressure; and impaired bone marrow function resulting in low numbers of different types of blood cells, which can increase the risk of bleeding problems and infections. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Grapefruit juice and Seville orange juice can increase the blood levels of nintedanib. This may increase the risk and/or severity of side effects such as liver problems, diarrhea, nausea, vomiting, stomach or intestinal wall perforation, bleeding, and cardiovascular problems such as heart attack, chest pain, or stroke. It is best to avoid or minimize the consumption of Seville oranges, Seville orange juice, grapefruit, and grapefruit juice during treatment. You should take nintedanib with food and swallow it whole with water. Taking nintedanib with food may help with absorption of the medication and reduce gastrointestinal side effects. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

The recommended maximum number of medicines in the 'multikinase inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'multikinase inhibitors' category:

• cabozantinib
• nintedanib

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.