Blog North Dakota: Nilotinib

nye-LOE-ti-nib

Oral route(Capsule)

Prolongation of the QT interval and sudden death have been reported. Do not use nilotinib in the presence of hypokalemia, hypomagnesemia, or long QT syndrome. Hypokalemia or hypomagnesemia must be corrected prior to nilotinib administration and monitored during treatment. Avoid drugs that prolong the QT interval and strong CYP3A4 inhibitors. Avoid food 2 hours before and 1 hour after taking nilotinib. ECGs should be obtained to monitor the QTc .

Commonly used brand name(s)

In the U.S.

Tasigna

Available Dosage Forms:

Capsule

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Tyrosine Kinase Inhibitor

Uses For nilotinib

Nilotinib is used to treat different types of leukemia. Leukemia is a type of cancer where the body makes too many abnormal white blood cells. It belongs to the general group of medicines known as antineoplastics or cancer medicines.

Nilotinib interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells may also be affected by nilotinib, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects may not be serious but may cause concern.

Before you begin treatment with nilotinib, you and your doctor should talk about the benefits nilotinib will do as well as the possible risks of using it.

nilotinib is available only with your doctor's prescription.

Before Using nilotinib

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For nilotinib, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to nilotinib or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of nilotinib in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nilotinib in the elderly.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	D	Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nilotinib, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using nilotinib with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Dronedarone

Fluconazole

Mesoridazine

Pimozide

Posaconazole

Saquinavir

Sparfloxacin

Thioridazine

Ziprasidone

Using nilotinib with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Alfuzosin

Amiodarone

Amitriptyline

Amoxapine

Apomorphine

Arsenic Trioxide

Asenapine

Atazanavir

Azithromycin

Carbamazepine

Chloroquine

Chlorpromazine

Ciprofloxacin

Cisapride

Citalopram

Clarithromycin

Clomipramine

Clozapine

Crizotinib

Dasatinib

Desipramine

Dexamethasone

Dexlansoprazole

Disopyramide

Dofetilide

Dolasetron

Droperidol

Erythromycin

Esomeprazole

Flecainide

Gatifloxacin

Gemifloxacin

Granisetron

Halofantrine

Haloperidol

Ibutilide

Iloperidone

Imipramine

Indinavir

Itraconazole

Ketoconazole

Lansoprazole

Lapatinib

Levofloxacin

Lumefantrine

Methadone

Midazolam

Moxifloxacin

Nefazodone

Nelfinavir

Norfloxacin

Nortriptyline

Octreotide

Ofloxacin

Omeprazole

Ondansetron

Paliperidone

Pantoprazole

Pazopanib

Perflutren Lipid Microsphere

Phenobarbital

Phenytoin

Prochlorperazine

Promethazine

Propafenone

Protriptyline

Quetiapine

Quinidine

Quinine

Rabeprazole

Ranolazine

Rifabutin

Rifampin

Rifapentine

Ritonavir

Salmeterol

Sodium Phosphate

Sodium Phosphate, Dibasic

Sodium Phosphate, Monobasic

Solifenacin

Sorafenib

Sotalol

St John's Wort

Sunitinib

Telavancin

Telithromycin

Terfenadine

Tetrabenazine

Toremifene

Trazodone

Trifluoperazine

Trimipramine

Vandetanib

Vardenafil

Vemurafenib

Voriconazole

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using nilotinib with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use nilotinib, or give you special instructions about the use of food, alcohol, or tobacco.

food

Grapefruit Juice

Proper Use of nilotinib

Take nilotinib exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Do not change the dose or stop using nilotinib without checking first with your doctor.

nilotinib should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the medication guide if you do not have one.

It is best to take nilotinib on an empty stomach (at least 1 hour before or 2 hours after a meal).

Swallow the capsule whole with water. If you have trouble swallowing the capsule, the capsules can be opened and the contents can be sprinkled in one teaspoon of applesauce. This mixture must be taken immediately within 15 minutes and should not be stored for later use.

