Drug Name: Cabozantinib (Cometriq®)
About This Drug
Cabozantinib is used to treat cancer. It is given orally (by mouth).
Possible Side Effects
- Changes to the color of your skin or hair
- Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
- Nausea and throwing up (vomiting).
- Decreased appetite (decreased hunger)
- Changes in the way food and drinks taste
- Pain in the abdomen
- 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.
- Changes in your liver function. Your doctor will check your liver function as needed.
- Electrolyte changes. Your blood will be checked for electrolyte changes as needed.
- Bone marrow depression. This is a decrease in the number of white blood cells, and platelets. This may raise your risk of infection, make you tired and raise your risk of bleeding.
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.
- Osteonecrosis of the jaw. This is a breakdown of the jaw bone. This is a bad but rare health problem. Possible symptoms are:
- Pain, swelling, or infection of the gums
- Loose teeth
- Poor healing of the gums
- Numbness or the feeling that your jaw is heavy
- Slow wound healing
- Changes to your kidneys causing protein in urine
- 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.
- Do not substitute the capsules for the tablets.
- Cabozantinib may cause slow wound healing. It should not be given within 28 days of surgery 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 open the capsules.
- 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 12hrs 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).
- Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or ½ teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
- If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
- 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
- Keeping your pain under control is important to your wellbeing. Please tell your doctor or nurse if you are experiencing pain.
- 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.
- Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.
- Talk to your doctor or nurse about precautions you can take to avoid infections and bleeding.
- Tell your cancer doctor if you have any problems with your teeth or jaw before you start this drug. It is important that your dentist knows that you are on this drug. Give your dentist and your cancer doctor each other’s name and phone number so they may call each other if they have any questions.
Food and Drug Interactions
- There are known interactions of cabozantinib with grapefruit. Do not eat grapefruit or drink grapefruit juice while taking this drug.
- 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
- 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
- Rash or itching
- Feeling dizzy or lightheaded
- Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
- Blurred vision or other changes in eyesight
- Confusion or agitation
- Pain in your mouth or throat that makes it hard to eat or drink
- Lasting loss of appetite or rapid weight loss of five pounds in a week
- Fatigue that interferes with your daily activities
- Nausea that stops you from eating or drinking or relieved by prescribed medicine
- Throwing up more than 3 times a day
- Heavy menstrual period that lasts longer than normal
- 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
- No bowel movement for 3 days or if you feel uncomfortable
- Bad abdominal pain, especially in upper right area
- Pain between shoulder blades, or in right shoulder
- Your leg or arm is swollen, red or painful
- 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.
- Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
- Rash that is not relieved by prescribed medicine
- Infertility warning: Sexual problems and reproduction concerns may happen. 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.