Oral Oncology

Note

[G] indicates that a generic version of this product is available.
Oral Oncology Drugs not provided by Magellan Rx Specialty Pharmacy are not listed.

Oral Therapies Used for Cancer Treatments

Afinitor®/Zortress® (everolimus)

Description

Everolimus is commonly used to treat breast cancer, pancreatic tumors, kidney cell cancer, and certain brain cancers.

Dosing and Administration

The recommended dosage of everolimus may be based on body surface area (BSA) depending on the cancer type and other treatments used in combination. It is usually taken once per day with or without food.

Drug Interactions

Everolimus should not be used together with strong CYP3A4/P-gP inducers (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) or strong and moderate CYP3A4/P-gP inhibitors (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, voriconazole). If concomitant use is unavoidable, dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Stomatitis, infections, rash, fatigue, diarrhea, edema, abdominal pain, nausea, fever, asthenia, cough, headache and decreased appetite.

Alkeran® (melphalan)

Description

Melphalan is an alkylating agent that treats multiple myeloma and ovarian cancer.

Dosing and Administration

The recommended dosage of melphalan depends on the specific type of cancer and other treatments used in combination. It is generally taken for five days and then repeated every four to five weeks.

Drug Interactions

There are no known drug/drug interactions with oral melphalan to date, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood counts, diarrhea, nausea, mouth sores, skin rash, and hair loss.

Arimidex® (anastrozole) [G]

Description

Anastrozole is an aromatase Inhibitor indicated to treat breast cancer. Women of premenopausal endocrine status, including pregnant women, should not use this drug.

Dosing and Administration

The recommended dosage of anastrozole is one tablet once daily.

Drug Interactions

Anastrozole should not be used together with tamoxifen. Concomitant use with other estrogen-containing products may make anastrozole less effective. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hot flashes, tiredness, nausea, depression, trouble sleeping and pain.

Aromasin® (exemestane) [G]

Description

Exemestane is used to treat breast cancer. Exemestane should not be used in pregnant women due to fetal toxicity.

Dosing and Administration

The recommended dosage of exemestane is one tablet once daily after a meal.

Drug Interactions

Concomitant use of exemestane with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, St. John’s wort) may reduce the effectiveness of exemestane. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Nausea, tiredness, joint pain, headache, insomnia, hot flushes, and increased sweating.

Cometriq® (cabozantinib)

Description

Cabozentinib is kinase inhibitor used to treat thyroid cancer. Cabozentinib is associated with risk for developing stomach ulcers and bleeds. Monitor carefully for any signs of dark and tarry stool.

Dosing and Administration

The recommended dosage of cabozentinib is one tablet once daily. Do not eat food for at least 2 hours before and at least 1hour after taking cabozentinib.

Drug Interactions

Concomitant use of cabozentinib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, voriconazole) may cause severe toxicities, and use with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, St. John’s wort) may reduce the effectiveness of cabozentinib. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Diarrhea, stomach discomfort, decreased appetite, nausea, tiredness, hair color changes, constipation, liver toxicities, and decreased blood count.

Cyclophosphamide (available as generic only)

Description

Cyclophosphamide is an alkylating agent used to treat various cancers. The most common ones include: acute myeloid leukemia (AML), chronic lymphoid leukemia (CLL), breast cancer, non-Hodgkin’s disease, and Mental Cell Lymphoma.

Dosing and Administration

The recommended dosage of cyclophosphamide is based on body weight depending on the cancer type, other treatments used in combination, and tolerability. It can be taken as a daily therapy or may be divided in doses over four to five days.

Drug Interactions

Alcohol may increase cyclophosphamide-induced vomiting and nausea, and decrease the effectiveness of this drug. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Nausea, vomiting, hair loss and decreased blood counts.

Emcyt® (estramustine)

Description

Estramustine is used to treat prostate cancers.

