Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (430 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ka′boe-zan′ti-nib)
Cometriq
Func. class.:
Antineoplastic biologic response modifiers
Chem. class.:
Signal transduction inhibitor (STI)
Inhibits abnormal tyrosine kinase associated with growth and development of metastatic medullary thyroid cancer
Treatment of progressive metastatic medullary thyroid cancer
Pregnancy (D), hypersensitivity
Precautions:
Breastfeeding, children, geriatric patients, cardiac/renal/hepatic/dental disease, bone marrow suppression, wound dehiscence, skin disease MI, hypertension, proteinuria, infertility, surgery, thrombocytopenia, neutropenia, immunosuppression
Black Box Warning:
Bleeding, fistula, GI bleeding/perforations
Calculator
• Adult:
PO
140 mg/day until disease progression or unacceptable toxicity
•
Avoid the concomitant use of strong 3A4 inhibitors or inducers if possible; temporary interruption of therapy and a dosage reduction may be necessary in patients who develop toxicity or intolerable side effects
Available forms:
Tabs 60, 100, 140 mg
•
Take on an empty stomach; do not eat for ≥2 hr before and ≥1 hr after use; swallow whole; do not open or crush caps
•
Do not take with grapefruit juice
•
Do not take a missed dose within 12 hr of the next dose; if the next dose is in 12 hr or more, take the missed dose; if the next dose is in less than 12 hr, skip the missed dose and take the next dose at the scheduled time
•
Store at room temperature
Grade 4 hematologic toxicity, grade 3 or higher nonhematologic toxicity, or intolerable grade 2 toxicity:
Hold until resolution/improvement, then reduce the daily dosage by 40 mg (eg, 140 mg/day to 100 mg/day or 100 mg/day to 60 mg/day)
Strong CYP3A4 inhibitors:
Avoid use if possible; if a strong CYP3A4 inhibitor is used, reduce the daily cabozantinib dosage by 40 mg; resume the prior dosage after 2 or 3 days if the strong CYP3A4 inhibitor is discontinued
Strong CYP3A4 inducers:
Avoid chronic concomitant use if possible; if a strong CYP3A4 inducer is required, increase the daily cabozantinib dosage by 40 mg, max 180 mg/day; resume the prior dosage after 2 or 3 days if the strong CYP3A4 inducer is discontinued
CNS:
Headache, dizziness
GI:
Nausea, vomiting, dyspepsia, anorexia, abdominal pain, diarrhea, GI bleeding/fistula/perforation
HEMA:
Neutropenia, thrombocytopenia, bleeding
INTEG:
Rash
META:
Hypokalemia
MISC:
Fatigue, hypothyroidism, elevated liver enzymes
MS:
Arthralgia, myalgia
Protein binding 99%, metabolized by CYP3A4
Increase:
cabozantinib concentrations—CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin)
Increase:
plasma concentrations of simvastatin, calcium channel blockers, ergots
Decrease:
cabozantinib concentrations—CYP3A4 inducers (dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital)
Increase:
cabozantinib effect—grapefruit juice; avoid use while taking product
Cabozantinib concentration—St. John’s wort
Proteinuria:
monitor urine protein regularly; discontinue if nephritic syndrome occurs
GI bleeding/fistula/perforation:
can be fatal
Wound dehiscence:
discontinue product ≥20 days before surgery
•
Therapeutic response: decrease in size, spread of tumor
•
To report adverse reactions immediately: bleeding
•
About reason for treatment, expected results
•
That effect on male infertility is unknown
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert