Lenvatinib (Oral)

By interfering with the growth and spread of kidney cancer cells, lenvatinib allows the body to destroy those cancer cells and slow down the progress of the disease.

Overview

Lenvatinib is a prescription medication which works to prevent cancer cells from growing and spreading, and is often used together with another cancer-hindering medication called everolimus. This medicine is only used after other medicines have been tried and found to be unsuccessful. It is also used at the stage where iodine will not be successful as a treatment anymore, and the cancer has already spread to other parts of the body.

Condition Treated

Type Of Medicine

  • Tyrosine kinase inhibitors

Side Effects

In addition to its cancer-inhibiting properties, lenvatinib may also impart some side effects to patients using it. Some of these may be fairly mild, while others are relatively severe, and the severity or frequency which you experience any of the side effects will have more to do with your body chemistry than anything else.

If any of the side effects listed below should be experienced at an uncomfortable level, you should contact your doctor as soon as possible for advice. One of the first and most important side effects that you should be on alert for is an allergic reaction, which has the potential to become life-threatening because of the symptoms involved. The symptoms to look for in an allergic reaction are as follows:

  • Extreme puffiness or swelling in the eyelids, or in the tongue, throat, and lips
  • Itchiness around the body
  • Dizziness or lightheadedness, with the sensation that you are about to faint
  • Tightness of the chest, often accompanied by difficulty with breathing
  • The appearance of highs and or rashes on skin surfaces.

Some of the most common other side effects which might appear on the following:

  • Hoarseness
  • Dry mouth
  • Nosebleeds
  • Tiredness
  • Headaches
  • Weight loss
  • Muscle pain
  • Joint pain
  • Changes in taste
  • Difficulty with sleeping
  • Constipation
  • Diarrhea
  • Upset stomach
  • Vomiting
  • Nausea
  • Loss of appetite.

When nausea and vomiting occur, they can be very severe, and you may need to have medication prescribed for you by your doctor to manage it. Some patients have mitigated the effects of the nausea and vomiting by eating several small meals each day rather than fewer large ones, by avoiding food right before treatments, and by limiting activities that cause significant exertion.

It's very possible that unchecked vomiting coupled with diarrhea can result in a significant dehydration in the body, because so many fluids are being lost on a regular basis. The signs of dehydration which are of concern are persistent dry mouth, constant thirst, and lightheadedness. For the relief of dry mouth, some simple things like sucking on hard candy or chewing sugarless gum can help, and obviously drinking plenty of fluids can help to replace lost body fluids.

You may notice that pain or sores develop in your mouth or throat, and when this happens you should brush your teeth very carefully, so as to avoid those sores. You should also not use mouthwash containing alcohol, and you should implement a program where you rinse your mouth out frequently with cool water mixed with salt or possibly baking soda. You may also find it helpful to eat foods which tend to be moist and soft.

You may notice that you experience a temporary loss of hair during treatment with lenvatinib, although this hair loss should be recovered when the treatment period has finished. It's possible for lenvatinib to increase your blood pressure, so you will need to have it checked more regularly than normal, especially if you have high blood pressure to begin with. It's possible that your doctor may prescribe the use of new high blood pressure medications to manage this, if it is deemed to be of concern.

Other side effects that you may notice include the following:

  • Signs of kidney problems, such as a change in the amount of urine passed, or urine which appears frothy
  • Signs of heart failure, such as unusual tiredness or weakness and swelling in the ankles and feet
  • Indicators of an underactive thyroid, for instance intolerance to cold, slow heartbeat, and weight gain
  • Muscle spasms
  • Easy bruising or bleeding
  • Pain, redness, blisters, or swelling which appears on the palms of your hands, and sometimes also on the soles of your feet.

It's extremely important that you seek emergency medical attention if you suspect that you are having a heart attack, which will generally be preceded by the warning signs of unusual and persistent sweating, shortness of breath, and pain in the jaw, chest, or left arm.

Some of the very serious signs of a stroke would be difficulty speaking, often because of slurred speech, sudden changes to your vision, confusion or disorientation, and a general weakness on one entire side of the body.