Dosing and Administration

The recommended dosage of estramustine is based on body weight. It can be taken 3 or 4 divided doses daily.

Drug Interactions

There are no known drug/drug interactions with estramustine, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Nausea, diarrhea, GI discomfort, breast tenderness, edema, leg cramps, shortness of breath.

Erivedge TM (vismodegib)

Description

Vismodegib is indicated to treat metastatic basal cell skin cancer. Vismodegib should not be used in pregnant women due to fetal toxicity. Contraception is strongly advised to prevent pregnancy while on therapy.

Dosing and Administration

The recommended dosage of vismodegib is one tablet once daily.

Drug Interactions

There are no significant drug/drug interactions with vismodegib, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Muscle spasms, hair loss, altered taste, weight loss, tiredness, nausea, diarrhea, decreased appetite, constipation and vomiting.

Etoposide (available as generic only)

Description

Etoposide is indicated to treat various types of cancer including testicular cancer and lung cancer. Etoposide should not be used in pregnant women due to fetal toxicity.

Dosing and Administration

The recommended dosage of etoposide is based on body surface area (BSA). It is typically given in divided doses twice daily.

Drug Interactions

Dose adjustments may be necessary when etoposide is used with cyclosporine A. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

GI discomfort, liver toxicities, and increase in blood pressure.

Fareston® (toremifene)

Description

Toremifene is indicated to treat breast cancer.

Dosing and Administration

The recommended dosage of toremifene is one tablet once daily.

Drug Interactions

Concomitant use of toremifene with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, voriconazole) may cause severe toxicities, and use with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, St. John’s wort) may reduce the effectiveness of toremifene. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hot flashes, sweating, nausea and vaginal discharge.

Flutamide (available as generic only)

Description

Flutamide is a luteinizing hormone-releasing hormone (LHRH)-agonist indicated to treat prostate cancer.

Dosing and Administration

The recommended dosage of flutamide is 2 capsules three times daily approximately 8 hours apart.

Drug Interactions

Concomitant use of flutamide with warfarin may increase your risk of bleeding and should be carefully monitored. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hot flashes, diarrhea, nausea, and skin rash.

FemaraTM (letrozole) [G]

Description

Letrozole is an aromatase Inhibitor used to treat breast cancer. Women of premenopausal endocrine status, including pregnant women, should not use this drug.

Dosing and Administration

The recommended dosage of letrozole is one tablet once daily.

Drug Interactions

There are no significant drug/drug interactions with letrozole, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hot flashes, nausea, arthritis, muscle pain and increased cholesterol.

Gleevec® (imatinib)

Description

Imatinib is a kinase inhibitor that treats various types of cancers. The mostly common ones include Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML), Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL), and myelodysplastic/myeloproliferative diseases (MDS/MPD).

Dosing and Administration

The recommended dosage of imatinib is one tablet once daily.

Drug Interactions

Concomitant use of imatinib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, voriconazole)may result in increased toxicity, and concomitant use with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, St. John’s wort) may result in decreased effectiveness of imatinib. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Edema, nausea, vomiting, muscle cramps, musculoskeletal pain, diarrhea, rash, fatigue and abdominal pain

Special Monitoring Requirements

For patients with Ph+ CML, PCR tests are recommended every 3 months for the first 3 years following complete cytogenetic response, then every 6 months thereafter.

GleostineTM (lomustine)

Description

Lomustine is an alkylating agent used to treat brain tumors and Hodgkin’s disease. Lomustine should not be used in pregnant women due to fetal toxicity.

Dosing and Administration

The recommended dosage of lomustine is based on body surface area (BSA) depending on the cancer type, other treatments used in combination, and tolerability. It is usually taken as a single dose once every 6 weeks.

Drug Interactions

There are no known drug/drug interactions with oral lomustine to date, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood counts, nausea and vomiting.

Special Monitoring Requirements

Due to delayed bone marrow suppression, blood counts should be monitored weekly for at least 6 weeks after a dose.

Hexalen® (altretamine)

Description

Altretamine is a palliative treatment used for patients with ovarian cancer.

Dosing and Administration

The recommended dosage of altretamine is based on body surface area (BSA). It is usually taken 4 times daily on designated days in a 28 day cycle.

Drug Interactions

Concomitant use of altretamine with a MAOI (e.g., selegiline, phenelzine, and isocarboxazil) may put your at high risk for orthostatic hypotension causing you to fall. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood counts, nausea, vomiting, dizziness, and GI discomfort.

Hycamtin® (topotecan)

Description

Topotecan is used to treat lung cancer.

Dosing and Administration

The recommended dosage of topotecan is based on body surface area (BSA). It is usually taken daily on designated days in a 28 day cycle.

Drug Interactions

Concomitant use of topotecan with a P-gp inhibitor (e.g., cyclosporine, ketoconazole, quinidine, tacrolimus, and verapamil) or a BCRP inhibitor (e.g., sulfasalazine) should be avoided. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood counts, nausea, diarrhea, vomiting, alopecia, and tiredness.

Hydrea®/Droxia® (hydroxyurea) [G]

Description

Hydroxyurea is an antimetabolite used to treat various types of cancer including chronic myeloid leukemia (CML) and head and neck cancer.

Dosing and Administration

The recommended dosage of hydroxyurea is based on the types of cancer, response to treatment, and patient risk factors.

Drug Interactions

There are no significant drug/drug interactions with hydroxyurea, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood counts, GI discomfort, and anorexia.

Leukeran® (chlorambucil)

Description

Chlorambucil is an alkylating agent that treats various lymphomas and leukemia, including, chronic lymphatic leukemia (CLL) and Hodgkin’s disease.

Dosing and Administration

The recommended dosage of chlorambucil is based on body weight and tolerability. It is generally taken daily for 3-6 weeks per cycle depending on the type of cancer.

Drug Interactions

There are no known drug/drug interactions with chlorambucil, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Tremors, nausea, vomiting, diarrhea, mouth sores and decreased blood counts.

Lysodren® (mitotane)

Description

Mitotane is indicated to treat adrenal cortical carcinoma. Mitotane should not be used in pregnant women due to fetal toxicity. Contraception is strongly advised to prevent pregnancy while on therapy.

Dosing and Administration

The recommended dosage of mitotane is based on disease severity, blood concentration, and tolerability. It is generally taken in 3-4 divided doses daily.

Drug Interactions

Concomitant use of mitotane with warfarin may increase your risk of bleeding and should be carefully monitored. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Anorexia, nausea, vomiting, diarrhea, depression, dizziness, and rash.

Mekinist® (trametinib)

Description

Trametinib is a kinase inhibitor that is indicated to treat melanoma with BRAF V600E or V600K mutations. It may be used as a single agent or in combination with Tafinlar® (dabrafenib). Trametinib should not be used in pregnant women due to fetal toxicity.

Dosing and Administration

The recommended dosage of trametinib is once daily taken at least 1 hour before or at least 2 hours after a meal.

Drug Interactions

There are no known drug/drug interactions with trametinib, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Rash, diarrhea, and lymphedema.

Myleran® (busulfan)

Description

Busulfan is an alkylating agent used to treat chronic myelogenous leukemia (CML).

Dosing and Administration

The recommended dosage of busulfan may be based on body surface area (BSA). It is generally taken once daily.

Drug Interactions

Concomitant use with itraconazole may result in increased toxicity. Dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Heart conditions, seizures, discoloration of the skin, severely decreased blood counts and liver disease.

Nilandron® (nilutamide) [G]

Description

Nilutamide is an LHRH agonist indicated to treat prostate cancer.

Dosing and Administration

The recommended dosage of nilutamide is 1-2 tablets once daily.

