Vandetanib (Oral)

Approved by the Food and Drug Administration (FDA), Vandetanib is a tyrosine kinase inhibitor that is used for treating symptomatic or progressive medullary thyroid cancer in patients with locally advanced, unresectable, or metastatic disease.


Vandetanib is manufactured in tablet form and should be taken on a daily basis with or without food. The drug is administered orally to inhibit tumor cell proliferation and tumor angiogenesis for a range of tumor types. The drug is used as an alternative to local therapies for both disseminated and unresectable diseases. Since Vandetanib prolongs the Q-T interval, it is contraindicated for use in patients with a history of cardiac conditions such as congenital QT syndrome and uncompensated heart failure.

Vandetanib is administered to patients whose cancer cannot be removed via surgery or that has spread to other parts of the body. The drug works by blocking the action of a protein that triggers multiplication of cancer cells. The use of Vandetanib in patients with asymptomatic, indolent or slowly advancing disease should be carefully considered because of treatment related risks associated with the drug.

This medication comes in tablet form and is usually taken once daily, with or without food.

How Vandetanib works

Vandetanib is a targeted therapy that isolates and binds to the tyrosine kinase reporters to inhibit Epidermal Growth Factor Receptor (EGFR), Rearranged During Transfection (RET), Vascular Endothelial Growth Factor (VEGF), EPH kinase receptors, TIE2, protein tyrosine kinase 6 (BRK), and SRC kinase receptors on the cell's surface. By binding to these receptors, Vandetanib blocks the pathway that promotes cell division and the spread of cancer.

How to use Vandetanib tablet

Like with any other medication, it is important that you read your Medication Guide as provided by the pharmacist before you start using Vandetanib and every time you get a refill. Ask your doctor or pharmacist the questions you might have as concerns the medication.

Vandetanib should be taken orally with or without food as directed by your doctor. The drug should be taken once per day. It is recommended that you swallow the tablet whole. However, if this is a challenge, place the tablet in a glass of non-carbonated water (about 2 ounces) and stir until the tablet has broken apart. Swallow the solution right away.

Do not crush or break the tablets. Also, do not touch the powder or dust from this drug. Since the drug can be absorbed via the lungs and skin, and may harm an unborn baby, expectant women are advised not to handle or breath dust from the tablets. Vandetanib dosage is strictly based on the patient's medical condition and response to treatment. Patients are advised to take the medication regularly to get the most benefits from it.

Conditions treated by Vandetanib

Type of medicine

  • Oral receptor tyrosine kinase inhibitor

Vandetanib side effects

Most people using Vandetanib do not experience serious side effects. However:

  • Patients may experience decreased appetite, nausea, dry mouth, changes in taste, vomiting, stomach pain, diarrhea, blurred vision and headache when taking this drug.
  • Nail problems (such as swelling, infection, nail bed and tenderness may also occur. Consult your doctor if these effects persist.
  • Some patients may also experience temporary hair loss when taking Vandetanib.
  • Some patients may also notice mild to moderate skin reactions such as dry skin, acne, or mildly irritated and itchy rash.
  • Serious side effects of Vandetanib include redness and swelling of palms of the hand soles of the feet, signs of heart failures like breathing difficulty, swelling ankles and persistent fatigue. Other side effects include depression and under-active thyroid.
  • Vandetanib medication may also raise the patient's blood pressure. Monitor your blood pressure regularly and consult your doctor if the results are higher than normal.
  • Long term administration of Vandetanib may cause a rare (possibly fatal) type of breathing complication referred to as interstitial lung disease. Consult your doctor as soon as you experience sudden and worsening shortness of breath, fever and/or cough.
  • Vandetanib use may also cause brain problems.
  • Allergic reactions to Vandetanib are rare. However, seek medical help when you notice allergic reactions like peeling of skin, rashes, joint pains, itching or swelling face, throat or tongue.

Vandetanib Dosage

  • As already mentioned, Vandetanib comes as a tablet and is administered through the mouth.
  • Take Vandetanib dosage exactly as prescribed by your doctor.
  • Never change or stop your dose unless on advice from your doctor
  • If you miss your dose, be sure to take it as soon as possible. However, if it is very close to the next dose (8 hours), just wait and take the next dose at the regular time
  • The amount of dosage you will receive depends on a number of factors, your general health or underlying health complications, and the type of condition or cancer you are treating.
  • Your doctor may adjust your dose or advise you to stop the medication for some time during your treatment. This depends entirely on how you are responding to the medication and the side effects that you are exhibiting.

Usual dosage for Thyroid cancer

  • Initial dose: 300 mg daily
  • Duration of use: Take the drug continually until disease progression or unacceptable toxicity levels are reported

Dosage forms and strengths

Vandetanib 100-mg tabs are white, round, film-coated and biconcave. They are plain on one side with the inscriptionœZ-100 on the reverse side.

Vandetanib 300-mg tabs, on the other hand, are white, biconcave, oval and film-coated. The carry the inscription œZ-300' on one side and are plain on the reverse side.

Renal dose adjustments

Mild renal impairment (CrCl 50 mL/min or greater): No need for dose adjustment. However, for moderate to severe renal impairment (CrCl less than 50 mL/min), the patient may take an initial dose of 200 mg per day.


The US Food and Drug Administration recommends a Risk Evaluation and Mitigation Strategy (REMS) for Vandetanib. This includes medication guide, assurance for safe use, communication plan, and a system of implementation. Refer to for additional information.

Vandetanib Interactions

A total of 355 drugs (both brand and generic names) have been reported to interact with Vandetanib.

Vandetanib and High blood pressure (hypertension)

Hypertension, including hypertensive crisis, has been reported in patients on Vandetanib medication. Monitoring the patient for hypertension and dose interruption or reduction may be considered. In cases where hypertension cannot be controlled, the patient should not resume Vandetinab.

Vandetanib and disease interactions

Vandetanib and lung toxicity

The use of Vandetanib has been associated with pulmonary infections. Severe cases of Interstitial Lung Disease (ILD), including fatalities as a result of pulmonary fibrosis or interstitial pneumonitis have been reported in patients who are on Vandetanib medication. Caution is recommended when prescribing this medication to patients with a history of pulmonary fibrosis or interstitial pneumonitis, or patients who exhibit severe onset of new or progressive unexplained pulmonary symptoms like persistent cough, dyspnea and fever. The medication should be permanently discontinued if ILD is confirmed.

Vandetanib and cardiovascular conditions

Cardiovascular failures, including fatalities have been reported in patients on Vandetanib treatment. It is important to be on the look for signs and symptoms of heart failures with immediate discontinuation on patients with these symptoms.

Vandetanib and hemorrhage

Serious bleeding cases, including fatalities, have occurred in patients on Vandetanib treatment. The drug is not recommended for patients with a recent history of hemoptysis that is equal to or greater than 0.5 teaspoon of red blood. Medication should be discontinued in patients with severe hemorrhage.

Vandetanib and hepatic impairment

Vandetanib medication is not recommended for patients with moderate to severe hepatic impairment, or other liver diseases, as the safety and efficacy of this medication is yet to be established.

Vandetanib and hypertension

Hypertension, including hypertensive crisis, have been reported in patients on Vandetanib medication. The patient should be monitored for blood pressure changes and dose reduction or termination effected based on severity of the hypertension. In cases where hypertension cannot be controlled, the patient should not resume Vandetanib treatment.

Vandetanib and hypothyroidism

Increased thyroid replacement therapy is recommended in patients with a history of thyroidectomy. It is thus recommended to administer Thyroid-stimulating hormone (TSH) at baseline during Vandetanib treatment and thereafter as directed by your doctor. If symptoms of hypothyroidism persist, the patient's thyroid hormone levels should be examined, and thyroid replacement therapy adjusted accordingly during Vandetanib treatment.

Vandetanib and Ischemic attack

Episodes of Ischemic cerebrovascular attacks, including fatalities, have occurred in patients on Vandetanib therapy. The safety of resuming Vandetanib treatment after resolving an ischemic cerebrovascular episode has not yet been fully studied. Thus, care should be taken when prescribing this medication to a patient who has experienced ischemic cerebrovascular event.

