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SUNItinib

( soo-NIT-in-ib )
Funding:
Exceptional Access Program
  • SUNItinib - Unresectable or metastatic/recurrent Gastrointestinal Stromal Tumour, with specific criteria
  • SUNItinib - Metastatic renal cell carcinoma, with specific criteria
  • SUNItinib - For patients who have progressive, unresectable, well or moderately differentiated, locally advanced or metastatic pancreatic neuroendocrine tumours (pNET), according to specific criteria
Other Name(s): Sutent®
Appearance: capsule In various strengths and colours

Medication Information Sheet
SUNItinib (soo-NIT-in-ib)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Sutent®

Appearance:
capsule

In various strengths and colours

What is this medication for?
  • For treating some types of kidney cancer, as well as gastrointestinal stromal tumors (GIST) - a rare cancer usually affecting the stomach or intestines, and a rare type of pancreas cancer.

What should I do before I have this medication?
  • Tell your doctor and pharmacist if you have/had liver, kidney, thyroid, adrenal gland, heart problems (including stroke, fainting spells), family history of heart problems, high blood pressure, bleeding problems, any recent or upcoming surgery, severe injury or infection, or any allergies.
  • People who have cancer or leukemia are at a higher risk of developing other cancers/leukemias (usually some years later) or blood clots. Some cancer medications may increase these risks, especially if used for a prolonged period of time. You should discuss any concerns with your doctor.
How will this medication affect sex, pregnancy and breastfeeding?
  • Sunitinib can harm the unborn baby and should not be used by pregnant women. 
  • If there is ANY chance that you or your partner may become pregnant, you and your partner together must:  ►Use 2 effective forms of birth control at the same time during treatment and until at least 6 months after stopping treatment (general recommendation). Discuss with your healthcare team.
  • Tell your doctor right away if you or your partner becomes pregnant.
  • Do not breastfeed while taking sunitinib.
  • Effects on Fertility: Probable
How is this medication given?
  • Swallow whole with a glass of water, with or without food.
  • Do not crush or open the capsules.
  • Take it exactly as directed by your doctor. Make sure you understand the instructions. Do not take it more often or for a longer time than your doctor ordered.
  • Sunitinib is usually taken once a day on treatment days.
What else do I need to know while on this medication?
  • Do not eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.

  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain or fever:

    • If you feel unwell, take your temperature before taking any medications for pain or fever. They may hide a fever. 
       
    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
       
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding. Talk to your health care team before you start or stop these medications.
       
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
How should I safely store this medication?
  • Keep this medication in the original packaging at room temperature in a dry place, away from heat and light. Keep out of sight and reach of children and pets.

  • Do not throw out any unused medications at home. Bring them to your pharmacy to be thrown away safely.

 

 

 

What are the side effects of this medication?

The following side effects are common or severe. You may not have all of the side effects listed, while others not on this list may also occur. Discuss with your doctor if you have any unusual or bothersome symptoms.

Side effects and what to do When to contact doctor?
More Common Side Effects

Abnormal liver and/or pancreas lab tests (may be severe)

  • Your doctor will monitor these regularly.  Call your doctor if you have yellowish skin or eyes, unusual dark urine or increased pain in centre of belly that may extend to the back.
Contact your health care team if no improvement or if severe

Abnormal kidney lab tests (may be severe)

  • Your doctor may monitor your kidney function regularly.
  • Call your doctor or get emergency medical help if you have signs of kidney problems such as body swelling, passing little or no urine, or recent unusual weight gain.
Contact your health care team if no improvement or if severe

Diarrhea

  • Drink plenty of clear fluids. Limit hot, spicy, fried foods, foods/drinks with caffeine, orange or prune juice. Try a low-fiber BRAT diet (Bananas, white Rice, Apple sauce, Toast made with white bread).
  • Take anti-diarrhea drug(s) if given to you by your doctor.
  • Also see Diarrhea pamphlet.*
Contact your health care team if no improvement or if severe

Tiredness

  • Rest often; take naps if needed. Move slowly when getting up.
  • Eat well-balanced meals and drink plenty of fluids. Light exercise may help.
  • Do not drive a motor vehicle or operate machinery when feeling tired.
Contact your health care team if no improvement or if severe

Nausea and vomiting (generally mild)

  • Drink clear fluids and avoid large meals. Get fresh air and rest.
  • Limit spicy, fried foods or foods with a strong smell.
  • Take anti-nausea drug(s) exactly as directed by your doctor. It is easier to prevent nausea than to treat it.
  • Contact your doctor if nausea lasts more than 48 hours or vomiting for more than 24 hours.
  • Also see Nausea & Vomiting pamphlet.*