Drug Interactions

Concomitant use of nilutamide with warfarin may increase your risk of bleeding and should be carefully monitored. Concomitant use of nilutamide with theophylline and phenytoin should also be carefully monitored. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hot flashes, nausea, constipation, impaired adaption to darkness, and skin rash.

Pomalyst® (pomalidomide)

Description

Pomalidomide is an immunomodulator used to treat multiple myeloma. Pomalidomide should not be used in pregnant women due to fetal toxicity, and two or more forms of reliable methods of contraception are strongly advised to prevent pregnancy while on therapy.

Dosing and Administration

The recommended dosage of pomalidomide is one tablet daily on days 1-21 of a 28-day cycle.

Drug Interactions

Concomitant use of pomalidomide with a CYP1A2 inhibitor (e.g., fluvoxamine) may result in increased toxicity. Dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Blood clots, dizziness, tiredness, muscle weakness, nausea, constipation, diarrhea, decreased blood cell counts, and shortness of breath.

Promacta® (eltrombopag)

Description

Eltrombopag is indicated for the treatment of many hematologic disorders including chronic immune (idiopathic) thrombocytopenia (ITP) and aplastic anemia.

Dosing and Administration

The recommended dosage of eltrombopag is one tablet once daily.

Drug Interactions

Eltrombopag should be given least 2 hours before or 4 hours after any medications or products containing polyvalent cations such as antacids, calcium-rich foods, and mineral supplements. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Nausea, diarrhea, upper respiratory tract infection, vomiting, muscle pain, and urinary tract infection.

Purinethol®/Purixan® (mercaptopurine) [G]

Description

Mercaptopurine is an antimetabolite that treats acute lymphatic leukemia. Mercaptopurine is commonly used in combination with other anti-cancer agents.

Dosing and Administration

The recommended dosage of mercaptopurine is based on body weight and is generally taken as a single dose once daily.

Drug Interactions

Concomitant use with allopurinol may result in increased toxicity. Dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Skin rashes, nausea and vomiting, discoloration of the skin, severely decreased blood counts and liver disease.

Revlimid® (lenalidomide)

Description

Lenalidomide is an immunomodulator used to treat various types of cancers. The mostly common ones include multiple myeloma, myelodysplastic syndrome, and mantle cell lymphoma. Lenalidomide should not be used in pregnant women due to fetal toxicity, and two or more forms of reliable methods of contraception are strongly advised to prevent pregnancy while on therapy.

Dosing and Administration

The recommended dosage of lenalidomide is one tablet daily, and the treatment duration depends on the specific type of cancer.

Drug Interactions

Concomitant use of lenalidomide with digoxin may result in increased toxicity. Dose adjustments may be necessary. Concomitant use of lenalidomide with any estrogen-containing products may also increase your risk for developing blood clots. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Blood clots, tiredness, low white blood cell counts, constipation, diarrhea, muscle cramps, low red blood cell counts, fever, swelling, nausea, back pain, upper respiratory tract infection, shortness of breath, dizziness, tremor and rash.

Sprycel® (dasatinib)

Description

Dasatinib is a kinase inhibitor that treats Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) and chronic myeloid leukemia (Ph+ CML).

Dosing and Administration

The recommended dosage of dasatinib is one tablet once daily, and the treatment duration depends on the specific type of cancer.

Drug Interactions

Concomitant use of dasatinib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and, voriconazole) may result in increased toxicity, and concomitant use with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) may result in decreased effectiveness of dasatinib.Concomitant use of dasatinib with an antacid (e.g., famotidine, omeprazole, and pantoprazole) should be separated by at least 2 hours. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood cell counts, fluid retention, diarrhea, tiredness, nausea, rash, shortness of breath, headache, and bleeding risk.

Special Monitoring Requirements

For patients with Ph+ CML, PCR tests are recommended every 3 months for the first 3 years following complete cytogenetic response, then every 6 months thereafter.

