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Neratinib (Nerlynx)

About This Drug

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

Possible Side Effects

  • Soreness of the mouth and throat. You may have red areas, white patches, or sores in your mouth that hurt.
  • Nausea and vomiting (throwing up)
  • Pain in your abdomen
  • Diarrhea (loose bowel movements)
  • Constipation (unable to move bowels)
  • Bloating (distention)
  • Indigestion
  • Weight loss
  • Tiredness and weakness
  • Nosebleed
  • Changes in your liver function
  • Changes in your kidney function
  • Urinary tract infection
  • Upper respiratory infection
  • Decreased appetite (decreased hunger)
  • Muscle spasm
  • Back and joint pain
  • Feeling dizzy
  • Changes in your nail color, nail loss and/or brittle nail
  • Rash, dry skin

Note: Each of the side effects above was reported in 5% or greater of patients treated with neratinib alone or in combination with other chemotherapy. Not all possible side effects are included above.

Warnings and Precautions

  • Severe diarrhea which can cause dehydration, low blood pressure and changes in your kidney function
  • Severe changes in your liver function

Important Information

  • Your doctor will recommend medication to decrease your diarrhea. Please call your doctor or nurse if you have diarrhea, or more than 2 bowel movements a day.

How to Take Your Medication

  • Swallow the medicine whole with food. Do not chew, break, split, or crush it.
  • Take this medicine at the same time each day.
  • Missed dose: If you vomit or miss a dose, take your next dose at the regular time, and contact your physician. Do not take 2 doses at the same time and do not double up on the next dose.
  • 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 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 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

  • 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).
  • If you have 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 and/or constipation.
  • 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 stop or lessen these symptoms.
  • 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 bloating, avoid gas-producing foods, such as brussels sprouts, cabbage, cauliflower, carrots, prunes and apricots.
  • Manage tiredness by pacing your activities for the day.
  • Be sure to include periods of rest between energy-draining activities.
  • If you are dizzy, get up slowly after sitting or lying.
  • To help with decreased appetite, eat foods high in calories and protein, such as meat, poultry, fish, dry beans, tofu, eggs, nuts, milk, yogurt, cheese, ice cream, pudding, and nutritional supplements. 
  • Consider using sauces and spices to increase taste. Daily exercise, with your doctor’s approval, may increase your appetite.
  • To help avoid weight loss, consider drinking fluids that contribute calories (whole milk, juice, soft drinks, sweetened beverages, milkshakes, and nutritional supplements) instead of water.
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain.
  • Keeping your nails moisturized may help with brittleness.
  • 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.
  • To help with itching, moisturize your skin several times day.
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain.
  • Avoid sun exposure and apply sunscreen routinely when outdoors.
  • If you have a nosebleed, sit with your head tipped slightly forward. Apply pressure by lightly pinching the bridge of your nose between your thumb and forefinger. Call your doctor if you feel dizzy or faint or if the bleeding doesn’t stop after 10-15 minutes.

Food and Drug Interactions

  • Avoid grapefruit or grapefruit juice while taking this medicine. Grapefruit and grapefruit juice may raise the levels of neratinib in your body. This could make side effects worse.
  • Check with your doctor or pharmacist about all other prescription medicines and over-the-counter medicines and dietary supplements (vitamins, minerals, herbs and others) you are taking before starting this medicine as there are known drug interactions with neratinib. Also, check 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.
  • Medications that treat heartburn and stomach upset affect the way neratinib works. Speak to your doctor, nurse or pharmacist for specific directions if you are taking any medications to treat heartburn or upset stomach.
  • Avoid the use of St. John’s Wort while taking neratinib as this may lower the levels of the drug in your body, which can make it less effective.

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 100.4° F (38° C) or higher
  • Chills
  • Tiredness that interferes with your daily activities
  • Feeling dizzy or lightheaded
  • Nosebleed that doesn’t stop bleeding after 10-15 minutes
  • Wheezing or trouble breathing
  • Coughing up yellow, green, or bloody mucus
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Diarrhea, 4 times in one day or diarrhea with lack of strength or a feeling of being dizzy
  • No bowel movement in 3 days or when you feel uncomfortable
  • Difficulty urinating
  • Pain or burning when you pass urine
  • Decreased urine, or very dark urine
  • Cloudy urine and/or urine that smells bad
  • Feeling like you have to pass urine often, but not much comes out when you do
  • Tender or heavy feeling in your lower abdomen
  • Pain on one side of your back under your ribs. This is where your kidneys are.
  • Pain or uncomfortable bloating in your abdomen that does not go away
  • Muscle spasms that are bothersome
  • Pain that does not go away, or is not relieved by prescribed medicines
  • A new rash or a rash that is not relieved by prescribed medicines
  • Signs of inflammation/infection (redness, swelling, pain) of the tissue around your nails.
  • 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

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 1 month after treatment. Men with female partners of childbearing potential should use effective methods of birth control during your cancer treatment and for 3 months after your cancer treatment. Let your doctor know right away if you think you may be pregnant or may have impregnated your partner.
  • Breastfeeding warning: Women should not breastfeed during treatment and for at least 1 month after treatment because this drug could enter the breast milk and cause harm to a breastfeeding baby.
  • Fertility warning: Human fertility studies have not been done with this drug. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.

Revised March 2020

This patient information was developed by Via Oncology, LLC © 2020. 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.