Mosby's 2014 Nursing Drug Reference (430 page)

BOOK: Mosby's 2014 Nursing Drug Reference
12.4Mb size Format: txt, pdf, ePub

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

cabozantinib

(ka′boe-zan′ti-nib)

Cometriq

Func. class.:
Antineoplastic biologic response modifiers

Chem. class.:
Signal transduction inhibitor (STI)

ACTION:

Inhibits abnormal tyrosine kinase associated with growth and development of metastatic medullary thyroid cancer

USES:

Treatment of progressive metastatic medullary thyroid cancer

CONTRAINDICATIONS:

Pregnancy (D), hypersensitivity

Precautions:
Breastfeeding, children, geriatric patients, cardiac/renal/hepatic/dental disease, bone marrow suppression, wound dehiscence, skin disease MI, hypertension, proteinuria, infertility, surgery, thrombocytopenia, neutropenia, immunosuppression

 

Black Box Warning:

Bleeding, fistula, GI bleeding/perforations

DOSAGE AND ROUTES
Calculator

• Adult:
PO
140 mg/day until disease progression or unacceptable toxicity

• 
Avoid the concomitant use of strong 3A4 inhibitors or inducers if possible; temporary interruption of therapy and a dosage reduction may be necessary in patients who develop toxicity or intolerable side effects

Available forms:
Tabs 60, 100, 140 mg

Administer:

• 
Take on an empty stomach; do not eat for ≥2 hr before and ≥1 hr after use; swallow whole; do not open or crush caps

• 
Do not take with grapefruit juice

• 
Do not take a missed dose within 12 hr of the next dose; if the next dose is in 12 hr or more, take the missed dose; if the next dose is in less than 12 hr, skip the missed dose and take the next dose at the scheduled time

• 
Store at room temperature

Dosage adjustments for treatment-related toxicity:

 
Grade 4 hematologic toxicity, grade 3 or higher nonhematologic toxicity, or intolerable grade 2 toxicity:
Hold until resolution/improvement, then reduce the daily dosage by 40 mg (eg, 140 mg/day to 100 mg/day or 100 mg/day to 60 mg/day)

Dosage guidance in patients on strong CYP3A4 inducers/inhibitors:

 
Strong CYP3A4 inhibitors:
Avoid use if possible; if a strong CYP3A4 inhibitor is used, reduce the daily cabozantinib dosage by 40 mg; resume the prior dosage after 2 or 3 days if the strong CYP3A4 inhibitor is discontinued

 
Strong CYP3A4 inducers:
Avoid chronic concomitant use if possible; if a strong CYP3A4 inducer is required, increase the daily cabozantinib dosage by 40 mg, max 180 mg/day; resume the prior dosage after 2 or 3 days if the strong CYP3A4 inducer is discontinued

SIDE EFFECTS

CNS:
Headache, dizziness

GI:
Nausea, vomiting, dyspepsia, anorexia, abdominal pain, diarrhea, GI bleeding/fistula/perforation

HEMA:
Neutropenia, thrombocytopenia, bleeding

INTEG:
Rash

META:
Hypokalemia

MISC:
Fatigue, hypothyroidism, elevated liver enzymes

MS:
Arthralgia, myalgia

PHARMACOKINETICS

Protein binding 99%, metabolized by CYP3A4

INTERACTIONS

Increase:
cabozantinib concentrations—CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin)

Increase:
plasma concentrations of simvastatin, calcium channel blockers, ergots

Decrease:
cabozantinib concentrations—CYP3A4 inducers (dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital)

Drug/Food

Increase:
cabozantinib effect—grapefruit juice; avoid use while taking product

Drug/Herb

Cabozantinib concentration—St. John’s wort

Nursing considerations
Assess:

 
Proteinuria:
monitor urine protein regularly; discontinue if nephritic syndrome occurs

 
GI bleeding/fistula/perforation:
can be fatal

 
Wound dehiscence:
discontinue product ≥20 days before surgery

Evaluate:

• 
Therapeutic response: decrease in size, spread of tumor

Teach patient/family:

• 
To report adverse reactions immediately: bleeding

• 
About reason for treatment, expected results

• 
That effect on male infertility is unknown

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

Other books

By Book or by Crook by Eva Gates
The Silky Seal Pup by Amelia Cobb
The Future King: Logres by Mackworth-Praed, M. L.
Go Tell the Spartans by Jerry Pournelle, S.M. Stirling
Lucky Charm by Valerie Douglas
Bella by Barrett, D.J.
Heart of the Mountain Man by William W. Johnstone
Street Rules by Baxter Clare