Drug name: Cabozantinib (Cabometyx®)
About This Drug
Cabozantinib is used to treat cancer. It is given orally.
Possible Side Effects
- Nausea and throwing up (vomiting).
- Decreased appetite (decreased hunger)
- Changes in the way food and drinks taste
- Constipation (not able to move bowels)
- Loose bowel movements (diarrhea)
- Weight loss
- Hand-and-foot syndrome. The palms of your hands or soles of your feet may tingle, become numb, painful, swollen, or red.
- High blood pressure. Your doctor will check your blood pressure as needed.
Note: Each of the side effects above was reported in 25% or greater of patients treated with cabozantinib. Not all possible side effects are included above.
Warnings and Precautions
- Abnormal bleeding – symptoms may be coughing up blood, throwing up blood (may look like coffee grounds), red or black tarry bowel movements, abnormally heavy menstrual flow, nosebleeds or any other unusual bleeding.
- Abnormal opening in stomach, intestine or esophagus (fistula). Symptoms of a fistula may be: severe abdominal pain or difficulty swallowing.
- Blood clots and events such as stroke and heart attack. A blood clot in your leg may cause your leg to swell, appear red and warm, and/or cause pain. A blood clot in your lungs may cause trouble breathing, pain when breathing, and/or chest pain.
- Slow wound healing
- Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel extreme tiredness, agitation, confusion, hallucinations (see or hear things that are not there), trouble understanding or speaking, loss of control of your bowels or bladder, eyesight changes, numbness or lack of strength to your arms, legs, face, or body, and coma. If you start to have any of these symptoms let your doctor know right away.
- Severe high blood pressure. Your doctor will check your blood pressure as needed.
- Severe loose bowel movements (diarrhea).
- Severe hand-and-foot syndrome.
- Do not substitute the tablets for the capsules.
- Cabozantinib may cause slow wound healing. It should not be given within 28 days of surgery, dental procedures or any test or procedure that needs conscious sedation. If you must have emergency surgery or have an accident that results in a wound, tell the doctor that you are on cabozantinib. Call your cancer doctor as soon as possible for further orders.
How to Take Your Medication
- Swallow the medicine whole with a full glass of water (8 ounces). Do not crush tablets.
- Take this drug by mouth without food, at least 2 hour before you eat or 1 hour after you eat.
- Missed dose: If you miss a dose, and it is less than 12 hrs until your next dose, then skip the missed dose and go back to your normal schedule. If you miss a dose, and it is more than 12 hrs until your next dose, take it as soon as you think about it. Do not take 2 doses at the same time or extra doses.
- Handling: Wash your hands after handling your medicine; your caretakers should not handle your medicine with bare hands and should wear latex gloves.
- Storage: Store this medicine in the original container at room temperature
Treating Side Effects
- Drink plenty of fluids (a minimum of eight glasses per day is recommended).
- If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
- Ask your doctor or nurse about medicines that are available to help stop or lessen constipation, diarrhea and/or nausea.
- If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories
- To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help or stop lessen these symptoms.
- If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping. Ask your nurse or doctor about medicine that can lessen or stop your diarrhea.
- Manage tiredness by pacing your activities for the day. Be sure to include periods of rest between energy-draining activities
- If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
Food and Drug Interactions
- There are known interactions of cabozantinib with grapefruit. Do not eat grapefruit or drink grapefruit juice while taking this drug. This could make side effects worse.
- Check with your doctor or pharmacist about all other prescription medicines and dietary supplements you are taking before starting this medicine as there are a lot of known drug interactions with cabozantinib. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplement to make sure that there are no interactions.
- Check with your doctor before starting any other herbal medication, as there may be serious drug interactions.
- Talk with your doctor about taking St. John’s Wort, garlic, ginseng, and ginkgo. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.
When to Call the Doctor
Call your doctor or nurse if you have any of the following symptoms and/or any new or unusual symptoms:
- Fever of 100.5 F (38 C) or higher
- Blurred vision or other changes in eyesight
- Easy bleeding or bruising
- Blood in your urine, vomit (bright red or coffee-ground) and/or stools ( bright red, or black/tarry)
- Coughing up blood
- Wheezing or trouble breathing
- Pain in your chest
- Rash or itching
- Feeling dizzy or lightheaded
- Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
- Confusion or agitation
- Nausea that stops you from eating or drinking, not relieved by prescribed medicine
- Throwing up more than 3 times a day
- Lasting loss of appetite or rapid weight loss of five pounds in a week
- Fatigue that interferes with your daily activities
- Headache that does not go away
- Painful, red, or swollen areas on your hands or feet.
- No bowel movement for 3 days or you feel uncomfortable
- Extreme weakness that interferes with normal activities
- Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
- Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause. If you have any of these symptoms for 2 minutes, call 911.
- Your leg or arm is swollen, red, warm and/or painful
- Signs of possible liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
- If you think you may be pregnant or have impregnated your partner
- Infertility warning: In men and women both, this drug may affect your ability to have children. This cannot be determined before your therapy. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking. Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
- Pregnancy warning: This drug can have harmful effects on the unborn baby. It is recommended that effective methods of birth control should be used by women who could become pregnant and men with partners who could become pregnant during cancer treatment and for at least 4 months after treatment.
- Breast feeding warning: Women should not breast feed during treatment and for 4 month after treatment because this drug could enter the breast milk and cause harm to a breast feeding baby.