Vandetanib and QT prolongation

Studies have shown that Vandetanib can prolong the QT interval. In addition, its use is contraindicated in patients with congenital long QT syndrome. Patients with hypokalemia, hypocalcemia, hypomagnesemia and long QT syndrome should never use Vandetanib. It is recommended to correct these conditions before administering this medication to patients. Additionally, caution should be exercised when prescribing this medication for patients with recent myocardial infarction or arrhythmias.

Vandetanib and renal impairment

Increased exposure to Vandetanib have been linked to renal dysfunction. Patients with moderate to severe renal impairment are advised to reduce Vandetanib's starting dose and monitor their QT levels closely. Currently, there is no information on how patients with advanced renal infection, or those dialysis, can use Vandetanib.

Vandetanib and RPL Syndrome

Reversible Posterior Leukoencephalopathy Syndrome (RPLS), a subcortical vasogenic edema condition that is detected by an MRI of the brain, has been reported in patients who are Vandetanib treatment. The syndrome is characterized by headache, seizures, visual impairment, altered mental function and general confusion. Vandetanib therapy should be discontinued as soon as these symptoms are detected.

Vandetanib and skin reactions

Severe skin reactions, including Stevens-Johnson Syndrome, some leading to fatalities, have been reported in patients who are on Vandetanib medication. Treatment for severe skin reactions may include the use of corticosteroids followed by a permanent discontinuation from Vandetanib. Mild to moderate skin reactions (rashes, dry skin, acne, dermatitis and pruritis) may be treated using systemic antibiotics, oral antihistamines, topical or systemic corticosteroids. In case there is CTCAE grade 3 or greater skin reactions, the patient may need to discontinue Vandetanib treatment for until there is improvement upon which they may resume with treatment at a reduced dose.

Vandetanib and pregnancy

It is important that you inform your doctor if you are expectant or planning to conceive before starting Vandetanib treatment. This is because Vandetanib have been documented to affect unborn babies. Do not conceive for at least four months from your last Vandetanib dose.

Vandetanib and lactation

Be sure to inform your doctor if you are breastfeeding before taking this medication. While it is not clear if Vandetanib can pass on to your breast milk, it is not recommended that you use this medication while breastfeeding.

Vandetanib and other medications

Some are known to interact with Vandetanib. It is important that you disclose to your doctor all the medications you are currently before starting Vandetanib therapy. Some of the drugs that interact with Vandetanib include:

  • Arsenic trioxide, anagrelide, methadone and droperidol
  • Antibiotics like clarithromycin, azithromycin, erythromycin, moxifloxacin, levofloxacin, rifampicin and pentamidine.
  • Antidepressants like escitalopram and citalopram
  • Anti-malaria medications halofantrine and chloroquine
  • Heart medications like digoxin, amiodarone, disopyramide, dronedarone, dofetilide, flecainide, procainamide, ibutilide, sotalol and quinidine
  • Medications for nausea and vomiting such as ondansetron, dolasetron and gransetron
  • Medications for psychiatric disorders such as haloperidol, chlorpromazine, thioridazine and pimozide.

Vandetanib Warning

Before taking Vandetanib

  • Inform your pharmacist or doctor whether you are allergic to Vandetanib, or the ingredients in Vandetanib. Ask your doctor or check the Medication Guide for a list of ingredients in Vandetanib.
  • Inform your doctor or pharmacist of other prescription as well as non-prescription medication that you are currently on. These should include vitamins and nutritional supplements that you are taking or are planning to take. Be sure to mention if you are on medications listed in the IMPORTANT WARNING section as well as if you are on any of the following medications: dexamethasone, carbamazepine (Carbatrol, Tegretol, Equetro), rifabutin, rifapentine, rifampin, and thyroid hormones as well as the medications listed in the interactions section above. Your doctor may recommend a change in dosage or place you on monitoring for side effects.
  • Mention to your doctors all the herbal medications you are currently on, especially St. Johns Wort.
  • Tell your doctors if you have recently spotted blood in your sputum or had any form of bleeding problem, if you have or have had high blood pressure, seizures, skin infection, lung, liver or kidney infections.
  • Inform your doctor if you are pregnant or are planning to conceive. Talk to your doctor about the right birth control methods you should use while on this medication. Inform your doctor immediately if you become pregnant while on Vandetanib medication.
  • Inform your doctor if you are breastfeeding
  • If you are going for surgery, including dental surgery, inform your surgeon if you are on Vandetanib medication
  • You should know that you are likely to suffer from blurred vision, impaired judgement and drowsiness while on Vandetanib medication. Therefore, do not operation machinery or drive until you know how your system reacts to this medication
  • Avoid extended exposure to direct sunlight while on Vandetanib medication. Also, plan to wear sunscreen, sunglasses and protective clothing while on this medication. Reason: Vandetanib may make your skin sensitive to sunlight during therapy and up to four months after stopping the treatment.
  • Do not receive any kind of vaccination or immunization without the approval of your doctor while you are on Vandetanib therapy.
  • Avoid grapevine and grapevine juice while on Vandetanib treatment. Grapevine may cause the amount of the drug in your blood to increase to harmful levels.
  • Always discuss any symptoms and side effects that you experience during Vandetanib treatment with your doctor. This will form basis for prescribing medications or suggestions on how you can manage those side effects.
  • Reduce or avoid alcohol and beverage consumption while on Vandetanib medcation. Be sure to discuss this with your doctor
  • Get enough rest
  • Maintain a healthy nutrition