Sutent® (sunitinib)

Description

Sunitinib is a kinase inhibitor that treats various types of cancers. The mostly common ones include gastrointestinal stromal tumors, kidney cell carcinomas and pancreatic neuroendocrine tumors.

Dosing and Administration

The recommended dosage of dasatinib is one tablet once daily.

Drug Interactions

Concomitant use of sunitinib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and voriconazole) may result in increased toxicity, and concomitant use of sunitinib with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) may result in decreased effectiveness of dasatinib. Dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Liver toxicity, stomach pain, nausea, diarrhea, muscle and back pain, pain in the legs and arms, weight loss, tiredness, headache, fever, dizziness, constipation, cough, altered taste, mouth sores, dry skin, shortness of breath , hair color changes, hand-foot syndrome, high blood pressure, fluid retention, rash skin discoloration.

Tabloid® (thioguanine)

Description

Thioguanine is a potent drug used to treat acute nonlymphocytic leukemia.

Dosing and Administration

The recommended dosage of thioguanine is based on disease severity, concomitant therapy, and tolerability. It is given as a single dose once daily.

Drug Interactions

There are no significant drug/drug interactions with thioguanine, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Loss of appetite, nausea, stomatitis, vomiting.

Tafinlar® (dabrafenib)

Description

Dabrafenib is a kinase inhibitor that is indicated to treat melanoma with BRAF V600E or V600K mutations. It may be used as a single agent or in combination with Mekinist® (trametinib).

Dosing and Administration

The recommended dosage of dabrafenib is twice daily taken at least 1 hour before or at least 2 hours after a meal.

Drug Interactions

Concomitant use of dabrafenib with a CYP3A4 or CYP2C8 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, voriconazole, and gemfibrozil) or with a CYP3A4 or CYP2C8 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) should be avoided. Dose adjustments may be necessary if concomitant use is unavoidable. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Vision changes, high blood sugar, skin thickening and other skin conditions, headache, fever, muscle aches, hair loss, and a rash on your palms and feet.

Tamoxifen (available as generic only)

Description

Tamoxifen is used to treat breast cancer. In high risk populations, it can also be used to prevent breast cancer.

Dosing and Administration

The recommended dosage of tamoxifen is one tablet once daily.

Drug Interactions

Concomitant use of tamoxifen with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and, voriconazole) or any drugs that may cause QT prolongation (e.g., quetipine, aripiprazole, pimavanserin, ondansetron, escitalopram, etc.) should be avoided. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hot flashes, vaginal discharge, irregular periods (in women pre-menopausal).

Tarceva® (erlotinib)

Description

Erlotinib is a kinase inhibitor that treats advanced pancreatic cancer and EGFR+ non-small cell lung cancer.

Dosing and Administration

The recommended dosage of erlotinib is one tablet once daily on an empty stomach.

Drug Interactions

Concomitant use of erlotinib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and, voriconazole) may result in increased toxicity, and concomitant use of erlotinib with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) may result in decreased effectiveness of dasatinib. Concomitant use of dasatinib with an antacid (e.g., famotidine, omeprazole, and pantoprazole) should be separated by at least 2 hours. Cigarette smoking may also decrease the effectiveness of erlotinib.Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased appetite, muscle pain and fatigue, cough, diarrhea, and rash.

Targretin® (bexarotene)

Description

Bexarotene is a retinoid-type drug that treats skin problems arising from cutaneous T-cell lymphoma. Bexarotene should not be used in pregnant women due to fetal toxicity.

Dosing and Administration

The recommended dosage of bexarotene is based on body surface area (BSA) and usually taken as a single dose once daily.

Drug Interactions

There are no known drug/drug interactions with bexarotene, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Increased cholesterol, decreased blood counts, diarrhea, tiredness, headache, liver toxicity, rash, pancreatitis, nausea, anemia, allergic reaction, muscle spasm, pneumonia, and confusion.

Tasigna® (nilotinib)

Description

Nilotinib is a kinase inhibitor that treats Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML).