Dosing

The dose of nilotinib will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of nilotinib. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules):
- For the treatment of Ph+ CML-CP and CML-AP after other treatments have failed:
  - Adults—400 milligrams (mg) two times a day, with about 12 hours between the two doses. Your doctor may adjust your dose as needed.
  - Children—Use and dose must be determined by your doctor.
- For the treatment of newly diagnosed Ph+ CML-CP:
  - Adults—300 milligrams (mg) two times a day, with about 12 hours between the two doses. Your doctor may adjust your dose as needed.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of nilotinib, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using nilotinib

If you will be taking nilotinib for a long time, it is very important that your doctor check your progress at regular visits to make sure that nilotinib is working properly. Blood tests may be needed to check for unwanted effects.

nilotinib can cause changes in the heart rhythm, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Check with your doctor right away if you have any symptoms of heart rhythm problems, such as fast, pounding, or irregular heartbeats.

Using nilotinib while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Nilotinib can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

Avoid contact sports or other situations where bruising or injury could occur.

nilotinib may cause a serious type of reaction called tumor lysis syndrome. Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount; joint pain, stiffness, or swelling; lower back, side, or stomach pain; a rapid weight gain; swelling of the feet or lower legs; or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (St. John's wort) or vitamin supplements.

Do not eat grapefruit or drink grapefruit juice while you are using nilotinib. Grapefruit and grapefruit juice may change the amount of nilotinib that is absorbed in the body.

nilotinib Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Abdominal or stomach pain or tenderness

black, tarry stools

bleeding gums

blood in the urine or stools

blurred vision

bone pain

clay colored stools

confusion

convulsions

cough or hoarseness

dark urine

decreased appetite

difficult or labored breathing

dry mouth

fainting

fever or chills

flushed, dry skin

fruit-like breath odor

headache

increased hunger

increased thirst

increased urination

irregular heartbeat, recurrent

itching

loss of appetite

lower back or side pain

muscle aches, cramps, or pain

nausea and vomiting

no blood pressure

no breathing

no pulse

numbness, tingling, pain, or weakness in the hands or feet

painful or difficult urination

pale skin

pinpoint red spots on the skin

seizures

shortness of breath

skin rash

sore throat

stuffy or runny nose

sweating

swelling of the hands, ankles, feet, or lower legs

tightness in the chest

trembling

troubled breathing with exertion

ulcers, sores, or white spots in the mouth

unexplained weight loss

unusual bleeding or bruising

unusual tiredness or weakness

weakness and heaviness of the legs

wheezing

yellow eyes or skin

Less common

Coma

decreased urine output

dizziness

fast heartbeat

mood or mental changes

muscle cramps in the hands, arms, feet, legs, or face

nervousness

numbness and tingling around the mouth, fingertips, or lips

tremor

Less common or rare

Bladder pain

bloody or cloudy urine

body aches or pain

constipation

cough producing mucus

depressed mood

difficult, burning, or painful urination

dry skin and hair

ear congestion

feeling cold

frequent urge to urinate

hair loss

loss of voice

muscle stiffness

nasal congestion

pain or tenderness around the eyes and cheekbones

sensitivity to heat

slowed heartbeat

sneezing

swelling or puffiness of the face

tender, swollen glands in the neck

trouble with sleeping

trouble with swallowing

weight gain

weight loss

white patches in the mouth or throat or on the tongue

white patches with diaper rash

Incidence not known

Pain or swelling of the treated skin

rapid, shallow breathing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Back pain

burning, itching, and pain in hairy areas

diarrhea

difficulty with moving

lack or loss of strength

muscle spasms

pain in the arms or legs

pain in the joints

pus at the root of the hair

swollen joints

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: nilotinib side effects (in more detail)

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More nilotinib resources

Nilotinib Side Effects (in more detail)
Nilotinib Dosage
Nilotinib Use in Pregnancy & Breastfeeding
Nilotinib Drug Interactions
Nilotinib Support Group
7 Reviews for Nilotinib - Add your own review/rating

Nilotinib Professional Patient Advice (Wolters Kluwer)

Nilotinib Monograph (AHFS DI)

Nilotinib MedFacts Consumer Leaflet (Wolters Kluwer)

Tasigna Prescribing Information (FDA)

Tasigna Consumer Overview

Compare nilotinib with other medications

Chronic Myelogenous Leukemia

Blog North Dakota

Monday, October 17, 2016

Nilotinib