Drug Interaction:
Drug interaction -summary
+Sunitinib
CYP-4503A4 inducers- eg carbamzapine, dexamethasone, phenobarbital, phenytoin,
rifabutin, rifampin, rifapentine, St.johns Wart
Coadministration is not recommended. Consider a dose increase of suminitab to
a maximum of 87.5mg daily , if it siminitib must be coadminstered with a CYP3A4
inducer.
CYP-4503A4 inhibitors eg atazanavir,clarithromycin, indinavir, itraconazole, ketoconazole,nefazodone, nelfinavir, saquinavir, telitromycin , voriconazole
Consider a dose decrease of sunitinib to a minimum of 37.5mg daily if suninitib must be
coadministered. with a CYP3A4 inhibitor.
Indication:
Advanced renal cell carcinoma
GI stromal tumor (GIST )
Adverse Reaction:
Most common adverse reactions-
abdominal pain, altered taste, anorexia, asthenia, bleeding, constipation, diarrhea, dyspepsia, fatigue, hand- foot syndrome, hypertension,mucositosis/stomatitis, nausea, rash, skin discoloration and vomiting
Cardiovascular - hypertension 14%
CNS - asthenia 20%
Dermatologic - hand-foot syndrome 13% rash 12% skin discoloration 28%
GI - altered taste 20% anorexia 30% constipation 18% diarrhea 38%
mucositis/stomatitis 26%
Miscellaneous - myalgia/limb pain 13%
Lab/test abnormalites-
Cardiovascular - decreased LVEF 10%
GI - amylase 15% lipase 24%
Drug/food interaction- grape fruit may increase plasma concentrations of sunitinib
Hematologic/lymphatic - anemia 25% lymphoma 35% neutropenia 50%
thrombocytopenia 35%
Hepatic - alkaline phosphatase 23% AST/ALT 35% indirect bilirubin 8%
total bilirubin 14%
Metabolic/renal - creatinine 10% hypernatremia 8% hypokalemia 10%
Contra-Indications:
Special precautions/Warnings-
Left ventricular dysfuntion- interupt and or reduce the dose of sunitinib in patients without
clinical eveidence of CHF but the ejection fraction of less than the baseline .
Weigh the potential benefits of the sunitinib.
QT interval prolongation- use sunitinib with caution in patients who have a history of
QT interval prolongation, are taking antiarrhythmias or have preexisting cardiac disease,
bradycardia, or electrolyte disturbances.
Pregnancy - Advice women of childbearing potential to avoid becoming pregnant while
receiving treatment with sunitinib.
Lactation- decide whether to discontinue breast feeding or the drug depending on
the importance to the mother.
Children- Safety and efficacy of sunitinib in children have not been studied
Elderly- No overall difference in efficacy were observed between younger and older patients
Monitoring- perform complete blood counts with platelet count and serum chemistries,
including phosphates at the beginning of each treatment cycle
Monitor patients for hypertension and treat as needed.
Dosages/ Overdosage Etc:
Indication-
Advanced renal cell carcinoma
GI stromal tumor (GIST )
Dosage-
The recommended dose for GIST and advanced renal cell carcinoma is one 50mg oral dose once daily on a schedule of 4 weeks on treatment followed by 2 weeks off.
It may taken with or without food.
Dose mdification- dose increase or reduction in 12.5mg increments is recommended based on individual safety and toleralibity.
Storage - store at 25C( 77F) excursions are permitted to 15 to 30C ( 59 to 86F)
Patient Information:
1. Advice patients about GI disorders. Diarrhea, dyspepsia, nausea, stomatitis, and vomiting
are most commonly reported GI reactions occuring in patients receiving sunitinib. Supporting care for GI adverse reactions requiring treatment may include antiemtic or antidiarrheal medication.
2. Advice patients of possible skin discoloration is due to the color ( yellow ) which occurs
approximately one-third of the patients .
Advice patients that pigmentation of the hair or skin may occur during treatment with sunitinib
Other possible dermatological effects include dryness, thickness, or cracking of the skin,
blister on the palms of the hands and soles of the feet.
3. Advice patients that other commonly adverse reactions include bleeding,fatigue,
high blood pressure, mouth pain/irritation, swelling, and taste disturbance.
4. Advice patients in inform their health care providers of all concomittant medications,
including nonprescription medications and dietary supplements
Interaction with Food:
It may taken with or without food.
Pregnancy and lactation:
Pregnancy -
Advice women of childbearing potential to avoid becoming pregnant while
receiving treatment with sunitinib.
Lactation-
Decide whether to discontinue breast feeding or the drug depending on
the importance to the mother.
Children-
Safety and efficacy of sunitinib in children have not been studied
Elderly-
No overall difference in efficacy were observed between younger and older patients
Manufacturer Details