Dosing and Administration

The recommended dosage of nilotinib is one tablet twice daily approximately 12 hours apart. Avoid food for at least 2 hours before the dose is taken and avoid food for at least 1 hour after the dose is taken.

Drug Interactions

Concomitant use of nilotinib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and, voriconazole) may result in increased toxicity, and concomitant use with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) may result in decreased effectiveness of nilotinib. Nilotinib may also alter the effectiveness and toxicity level of other drugs. Therefore, be sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Decreased blood counts, nausea, rash, headache, fatigue, pruritus, vomiting, diarrhea, cough, constipation, arthralgia, nasopharyngitis, pyrexia, and night sweats.

Special Monitoring Requirements

For patients with Ph+ CML, PCR tests are recommended every 3 months for the first 3 years following complete cytogenetic response, then every 6 months thereafter.

Temodar® (temozolomide):

Description

Temozolomide is an alkylating agent used to treat various cancers. The most common ones include: glioblastoma multiforme and anaplastic astrocytoma.

Dosing and Administration

The recommended dosage of temozolomide is based on body weight depending on the cancer type and tolerability. It can be taken as a daily therapy or may be divided in doses over five days during a 28-day cycle.

Drug Interactions

Valproic acid may increase toxicities associated with temozolomide. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Nausea, vomiting, hair loss, weight loss, tiredness, constipation and headache.

Thalomid® (thalidomide)

Description

Thalidomide is an immunomodulator used to treat multiple myeloma. Thalidomide should not be used in pregnant women due to fetal toxicity, and two or more forms of reliable methods of contraception are strongly advised to prevent pregnancy while on therapy.

Dosing and Administration

The recommended dosage of thalidomide is one tablet daily on designated days during a 28-day cycle.

Drug Interactions

Thalidomide should be used with caution is used in combination with any drugs that have sedative or hypnotic properties that may slow the heart rate and/or cause peripheral neuropathy. Concomitant use ofthalidomide with any estrogen-containing products may also increase your risk for developing blood clots. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Confusion, constipation, shortness of breath, fluid retention, decreased calcium levels, sensory neuropathy, thrombosis or embolism, and rash.

Trexall® (methotrexate) [G]

Description

Methotrexate is indicated to treat many types of cancers, including breast cancer, head and neck cancer, lung cancer, and non-Hodgkin’s lymphoma. It can also be used to treat other autoimmune conditions, including rheumatoid arthritis, psoriasis, and lupus.

Dosing and Administration

The recommended dosage of methotrexate is based on body surface area (BSA) and the specific type of cancer.

Drug Interactions

Methotrexate should not be used together with NSAIDs (e.g., ibuprofen, naproxen, and aspirin). Concomitant use with oral antibiotics may decrease the effectiveness of methotrexate. If concomitant use is unavoidable, dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Photosensitivity, rash, nausea, vomiting, GI discomfort, and decreased blood counts.

Tykerb® (lapatinib)

Description

Lapatinib is a kinase inhibitor used in combination with capecitabine or letrozole to treat advanced breast cancer.

Dosing and Administration

The recommended dosage of lapatinib is based on body surface area (BSA). It is generally taken once daily on designated days during a 21-day cycle.

Drug Interactions

Lapatinib should not be used together with strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) or strong CYP3A4 inhibitors (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, voriconazole). If concomitant use is unavoidable, dose adjustments may be necessary. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Diarrhea, hand-foot rash, nausea, vomiting and fatigue.

Votrient® (pazopanib)

Description

Pazopanib is a kinase inhibitor that treats kidney cell carcinoma and types of soft-tissue sarcoma.

Dosing and Administration

The recommended dosage of pazopanib is one tablet once daily without food.

Drug Interactions

Concomitant use of pazopanib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and voriconazole) may result in increased toxicity, and concomitant use of sunitinib with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) may result in decreased effectiveness of dasatinib. Dose adjustments may be necessary. Pazopanib may also alter the effectiveness and toxicity level of other drugs. Therefore, be sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Diarrhea, hypertension, hair color changes (depigmentation), nausea, anorexia, and vomiting.

Xeloda® (capecitabine) [G]

Description

Capecitabine is a nucleoside metabolic inhibitor used to treat various types of cancers including colon cancer, colorectal cancer, and breast cancer.

Dosing and Administration

The recommended dosage of capecitabine is individualized based on body surface area (BSA), type of cancer, tolerability, and combination with other drugs. It is typically given twice daily without food.

Drug Interactions

Concomitant use of capecitabine with an anticoagulant (e.g., warfarin), phenytoin, and leucovorin should be carefully monitored for any signs of toxicity. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Diarrhea, nausea, mouth sores and inflammation, tiredness, muscle weakness, abdominal pain and vomiting.

Zelboraf® (vemurafenib)

Description

Vemurafenib is a kinase inhibitor that is indicated to treat melanoma with BRAF V600E mutations.

Dosing and Administration

The recommended dosage of vemurafenib is one dose twice daily at least 12 hours apart.

Drug Interactions

Concomitant use of vemurafenib with a CYP3A4 inhibitor (e.g., atazanavir/ritonavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, saquinavir, telithromycin, and voriconazole) or with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) should be avoided. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Tiredness, diarrhea, joint pain, sunburn or sun sensitivity, rash, nausea, hair loss, and itching.

Zolinza® (vorinostat)

Description

Vorinostat is indicated to treat cutaneous T-cell lymphoma.

Dosing and Administration

The recommended dosage of vorinostat is one tablet once daily with food.

Drug Interactions

Concomitant use of vorinostat with warfarin may result in prolongation of prothrombin time and INR, and should be monitored carefully. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Diarrhea, tiredness, nausea, blood clotting problems, weight loss, altered taste, chills, decreased blood counts and pulmonary embolism.

Special Monitoring Requirements

Blood counts should be monitored every two weeks during the first two months of therapy and then monthly.

Zytiga® (abiraterone)

Description

Abiraterone is an androgen inhibitor used to treat prostate cancer.

Dosing and Administration

The recommended dosage of abiraterone is one dose once daily in combination with prednisone.

Drug Interactions

Concomitant use of abiraterone with a CYP3A4 inducer (e.g., phenytoin, carbamazepine, rifampin, and St. John’s wort) should be avoided. Dose adjustments may be necessary if concomitant use is unavoidable.Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Joint swelling or discomfort, decreased potassium, fluid retention, muscle pain, hot flashes, diarrhea, urinary tract infection, cough, high blood pressure, arrhythmia, urinary frequency and upper respiratory tract infection.

Therapies Used for Supportive Care

Megace® (megestrol acetate) [G]

Description

Megestrol acetate is used to treat anorexia and significant weight loss or muscle loss. It is usually used in addition to standard cancer treatments to help maintain your health.

Dosing and Administration

The recommended dosage of megestrol acetate is one cup (10mL or 20mL) once daily.

Drug Interactions

Concomitant use of megestrol acetate with dofetilide may result in additional toxicities associated with the heart. Tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Rash, sweating, increase in blood pressure, diarrhea, indigestion, nausea, vomiting, insomnia, and mood swings.

Mesnex® (mesna)

Description

Mesna is used to treat chemotherapy associated hemorrhagic cystitis.

Dosing and Administration

The recommended dosage of mesna is based on body surface area (BSA) and the type of chemotherapy used.

Drug Interactions

There are no significant drug/drug interactions with oral mesna, but make sure to tell your care providers about all medicines you take, including prescriptions and non-prescription medications, vitamins, and herbal supplements.

Common Side Effects

Hair loss, stomach pain, constipation, diarrhea, loss of appetite, nausea, vomiting, decrease in blood counts, headache, tiredness, and fever.