Cometriq (Cabozantinib S-Malate)

Cabozantinib (advanced renal cell carcinoma) (ka'' boe zan' ti nib) Cabometyx®

Cabozantinib (Cabometyx) is used to treat advanced renal cell carcinoma (RCC; a type of cancer that begins in the cells of the kidneys) that has worsened after treatment with other chemotherapy medications. Cabozantinib (Cabometyx) is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps slow or stop the spread of cancer cells. Cabozantinib is also available as a capsule (Cometriq) to treat a certain type of thyroid cancer. This monograph only gives information about cabozantinib tablets (Cabometyx) for advanced RCC. If you are using this medication for thyroid cancer, read the monograph entitled cabozantinib (thyroid cancer).

Cabozantinib (Cabometyx) comes as a tablet to take by mouth. It is usually taken once a day on an empty stomach, at least 1 hour before and 2 hours after eating. Take cabozantinib (Cabometyx) at around the same time every day. The length of your treatment depends on how well your body responds to the medication and the side effects that you experience. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cabozantinib (Cabometyx) exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the tablets whole with a full glass (8 ounces, 240 mL) of water. Do not split, chew, or crush them. Your doctor may decrease your dose of cabozantinib (Cabometyx), or tell you to stop taking the medication for a time or permanently if you experience serious side effects. Be sure to talk to your doctor about how you are feeling during your treatment with cabozantinib (Cabometyx). Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with cabozantinib (Cabometyx) and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

Before taking cabozantinib (Cabometyx), tell your doctor and pharmacist if you are allergic to cabozantinib (Cabometyx, Cometriq), any other medications, or any of the ingredients in cabozantinib tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, you are taking or plan to take. Be sure to mention any of the following: boceprevir (Victrelis), carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril), clarithromycin (Biaxin, in Prevpac), conivaptan (Vaprisol), indinavir (Crixivan), itraconazole (Onmel, Sporanox), ketoconazole, nefazodone, nelfinavir (Viracept), phenobarbital, phenytoin (Dilantin, Phenytek), posaconazole (Noxafil), rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate, Rifater), rifapentine (Priftin), ritonavir (Norvir, in Kaletra, Technivie, Viekira Pak), saquinavir (Invirase), telithromycin (Ketek), and voriconazole (Vfend). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with cabozantinib (Cabometyx), so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. tell your doctor what herbal products you are taking, especially St. John's wort. tell your doctor if you have or have ever had any unusual bleeding, high blood pressure, or liver disease. tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant during your treatment and for 4 months after your final dose. Talk to your doctor about birth control methods that you can use during your treatment. If you become pregnant while taking cabozantinib (Cabometyx), call your doctor immediately. tell your doctor if you are breastfeeding. Your doctor may tell you not to breastfeed during your treatment and for 4 months after your final dose. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking cabozantinib (Cabometyx). Your doctor will probably tell you to stop taking cabozantinib (Cabometyx) at least 28 days before your surgery, and will tell you when you should start taking the medication again after your surgery. you should know that your blood pressure may increase during your treatment with cabozantinib. Your doctor will probably monitor your blood pressure before and during your treatment.

Do not drink grapefruit juice or eat grapefruit or any foods or supplements that contain grapefruit or grapefruit juice while you are taking this medication.

Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Cabozantinib (Cometriq) may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: diarrhea constipation hemorrhoids nausea vomiting heartburn change in ability to taste food difficulty swallowing redness, swelling, or pain in your mouth or throat loss of appetite tiredness or weakness bone pain muscle pain or spasms anxiety numbness, burning, or tingling in the hands, arms, feet, or legs rash dry skin patchy thickening of the skin redness, pain, swelling, or blistering on the palms or the soles hair loss hair color turning lighter or gray voice changes or hoarseness Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment: swelling or pain in the arms or legs shortness of breath lightheadedness or fainting sweating numbness or weakness of the face, arm, or leg on one side of your body dizziness difficulty with balance or coordination sudden, severe headache jaw pain toothache seizures vision problems confusion difficulty thinking clearly difficulty eating or drinking due to mouth sores or nausea and vomiting Cabozantinib (Cometriq) may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to cabozantinib (Cabometyx). It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.