​Cabozantinib (Generic Name)

Other Names: Cometriq®

About This Drug

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

Possible Side Effects (More Common)

  • Nausea and throwing up (vomiting)
  • 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.
  • Loose bowel movements (diarrhea)
  • Constipation (not able to move bowels)
  • Abdominal pain
  • High blood pressure. Your doctor will check your blood pressure as needed.
  • Headache
  • Decreased appetite (decreased hunger)
  • Changes in the way food and drinks taste
  • Fatigue
  • Weakness
  • 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.
  • Changes in your liver function. Your doctor will check your liver function as needed.
  • Electrolyte changes.  Your blood will be checked for electrolyte changes 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.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, especially 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. 
  • Slow wound healing (see Special Instructions)
  • This drug may affect how your kidneys work. Your kidney function will be checked as needed. 
  • 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.
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • 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 water in the body due to losing too much fluid).
  • 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 1/2 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.
  • 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.

Important Information

  • Do not eat grapefruit or drink grapefruit juice while taking this drug. 
  • Cabozantinib should not be taken with food.  Take this drug by mouth at least 2 hours before you eat or 1 hour after you eat.
  • Swallow the medicine whole with at least 8 ounces of water. Do not crush, break or chew the tablets.
  • Store this medicine in the original container at room temperature.
  • Missed dose: If you miss a dose take it as soon as you remember.  If it is close to your next dose (within12 hours) just take your next dose at your regular time. Do not take more than one dose at a time to make up for missed doses.

Special Instructions

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:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Rash, sores, reddened areas or itching that is not relieved by prescribed medicines
  • Easy bleeding or bruising
  • Feeling confused or agitated
  • Nausea that stops you from eating or drinking
  • Throwing up more than 3 times a day
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
  • 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:

  • Painful, red, or swollen areas on your hands or feet.
  • No bowel movement in 3 days or when you feel uncomfortable
  • Pain, nausea, throwing up, or loose bowel movements that are not relieved by prescribed medicines
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Fatigue that interferes with your daily activities
  • Pain in your mouth or throat that makes it hard to eat or drink

Reproduction Concerns

  • Pregnancy warning: This drug may have harmful effects on the unborn child, so effective methods of birth control should be used 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, women should talk to their doctor about the risks and benefits of breast feeding during treatment with this drug because this drug may enter the breast milk and badly harm a breast feeding baby.

New Sheet: November 2014

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