​Cabozantinib (Generic Name)

Other Names: Cometriq,® Cabometyx®

About This Drug

Cabozantinib is a drug used to treat cancer. This drug is given by mouth (orally).

Possible Side Effects (More Common)

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
  • Abnormal bleeding – symptoms may be coughing up blood, throwing up blood (may look like coffee grounds), red or black tarry bowel movements, abnormally heavy menstrual flow, nosebleeds or any other unusual bleeding.
  • Nausea and throwing up (vomiting)
  • Constipation (not able to move bowels)
  • Abdominal pain
  • Decreased appetite (decreased hunger)
  • Loose bowel movements (diarrhea) that may last for a few days.
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • High blood pressure. Your doctor will check your blood pressure as needed.
  • Weight loss
  • Changes in the way food and drinks taste
  • Tiredness
  • Weakness that interferes with daily activities
  • Headache
  • Shortness of breath, cough
  • Changes to the color of your skin or hair
  • Hand-and-foot syndrome. The palms of your hands or soles of your feet may tingle, become numb, painful, swollen, or red.
  • Rash
  • Changes in your liver function. Your doctor will check your liver function as needed.
  • This drug may affect how your kidneys work. Your kidney function will be checked as needed.
  • Electrolyte changes. Your blood will be checked for electrolyte changes as needed.
  • Increase in a type of fat in your blood (triglycerides). Your blood will be checked as needed.

Possible Side Effects (Less Common)

  • Blood clots. A blood clot in your leg may cause your leg to swell, appear red and warm, and/or cause pain. A blood clot in your lungs may cause trouble breathing, pain when breathing, and/or chest pain.
  • Abnormal opening in stomach, intestine or esophagus (fistula). Symptoms of a fistula may be: severe abdominal pain or difficulty swallowing.
  • Swollen veins inside the anal canal near the opening of the anus (hemorrhoids)
  • Slow wound healing –see special instructions.
  • Central nervous system changes - Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel extreme tiredness, agitation, confusion, hallucinations (see or hear things that are not there), trouble understanding or speaking, loss of control of your bowels or bladder, eyesight changes, numbness or lack of strength to your arms, legs, face, or body, and coma. If you start to have any of these symptoms let your doctor know right away.
  • Feeling worried or nervous (anxiety)
  • Muscular chest pain
  • Low blood pressure. Your doctor will check your blood pressure as needed.
  • Osteonecrosis (oss-tee-oh-ne-KRO-sis) of the jaw. This is a breakdown of the jaw bone. It is a bad but rare health problem. Possible symptoms are: pain, swelling or infection of the gums, loose teeth, poor healing of the gums, numbness or the feeling that your jaw is heavy.

Treating Side Effects

  • Drink 6-8 cups of fluids each day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements you should drink more fluids so that you do not become dehydrated (lack of water in the body due to losing too much fluid).
  • Ask your doctor or nurse about medicines that are available to help stop or lessen constipation.
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • Ask your doctor or nurse about medicine to help stop or lessen nausea, throwing up, stomach or abdominal pain, headache, loose bowel movements, and/or constipation.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
  • Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of ½ teaspoon of salt in 8 ounces of water or ½ teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
  • If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
  • If you have a nose bleed, sit with your head tipped slightly forward. Apply pressure by lightly pinching the bridge of your nose between your thumb and forefinger. Call your doctor if you feel dizzy or faint or if the bleeding doesn’t stop after 10 to 15 minutes.
  • Tell your cancer doctor if you have any problems with your teeth or jaw before you start this drug. It is important that your dentist knows that you are on this drug. Give your dentist and your cancer doctor each other’s name and phone number so they may call each other if they have any questions.

Food and Drug Interactions

  • There are known interactions of cabozantinib with grapefruit. Do not eat grapefruit or drink grapefruit juice while taking this drug. Grapefruit and grapefruit juice may raise the levels of cabozantinib in your body. This could make side effects worse.
  • There are known interactions of cabozantinib with some other medicines and food. Check with your doctor or pharmacist about all other prescription medicines and dietary supplements you are taking before starting this medicine as there are a lot of known drug interactions with cabozantinib.
  • Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplement to make sure that there are no interactions.
  • Talk with your doctor about taking St. John’s Wort, garlic, ginseng, and ginkgo. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

Special Instructions

  • Do not eat grapefruit or drink grapefruit juice while taking this drug.
  • Cabozantinib is available in two forms, tablets and capsules. You must take the form that are prescribed by your doctor. The tablets and capsules cannot be switched.
  • Cabozantinib should not be taken with food. Take this drug by mouth at least 1 hour before you eat or 2 hours after you eat.
  • Swallow the medicine whole with at least 8 ounces of water. Do not crush, break or chew the tablets. Do not open capsules.
  • Store this medicine in the original container at room temperature.
  • Missed dose: If you miss a dose take it as soon as you remember, unless it is within 12 hours of your next dose. If your next dose is due within 12 hours, just take your next dose at the regular time, and skip the missed dose. Do not take more than one dose at a time to make up for missed doses.
  • Cabozantinib may cause slow wound healing. It should not be given within 28 days of surgery or any test or procedure that needs conscious sedation. If you must have emergency surgery or have an accident that results in a wound, tell the doctor that you are on cabozantinib. Call your cancer doctor as soon as possible for further orders.

When to Call the Doctor

Call your doctor or nurse right away if you have any of these symptoms:

  • Bad abdominal pain
  • Bad headache
  • Coughing, gagging or choking during eating or drinking
  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Seizures
  • Rash, sores, reddened areas or itching that is not relieved by prescribed medicines
  • Easy bleeding or bruising
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Confusion or if you become easily upset (agitation)
  • Feeling dizzy or lightheaded
  • Wheezing or trouble breathing
  • Blurred vision or other changes in eyesight
  • Nausea that stops you from eating or drinking
  • Throwing up more than 3 times a day
  • Mouth sores-if you have pain, redness, swelling or sores in your mouth
  • Pain when passing urine; blood in urine
  • Pain in your lower back or side
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause. If you have any of these symptoms for 2 minutes, call 911.
  • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin

Call your doctor or nurse as soon as possible if any of these symptoms happen:

  • Pain, nausea, throwing up, loose bowel movements, or rash that are not relieved by prescribed medicines
  • Change in hearing, ringing in the ears
  • Decreased urine
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Heavy menstrual period that lasts longer than normal
  • Numbness, tingling, decreased feeling or weakness in fingers, toes, arms, or legs
  • Trouble walking or changes in the way you walk, feeling clumsy when buttoning clothes, opening jars, or other routine hand motions
  • Swelling of legs, ankles, feet, arms or hands
  • Weight gain of 5 pounds in one week (fluid retention)
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Fatigue that interferes with your daily activities
  • Headache that does not go away
  • Painful, red, or swollen areas on your hands or feet.
  • No bowel movement for 3 days or you feel uncomfortable
  • Extreme weakness that interferes with normal activities
  • Bad abdominal pain, especially in upper right area
  • Pain between shoulder blades, or in right shoulder
  • Abnormal blood sugar
  • Unusual thirst, passing urine often, headache, sweating, shakiness, irritability
  • Feeling that heart is beating too slow or too fast

Reproduction Concerns

  • Pregnancy warning: This drug may have harmful effects on the unborn child, so effective methods of birth control should be used by both females and males during your cancer treatment and for up to 4 months after the your treatment is done.
  • Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
  • Breast feeding warning: It is not known if this drug passes into breast milk. For this reason, it is recommended that women do not breast feed during treatment with this drug and for 4 months after the last treatment to prevent any possible harm to the breast-feeding baby.

Updated: December 2016

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