Cabozantinib interactions

Food & lifestyle

• high-fat foods

  Moderate

  Absorption

  Food may alter the oral bioavailability of cabozantinib. When healthy subjects were given a single 140 mg oral dose with a high-fat meal, cabozantinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 41% and 57%, respectively, relative to administration under fasting conditions.

  What to do: Cabozantinib should be administered at least one hour before or two hours after a meal. The consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit extract should be avoided.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

Conditions

Conditions in which Cabozantinib needs care, as documented in this source.

• Hemorrhage

  Major

  Fatal hemorrhagic events have been reported with the use of cabozantinib. Therapy with cabozantinib is not recommended in patients that have or are at risk for severe hemorrhage.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

• Hepatic Insufficiency

  Moderate

  Increased exposure to cabozantinib has been observed in patients with mild to moderate hepatic impairment. It is recommended to reduce the cabozantinib dose in patients with mild or moderate hepatic impairment. The use of cabozantinib is not recommended in patients with severe hepatic impairment. It is recommended to monitor liver function and urine bilirubin tests periodically during therapy.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

• Hypertension

  Moderate

  The use of cabozantinib causes hypertension. Blood pressure should be well-controlled prior to initiating cabozantinib and monitored and treated as needed with standard anti-hypertensive therapy. It is recommended to reduce the dose in case of persistent hypertension despite use of anti-hypertensive medications and to discontinue therapy if hypertension is severe and persistent despite these measures. Discontinue cabozantinib therapy for severe hypertension that cannot be controlled with anti-hypertensive therapy and if there is evidence of hypertensive crisis or severe hypertension despite optimal medical management. Close monitoring is recommended.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

• Kidney Diseases

  Moderate

  No dose adjustment is required in patients with mild or moderate renal impairment. There is no experience with cabozantinib in patients with severe renal impairment. Care should be exercised in these patients.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

• Lung Diseases

  Moderate

  The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, permanently discontinue these agents and institute appropriate measures. Immediately withhold treatment in patients diagnosed with ILD/pneumonitis and permanently discontinue therapy if no other potential causes of ILD/pneumonitis have been identified.

  7 sources

  1. "Product Information. Vandetanib (vandetanib)." Astra-Zeneca Pharmaceuticals (2011):
  2. "Product Information. Zelboraf (vemurafenib)." Genentech (2011):
  3. "Product Information. Xalkori (crizotinib)." Pfizer U.S. Pharmaceuticals Group (2011):
  4. "Product Information. Mekinist (trametinib)." GlaxoSmithKline (2013):
  5. "Product Information. Zykadia (ceritinib)." Novartis Pharmaceuticals (2014):
  6. "Product Information. Zydelig (idelalisib)." Gilead Sciences (2014):
  7. "Product Information. Alecensa (alectinib)." Genentech (2015):

• Peptic Ulcer Perforation

  Moderate

  Therapy with cabozantinib should be used with caution in patients who may be at increased risk for gastrointestinal perforation, such as those with a history of diverticulitis. Patients presenting with new onset of abdominal symptoms should be evaluated promptly for early identification of gastrointestinal perforation. It is recommended to monitor for symptoms of gastrointestinal perforation or fistula periodically throughout the treatment. Discontinue cabozantinib in patients who experience a fistula which cannot be appropriately managed or a GI perforation.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

• Posterior Leukoencephalopathy Syndrome

  Moderate

  Reversible posterior leukoencephalopathy syndrome (RPLS) has been reported in patients receiving cabozantinib. It is recommended to discontinue therapy in patients developing RPLS. The safety of reinitiating therapy in patients previously experiencing RPLS is not known. Care and close monitoring should be considered in these patients.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):

• Thromboembolism

  Moderate

  Arterial and venous thromboembolic events have been reported with the use of cabozantinib. Use with caution in patients who are at risk, or have a history of these events. It is recommended to monitor closely for signs and symptoms of thromboembolism. Discontinue cabozantinib in patients who develop an acute myocardial infarction or any other arterial thromboembolic complication.

  1 source

  1. "Product Information. Cometriq (cabozantinib)." Exelixis Inc (2012):