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Management tips for common side effects
Although GLIVEC is generally well tolerated, as with all treatments, there are risks of adverse events.1
- Side effects from treatment with GLIVEC are usually mild to moderate and can generally be managed while continuing treatment1
These tips are provided to help with the management of some common side effects that have been associated with GLIVEC.
|Potential nonhematologic side effects||Management tips|
|Fluid retention can result in swelling of the fingers and ankles and general weight gain. Swelling around the eyes (periorbital edema) may be seen. The swelling is usually most noticeable in the morning. It may occur on its own without fluid retention appearing anywhere else in the body.2||To reduce fluid retention, patients should try to eat a diet that is low in salt and avoid eating processed foods whenever possible, as these often have a high sodium content.
Antihistamines, topical corticosteroids, and elevating the head of the bed by 2 inches may be helpful in reducing swelling around the eyes.2
|Nausea and vomiting most often occur if GLIVEC is not taken with or after a main meal. For example, taking GLIVEC after a light breakfast of tea and toast may not be enough.2||Patients should take GLIVEC with or after a main meal and with a large glass of water—at least half a pint. If a patient is taking more than one GLIVEC tablet a day, he or she needs to take them at different times of the day. Also, patients should take GLIVEC at least 2 hours before bedtime. If symptoms continue, antinausea medications such as prochlorperazine or ondansetron can be helpful.2|
|Indigestion is usually mild, but if it persists, physicians may recommend an over-the-counter medication.||To reduce the chance of getting indigestion, patients should take GLIVEC with a meal and a large glass of water—at least half a pint.|
|Diarrhea is a common side effect. It may occur regularly or just after eating certain kinds of meals, such as spicy foods.2||A change in diet to bland foods may be helpful.2
Although antidiarrheal medication that is available over the counter may help to control or prevent diarrhea, patients should consult their physician before taking any medications that have not been prescribed.
|Itchy skin or rash is more likely to occur during the first month of treatment. The forearm or trunk is most often affected.2
Also, some patients find they burn more easily in the sun.
|Physicians may prescribe an additional medication such as an antihistamine tablet or cream or a corticosteroid cream. To avoid sunburn, patients should be sure to cover up and always use a high-factor sun cream whenever they go outside.2|
|Painful joints are most common at the start of treatment. This symptom usually occurs during the first week and may last for up to a few months. It may get better with time.||Patients should tell their physician if they experience pain in muscles, bones, or joints.
Also, caution is advised when taking GLIVEC with acetaminophen or paracetamol. Patients should not take over-the-counter pain medicine without consulting their physician first.
|Muscle cramps are quite common in patients when treatment first starts but often wear off after a few weeks. Cramps tend to occur primarily in the hands, feet, calves, and thighs.2||Using direct heat from a heated wrap has helped some patients. Increasing daily fluid intake, taking calcium and magnesium supplements, or drinking tonic water may also help.2
Patients should talk to their physician or nurse for other recommendations.
|Headaches are usually mild to moderate.||Caution is advised when taking GLIVEC with acetaminophen or paracetamol. Patients should not take over-the-counter pain medicine without consulting their physician first.|
Please see Warnings and Precautions page for more information.
Address hepatotoxicity, hematologic, and nonhematologic adverse events
Dose adjustment for hepatotoxicity and nonhematologic adverse events
- If a severe nonhematologic adverse reaction develops with GLIVEC use, treatment must be withheld until the event has resolved. Thereafter, treatment can be resumed as appropriate depending on the initial severity of the event1
- If elevations in bilirubin >3 x institutional upper limit of normal (IULN) or in liver transaminases >5 x IULN occur, GLIVEC should be withheld until bilirubin levels have returned to <1.5 x IULN and transaminase levels to <2.5 x IULN. Treatment with GLIVEC may then be continued at a reduced daily dose1
- In adults, the dose should be reduced from 400 mg to 300 mg, or from 600 mg to 400 mg, or from 800 mg to 600 mg. In children, reduce the dose from 340 mg/m2/day to 260 mg/m2/day1
Hematologic adverse reactions
- Hematologic side effects that have been reported by patients taking GLIVEC are neutropenia, thrombocytopenia, anemia, and pancytopenia1
- Dose reduction or treatment interruption for severe neutropenia and thrombocytopenia are recommended as indicated in the chart below1
|Starting dose||Absolute neutrophil count (ANC)/platelets||Guidelines|
|400 mg||ANC <1.0 x 109/L and/or platelets <50 x 109/L||
References: 1. Glivec® (imatinib) summary of product characteristics. Dublin, Ireland: Novartis Europharm Limited. 2. Joensuu H, Trent JC, Reichardt P. Practical management of tyrosine kinase inhibitor-associated side effects in GIST. Cancer Treat Rev. 2011;37(1):75-88.