Sunitinib - Oral

Sunitinib is used to treat certain cancers of the stomach or intestines, pancreas, and kidneys.

Take Sunitinib exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

You may take this medicine with or without food. Try to take it at the same time each day.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the course of treatment depending on the type of your condition and your response to the medication.

Sunitinib must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it unless instructed by the doctor.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to take your medicine, let your doctor and pharmacist know.

Inform your doctor if you have the following conditions:

• heart problems e.g. recent heart attack, irregular or abnormal heartbeat, heart failure (weakness and inability of the heart to pump blood)
• high blood pressure
• imbalance of essential minerals in the body
• history of aneurysm (weakness and bulging of the blood vessel wall in the lower major blood vessel away from the heart)
• history of blood clots or bleeding problems
• thyroid disease
• diabetes
• liver disease
• kidney disease

Let your doctor know if you are pregnant.

It is important that you do not get pregnant while being treated with Sunitinib. You may wish to discuss birth control methods with your doctor or pharmacist.

Breastfeeding is not recommended while taking this medicine.

Be sure to check with your doctor or pharmacist before giving this medicine to the elderly. Elderly people may be more sensitive to the side effects.

If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking Sunitinib.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Pregnancy tests must be done before treatment to know if this medicine is suited for you to take.
• Routine tests (e.g. liver function, complete blood count, blood sugar and electrolyte levels, ECG [test used to record the electrical activity of the heart]) may be done before and while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Your blood pressure may rise to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
• Regular monitoring for signs and symptoms of bleeding, thyroid problems, and hand-foot skin reactions may also be needed.

Sunitinib may cause dizziness. If affected, do not drive or take part in any activity in which you need to be alert.

Other side effects include any of the following: tiredness, difficulty sleeping, back pain, muscle pain, hair loss, changes in taste, diarrhoea, nausea, vomiting, stomach pain, indigestion, stomach wind, burping, dry mouth, and mouth sores.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• chest pain, tightness or pressure, irregular heartbeat, pain that may spread to the arms, jaw, neck, shoulder or back, shortness of breath, lightheadedness
• weakness or numbness on one side of the body, trouble speaking, vision problems, changes in balance or coordination
• yellowing of the skin or eyes, abdominal pain, dark coloured urine, swelling in the legs and ankles
• pain or difficulty in passing urine, change in how much urine is passed, blood in the urine
• pass out bloody or black as tar stools and vomiting blood or ground coffee-like material
• rashes with peeling of the skin or blistering of the lips, mouth or eyes accompanied by fever
• redness, dryness, thickness, blistering or cracking of the skin on the palms of the hands or soles of the feet
• pain, swelling and tenderness in your leg accompanied by redness and warmth
• change in weight, feeling nervous, depressed, excitable, restless, or weak, hair thinning, eye or neck swelling, not able to focus, increased sensitivity to heat or cold, tremors, sweating
• feeling confused, decreased alertness, change in eyesight, loss of eyesight, or very bad headache
• fits or seizures
• rashes, breathlessness, swelling of the face, eyes, mouth or throat

This medicine may cause the level of your red blood cells, white blood cells and platelets to drop.

Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.

White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, cough, or flu that does not go away.

Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Inform your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Inform your doctor and pharmacist if you are taking any of these medicines:

• medicines to treat fungal infection e.g. ketoconazole, itraconazole
• medicines for irregular heartbeat
• medicines for osteoporosis (thinning and weakening of bones) e.g. ibandronic acid, risedronic acid, zoledronic acid
• certain antibiotics e.g. clarithromycin, erythromycin
• ritonavir (medicine for HIV infection)
• rifampicin (medicine to treat TB [lung infection known as tuberculosis])
• dexamethasone (anti-inflammatory medicine)
• St. John's wort (herbal medicine)

This list does not include all medicines that may interact with Sunitinib.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol.

Avoid excessive consumption of grapefruit or grapefruit juice (more than 1 litre a day).

Store in a cool, dry place away from the reach of children.

Medicines must not be used past the expiry date.

As Sunitinib is a cancer medicine, always return any unused or expired capsules to the clinic, hospital, or pharmacy for disposal. Do not throw it away in the household waste.