You can also develop problems in the intestines or the stomach which would be manifested as stomach or abdominal pain, vomiting up of blood, vomiting up material which looks like coffee grounds, fast or irregular heartbeat, fainting, dizziness or lightheadedness, and stools which appear either bloody, black, or tarry.

It's also possible for lenvatinib to trigger a serious and potentially fatal liver disease. This means you should seek medical help immediately if you notice any signs of liver damage such as uncontrolled nausea and vomiting, loss of appetite, pain or cramping in the stomach or abdomen, or a yellowish tinge to the skin or around the eyes, and dark colored urine.

In some unusual cases, lenvatinib has caused a very serious condition of the brain called reversible posterior leukoencephalopathy syndrome (RPLS). You should seek emergency medical attention if you identify any of the symptoms of this condition which include, seizures and or convulsions, sudden changes to vision, persistent severe headaches, and noticeable changes in attitude or mood, commonly including severe confusion.

Dosage

Before taking lenvatinib, be sure to read the patient information guide which will be provided by your pharmacist, and which includes instructions on how this medication should be taken. Lenvatinib should be taken orally with or without food, according to your doctor's recommendation, one time each day.

For patients who have difficulty swallowing whole capsules, the lenvatinib capsule can be placed in a small glass of apple juice or water, and should be allowed to rest for approximately 10 minutes. Capsules should not be crushed, broken, or chewed. After the 10 minutes of rest time, the contents of the glass should be stirred for about three minutes, and then the entire mixture can be ingested all at once. Afterward, an additional amount of apple juice or water should be flushed around the glass and also drunk, so that you make sure you have gotten the entire amount of the capsule.

You should not prepare a capsule of lenvatinib until you are ready to ingest it. You should get in the habit of taking this medication at the same time every day, to help you remember it, and also to help your body adjust to it. You should not take any more or less of this medicine than your doctor has prescribed, because it will not improve your condition, or help you to recover any more quickly. Your doctor will prescribe your specific dosage of lenvatinib based on several factors, including your tolerance to the medication, the strength of the medicine itself, the specific medical condition for which you are being treated, and the number of times per day that a dosage is recommended.

  • For the treatment of thyroid cancer adults should take 24 mg in a single day, all at one time. This should be comprised of two 10 mg capsules and 4 mg capsule, although your doctor will make any adjustments as appropriate. Pediatric patients must have their precise dosage determined by the family doctor
  • For the treatment of advanced kidney cancer, with lenvatinib taken in conjunction with everolimus¬†' adults should take 18 mg of lenvatinib, comprised of one 10 mg capsule and two 4 mg capsules, in the same day as a single dose. Children must have their specific dosages determined and approved by the family doctor.

If you should forget to take lenvatinib at your normally scheduled time, it is permissible to take it as soon as you do remember it, unless you don't remember it until it's close to the time of your next scheduled dosage. In that event, skip the missed dosage and simply wait until the next scheduled dosage. You should never double up on doses simply for the sake of getting back on schedule, or because your symptoms happen to be particularly severe at any given time.

Interactions

Lenvatinib has the potential to interact with other drugs, and when this happens it can cause either or both of the drugs to be diminished in effectiveness. Another possibility occurring when two drugs interact is to worsen the side effects that the patient would experience from either one of the drugs, or both.

Since it is generally advisable to avoid any kind of drug interactions if possible, you should prepare a list of all the other medications which you are currently taking, including over-the-counter drugs, prescription drugs, vitamins, and herbal supplements, as well as the dosage levels of each of these. Your doctor can then review this list of medications and make a determination on whether or not there's a possibility of lenvatinib interacting with any of your other medications.

You can also use this medication list if you should have a need to go to healthcare clinic where your primary care doctor is not in residence, or if you have to make an unscheduled trip to an emergency room for treatment. In either case, a doctor at one of these facilities can review your medication list and prescribe a program of treatment for your condition which will not interfere with any of your other medications.

