Lenvatinib

Other Names: Lenvima®

About This Drug:

Lenvatinib is used to treat cancer. It is given orally (by mouth). 

Possible Side Effects 

  • Changes in your thyroid function
  • Voice disorder
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • Nausea and vomiting (throwing up)
  • Decreased appetite (decreased hunger)
  • Diarrhea (loose bowel movements)
  • Pain in your abdomen
  • Abnormal bleeding
  • Tiredness
  • Swelling of your legs, ankles and/or feet
  • Weight loss
  • Increased protein in your urine
  • Bone, joint and muscle pain
  • Headache
  • Cough, trouble breathing
  • Hand-and-foot syndrome. The palms of your hands or soles of your feet may tingle, become numb, painful, swollen, or red. 
  • Rash
  • High blood pressure

Note: Each of the side effects above was reported in 30% or greater of patients treated with lenvatinib. Not all possible side effects are included above. 

Warnings and Precautions

  • Severe high blood pressure
  • Congestive heart failure (your heart has less ability to pump blood properly) and other changes in your heart function which can be life-threatening. 
  • Abnormal heartbeat/EKG (electrocardiogram) 
  • 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.
  • Changes in your liver function, which can cause liver failure and be life-threatening
  • Severe diarrhea
  • Risk of gastrointestinal perforation, which is a hole in your stomach, small, and/or large intestine
  • Abnormal opening in stomach, intestine or esophagus (fistula). Symptoms of a fistula may be: severe abdominal pain or difficulty swallowing 
  • Changes in your thyroid function
  • Changes in your kidney function, which can cause renal failure and be life-threatening 
  • 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), have 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, seizures or coma. If you start to have any of these symptoms let your doctor know right away. 
  • Abnormal bleeding which can be life-threatening – 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.
  • Severe low calcium, which can be life-threatening. You may experience numbness or tingling around your mouth or in your hands or feet. Other symptoms of low calcium are muscle stiffness, twitching, spasms, or cramps.
  • Slow wound healing

Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team.

Important Information

  • Lenvatinib may cause slow wound healing. If you must have emergency surgery or have an accident that results in a wound, tell the doctor that you are on lenvatinib. 

How to Take Your Medication

  • Swallow the medicine whole with or without food, at the same time each day. 
  • If you have trouble swallowing, you can dissolve the capsules in 1 tablespoon of water or apple juice. Put the capsules whole in the liquid and let stand for at least 10 minutes. Stir for at least 3 minutes and drink the mixture. After drinking, add 1 tablespoon of water or apple juice to the glass, stir and drink the liquid right away.
  • Missed dose: If you miss a dose, take it as soon as you think about it. If it is within 12 hours of your next dose, then skip the missed dose. Do not take 2 doses at the same time and do not double up on the next dose. Instead, continue with your regular dosing schedule and contact your physician. 
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time.
  • Storage: Store this medicine in the original container at room temperature.
  • Disposal of unused medicine: Do not flush any expired and/or unused medicine down the toilet or drain unless you are specifically instructed to do so on the medication label. Some facilities have unused medication take-back programs and/or other options. If you do not have a take-back program in your area, then please discuss with your nurse or your doctor how to dispose of unused medicine.

Treating Side Effects

  • Manage tiredness by pacing your activities for the day.
  • Be sure to include periods of rest between energy-draining activities. 
  • 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 of water in the body from losing too much fluid).
  • 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.
  • 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 1/2 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.
  • To help with weight loss, drink fluids that contribute calories (whole milk, juice, soft drinks, sweetened beverages, milkshakes, and nutritional supplements) instead of water. 
  • Include a source of protein at every meal and snack, such as meat, poultry, fish, dry beans, tofu, eggs, nuts, milk, yogurt, cheese, ice cream, pudding, and nutritional supplements. 
  • To help with decreased appetite, eat high calorie food such as pudding, ice cream, yogurt and milkshakes. • Keeping your pain under control is important to your well-being. 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.

Food and Drug Interactions

  • There are no known interactions of lenvatinib with food.
  • This drug may interact with other medicines. Tell your doctor and pharmacist about all the prescription and over-the-counter medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. Also, check in with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions. 
  • 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. Do 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 these symptoms and/or any new or unusual symptoms: 

  • Fever of 100.5 F (38 C) or higher 
  • Chills 
  • A headache that does not go away 
  • You cough up yellow, green, or bloody mucus 
  • Coughing up blood
  • Wheezing or trouble breathing 
  • 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.
  • Confusion and/or agitation 
  • Seizures
  • Hallucinations 
  • Trouble understanding or speaking
  • Blurry vision or changes in your eyesight 
  • Numbness or lack of strength to your arms, legs, face, or body 
  • Pain in your chest 
  • Feeling that your heart is beating in a fast or not normal way (palpitations) 
  • Diarrhea 4 times in a day or loose bowel movements with lack of strength or a feeling of being dizzy 
  • Blood in your stool 
  • Pain in your abdomen that does not go away 
  • Difficulty swallowing
  • Nausea that stops you from eating or drinking or relieved by prescribed medicine 
  • Throwing up more than 3 times a day 
  • Signs of low calcium: numbness or tingling around your mouth or in your hands or feet, muscle stiffness, twitching, spasms, or cramps. 
  • Decreased urine
  • Blood in your urine, vomit (bright red or coffee-ground) and/or stools (bright red, or black/tarry) 
  • Fatigue that interferes with your daily activities
  • Unexplained weight gain 
  • A new rash or a rash that is not relieved by prescribed medicines
  • Your leg or arm is swollen, red, warm and/or painful
  • Pain that does not go away, or is not relieved by prescribed medicines 
  • 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.
  • Weight gain of 5 pounds in one week (fluid retention)
  • Swelling of your legs, ankles, and/or feet
  • 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. 
  • If you think you may be pregnant. 

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of childbearing potential should use effective methods of birth control during your cancer treatment and for at least 30 days after treatment. Let your doctor know right away if you think you may be pregnant.
  • Breastfeeding warning: Women should not breastfeed during treatment and for at least 1 week after treatment because this drug could enter the breast milk and cause harm to a breastfeeding baby.
  • Fertility warning: In men and women both, this drug may affect your ability to have children in the future. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.

Revised August 2018

This patient information was developed by Via Oncology, LLC © 2018. This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. CLIENT acknowledges that the Via Pathways and Via Portal are information management tools only, and that Via Oncology, LLC has not represented the Via Pathways or Via Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The clinical information contained in the Via Pathways and Via Portal are intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.