Rifampicin, phenobarbital, phenytoin, carbamazepine , St Johns Wort,
or other potent CYP3A4 Inducers.

 antifungal, ritonavir,macrolides, grapefruit juice, or other potent CYP3A4 inhibitors,

anticoagulants, antiarrhythmics, i.v. biphosphonates

Haemorrhage, blood dyscrasisias, dysgeusia, orophyngeal dryness/discomfort,

pleural effusion, dyspnoea, headache, hypertension, GI upset,

oseophagitis, stomatitis, anorexia,  skin disorders, fatigue,

asthenia, dizziness, insomnia, paresthesia, hypoaesthesia, hyperaesthesia

peripheral neuropathy, alopecia, hand foot-syndrome, fever, chills,

dehydration, depression, lacrimation,

flushing, hot flushes, cough, chelitis, 

muscle spasm, arthalgia, myalgia, renal failure, hypothyroidism, 

chromaturia, odema, wt. loss, pain, hair and nail discoloration,

decreased haemoglobin, platelet count anfd ejection factor,

raised liver enzyme, creatinine, amylase, creatine kinase and uric acid 

reports of thromboembolism, heart failure, cardiomyopathy, myocardial disorders,

GI perforation, seizures, tumor lysis, syndrome

Severe hepatic impairment
lactation, pregnancy
ensure adequate contrception in women of child bearing potential

Special Precautions-
Pulmonary tumors, hypertension, risk of fatal pulmonary haemorhage,

Perform FBC before each treatment cycle
Monitor patients with cardiovascular risk factors for signs of CHF
Discontinue if ejection function < 50% and > 20% below baseline

History of risk factors for QT prolongation.
Pre-existing cardiac disease, bradycardia, or electrolyte disturbances

Check thyroid function at base line every 3 months

Monitor for symptoms of pancreatitis or hepatic failure, discontinue if present

Perform baseline urine analysis and minitor for development or  worsening of protienuria

Discontinue if nephrotic syndrome occurs

Monitor LFT  discontinue if hepatic failure occurs

Risk of ostenonecrosis of jaw usually associated with concomittant or previous
i.v. bisphosphanate use

Perform dental examination and appropiate dental treatment prior to therapy

Avoid invasive dental procedures during therapy

risk of impaired wound healing, discontinue in major surgery

Indication-
Metastatic renal cell carcinoma( RCC)

Dosage-
GIST ( gastro intestinal stromal tumor )and RCC -
50mg daily for 4 weeks followed by a 2 week rest period

Adjust if necesary according to tolerance in 12.5mg steps
range 25 -75 mg daily for GIST and RCC

Below 18 years not recommended

Use contraindicated during pregnancy and lactation

Ensure adequate contrception in women of child bearing potential