Vandetanib Risk Evaluation and Mitigation Strategy (REMS) Program

Due to the risk of QT prolongation, sudden fatality, and Torsades de pointes, Vandetanib is only available via a restricted distribution program called the REMS Program. Thus, only pharmacies and prescribers certified with the REMS program are allowed to prescribe and dispense this medication.

Here is an overview of the requirements for pharmacies and prescribers:

  • Prescribers must review the educational materials and accept the REMS' terms of enrollment and compliance
  • Dispensing pharmacies must enroll in the program, train their staff to verify that presented prescriptions are duly written by certified prescribers before dispensing the medication to the patient

Vandetanib overdose

There is no specific Vandetanib overdose treatment. In addition, possible overdose symptoms are not yet very clear. Since the drug has 19-day half-life, severe reactions may take longer to resolve. That said, call the poisons control department, or 911 immediately when the patient exhibits serious symptoms like difficulty in breathing and passing out.

Vandetanib storage

It is advisable that you store this medication in the container it came with. Close the bottle tightly and keep out of children's reach. Store the medication at room temperature and away from excess moisture and heat. Do not keep the medication in your bathroom.

Dispose of all unused medication to ensure that pets, children and other members of your household do not reach and use them. That said, do not flush the medication down the toilet. Instead, use the medicine take-back program. You may learn about this from your pharmacist or from the local garbage collection and recycling department in your community. Visit the FDA's Safe Disposal of Medicines web page for more information on how you can dispose of Vandetanib. Do not store Vandetanib medication alongside other medications like creams, eye drops and inhalers. To prevent accidental use by children, or other members of your household, always keep this medication under lock and key in a safe location.

Points to remember:

  • Store under lock and key away from children
  • Do not flush down the toilet
  • Store at room temperature
  • Protect from moisture (store away from your kitchen and bathroom)


Developed by AstraZeneca, Vandetanib (trade name Caprelsa) is an anti-cancer medication that is used for treating certain tumors of the thyroid gland. It works by acting as a kinase inhibitor on certain cell receptors, mainly the Epidermal Growth Factor Receptor (EGFR), Vascular Endothelial Growth Factor Receptor (VEGFR), and the RET-tyrosine kinase. In addition, the drug stops endothelial cell migration, proliferation, growth and formation of new blood vessels in in vitro models of angiogenesis. This reduces tumor vessel permeability thus helps slow down or stop the spread of cancer cells altogether.

Vandetanib is administered to treat a type of thyroid cancer that cannot be treated via surgical procedures or that has spread to other parts of the body. Vandetanib belongs to a class of medications called kinase inhibitors.

During treatment, it is important that you keep all your appointment with the doctor and laboratory. Your doctor will recommend laboratory tests from time to time to check how your body is responding to the medication. Your doctor will also monitor your blood pressure from time to time during the treatment period.

Since Vandetanib interacts with most medications, it is important that you inform your doctor of all the prescription as well as non-prescriptions you are on before starting this therapy. Finally, always look out for Vandetinab side effects and discuss them with your doctor as soon they manifest for urgent action.

Last Reviewed:
December 25, 2017
Last Updated:
April 05, 2018
Content Source: