Cabozantinib - Oral

Cabozantinib is used to treat advanced stages of kidney, thyroid, and liver cancer.

Take Cabozantinib 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.

Take it on an empty stomach, at least 1 hour before or 2 hours after a meal.

Try to take it at the same time each day.

This medicine is available as film-coated tablet and capsule. Do not substitute tablets with capsules. Do not open, break or chew the capsules.

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

Cabozantinib 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.

If you miss a dose and it is 12 or more hours before the next dose is due, take the missed dose and return to your normal dosing schedule.

If it is less than 12 hours before the next dose is due, 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:

• bowel disease
• tumours involving the windpipe, airways, or food pipe
• recent serious bleeding
• history of coughing up blood, vomiting blood, or passing black, tarry stools
• at risk of blood clots
• high blood pressure
• history of aneurysm (weakness and bulging of the blood vessel wall in the brain or lower major blood vessel away from the heart)
• history of heart rhythm problems

Let your doctor know if you are pregnant or breastfeeding.

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

Be sure to check with your doctor or pharmacist before giving Cabozantinib to a child. Children may be more sensitive to the side effects.

If you are going for an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking this medicine.

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 and hepatitis B screening must be done before treatment to know if this medicine is suited for you to take.
• Routine tests (e.g. liver and kidney function, complete blood count, electrolyte levels, thyroid function, ECG [test used to record the electrical activity of the heart]) may be done 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 or fall to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
• Regular monitoring of signs of bleeding, jawbone problems, and thyroid problem may also be needed.

Cabozantinib may cause tiredness and weakness. 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: headache, dizziness, changes in taste, loss of taste, ear pain, ringing in the ears, blurred vision, nausea, vomiting, diarrhoea, indigestion, weight loss, sore throat, hoarse voice or changes in voice, cold hands and feet, hair loss, pale skin, dry skin, blister, and acne.

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

• yellowing of the skin or eyes, abdominal pain, dark coloured urine, tiredness, swelling in the legs and ankles
• pain in the mouth, teeth and/or jaw, swelling or sores inside the mouth, numbness or a feeling of heaviness in the jaw, or loosening of a tooth
• pass out bloody or black as tar stools and vomiting blood or ground coffee-like material
• fits or seizures, headache, confusion, difficulty concentrating
• very bad abdominal pain or cramping, bloating or swollen abdomen, fever or chills, tenderness in the abdomen
• wound that does not heal
• unusual or uncontrollable bleeding

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:

• rifampicin (medicine to treat TB [an infection known as tuberculosis])
• ketoconazole (medicine to treat fungal infection)
• clarithromycin (certain antibiotic)
• nefazodone (medicine to treat depression)
• probenecid (medicine for gout [high uric acid level in the blood])
• medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenytoin, phenobarbital
• medicines to treat viral infection e.g. atazanavir, abacavir, ritonavir, lamivudine
• medicines used to treat osteoporosis (thinning and weakening of bones) e.g. alendronic acid ibandronic acid

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

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