Some of the most commonly checked drugs for potential interactions with inventive are those listed below:

  • Lopinavir
  • Ritonavir
  • Tenofovir
  • Amitriptyline
  • Propoxyphene
  • Acetaminophen
  • Aspirin
  • Caffeine
  • Magnesium hydroxide
  • Aluminum hydroxide
  • Amoxicillin
  • Chlordiazepoxide
  • Imipramine
  • Omeprazole
  • Clarithromycin
  • Lansoprazole
  • Promethazine
  • Isoproterenol
  • Famotidine
  • Calcium carbonate
  • Albuterol
  • Aripiprazole.

In addition to interactions with other medications, there is a potential for lenvatinib to interact with a medical condition which you already have. If you have any of the conditions appearing on the list below, you should consult with your doctor before taking lenvatinib, so that you don't worsen an existing situation you have.

  • Severe kidney disease
  • Severe liver disease
  • Heart rhythm problems such as slow heartbeat or congenital long QT syndrome
  • Blood clots
  • Heart disease
  • Hypertension
  • Electrolyte imbalance
  • Congestive heart failure
  • Stomach perforation or fistula
  • Proteinuria
  • Hypocalcemia
  • Bleeding problems
  • Hypertension.

Warnings

There are some precautions or warnings that you should be aware of when taking lenvatinib. Make sure you let your doctor know if you are allergic to this medication or any of the ingredients used in its manufacture. Before taking lenvatinib, review your medical history with your doctor so that there won't be any impact on existing medical conditions you may have, especially those of high blood pressure, kidney disease, liver disease, dehydration, heart attack, or stroke.

There is a potential for lenvatinib to cause a condition which interferes with the rhythm of the heart, known as QT prolongation. In some rare cases, this condition can be fatal, so you should look for identifying symptoms such as fast and irregular heartbeat, often accompanied by severe dizziness and fainting. The potential for contracting QT prolongation can be increased if you have any kinds of heart problems in your medical history such as a slow heartbeat or heart failure, or if anyone in your family has ever passed away due to sudden cardiac death.

Low levels of potassium in your blood, or low levels of magnesium can also increase the risk of QT prolongation, and this happens especially for patients who are using diuretics, or those who commonly experience diarrhea, vomiting, or profuse sweating.

Before you have any kind of surgeries, including dental surgery, you should let your doctor or dentist know that you are taking lenvatinib, because there is a possibility that any kind of anesthesia or sedative issued may interact with this medication.

Geriatric patients are generally more prone to the side effects of this medication, especially QT prolongation, so increased monitoring and increased vigilance is necessary when this medication is being administered to older patients.

It is known that lenvatinib can be absorbed through the lungs and the skin, and this makes it a dangerous medication for an unborn infant. Women who are pregnant or thinking of becoming pregnant, should not take lenvatinib throughout the period of the pregnancy, since there is a distinct possibility that some adverse impact will be experienced by the fetus.

For the same reason, women should not be breast-feeding while taking lenvatinib, because it is known that the medication is passed on through breast milk, and can cause negative impacts on a nursing infant.

Storage

This medication should be stored at room temperature in a location which is not subject to any kind of extremes of heat, cold, direct light, or moisture, since any of these conditions can degrade the effectiveness of the medication. It should also be kept out of the reach of small children, because there is a serious danger of toxicity potential.

For that reason, it should be stored high out of reach of any youngsters in the household, and it should not be kept in any of the popular weekly pill reminders. Most of these lack any kind of locking mechanism which can prevent unwanted access, so they are not safe in an environment where young children are around.

If you have expired or unused lenvatinib, it should be disposed of according to proper disposal methods, and not simply flushed down the toilet or sink. Your doctor or pharmacist can inform you about the proper methods for disposal to be used, or you can consult the FDA website for the safe disposal of medicines.

Summary

Lenvatinib is a cancer-fighting medication often used in conjunction with everolimus, another cancer medication. It is generally used when other forms of treatment have proven unsuccessful, and when the cancer has moved to other parts of the body. It works by inhibiting the growth and spread of cancer cells, so these can subsequently be killed by the body's natural defense system.

This is a very serious medication, which does carry the possibility of a number of side effects and a number of interactions with other drugs. It is recommended only under doctor supervision, and by prescription. It comes in capsule form and is generally taken once daily, although the dosage level will need to be determined by a prescribing doctor.