 

Contact your health care team if no improvement or if severe

Unusual taste

  • Chewing gum or sucking on ice chips may help.
Contact your health care team if no improvement or if severe

Salt imbalances
(muscle twitching, severe weakness or cramping, confusion, irregular heartbeat)

Get emergency medical help right away

Heartburn; stomach upset

  • Avoid fatty or spicy foods.
  • Remain upright after eating. Drink clear fluids and avoid large meals.
Contact your health care team if no improvement or if severe

Mouth sores

  • Maintain good mouth hygiene. Regular teeth brushing with a soft toothbrush or Toothette®, and regular use of alcohol-free mouthwashes.
  • Instead, try a homemade mouthwash: 
    Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
  • Avoid hot, spicy, acidic, hard or crunchy foods.
  • Check with your doctor or nurse as soon as you notice sores in mouth/lips or pain with swallowing. Your doctor may prescribe a prescription mouthwash to relieve mouth sores and prevent infection.
  • Also see Mouth Care pamphlet.*
Contact your health care team as soon as possible

Poor Appetite; don't feel like eating; weight loss

  • Eat foods that you like and try to eat regular small meals.
  • Use meal supplements if possible.  See a dietitian.
Contact your health care team if no improvement or if severe

Changes in skin colour (yellow), lightening in hair colour or skin pigment

  • This is possibly due to the yellowish colour of the drug and is not harmful. May return to normal after your treatment ends.
Contact your health care team if no improvement or if severe

Rash; dry, itchy skin (may rarely be severe)

  • Stay out of the sun; wear sunblock, a hat and cover exposed skin.
  • Use daily moisturizer.
  • May be severe, including blisters, skin peeling or severe skin infection; get medical help right away if this occurs.
Contact your health care team if no improvement or if severe

Pains or cramps in the belly

  • Treat constipation or diarrhea.
  • May be due to other causes; check with your doctor or nurse if pain is severe, does not go away or worsens.
Contact your health care team if no improvement or if severe

Hand-foot syndrome
(pain, thinning or reddening palms or feet, including tingling, numbness, peeling)

  • Avoid activities that cause rubbing, pressure or heat exposure to hands and feet (i.e. gripping tools, vigorous washing, hot baths).
  • Apply moisturizer liberally and often to your hands and feet, especially in the creases.
  • Wear loose, comfortable footwear and clothes. Rest and try to keep off your feet.
  • Also see Hand-Foot Syndrome pamphlet.*
Contact your health care team if no improvement or if severe

High blood pressure

  • Check your blood pressure regularly; medication to treat high blood pressure may be needed.

Severe headache, severe dizziness, fainting (rare)

  • May be due to a significant rise in blood pressure. Get medical help right away if this happens.
Contact your health care team if no improvement or if severe

Decreased heart function (swelling in the legs/ankles/belly, shortness of breath, rapid or irregular heart beat)

Get emergency medical help right away

Abnormal blood sugar levels

  • Check your own blood sugar if you are diabetic.
  • Symptoms of high blood sugar levels: increased thirst and urinates frequently.
  • Symptoms of low blood sugar levels: hungry, shaky, dizzy, nervous, weak, confused. Sweetened lemonade, glucose tablets, or candy can help increase blood sugar levels in mild cases.
  • Get emergency medical help if you have significant changes in blood sugar levels.

 

 

 

Contact your health care team if no improvement or if severe

Constipation

  • Eat a balanced diet with fibres such whole grains, fruit and raw vegetables.
  • Drink plenty of fluids. Try light exercise regularly.
  • Speak to your doctor if no bowel movement for 3 or more days.
  • Also see Constipation Pamphlet.*
Contact your health care team if no improvement or if severe

Underactive thyroid (or less commonly, overactive)

  • May occur in weeks to months after the dose is given/after treatment starts.
  • Your doctor may monitor your thyroid function regularly.
  • Underactive thyroid: Look for unusual weight gain with some of the following: Feeling tired or having no energy, dry skin, brittle nails or hair, cannot tolerate coldness
  • Overactive thyroid: Look for unusual weight loss with some of the following: Increased sweating and/or appetite, feeling irritable or overactive, rapid or irregular heartbeats
Contact your health care team as soon as possible

Headache; joint, muscle pain or cramps 

  • Take painkiller(s) as directed, if given to you by your doctor.
  • Otherwise, take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
  • Rest often, but may try light exercise.
Contact your health care team if no improvement or if severe

Unusual bleeding or bruising

You may have black stools, cough up blood, blood in your urine, purple or red dots on your skin or bleeding that will not stop. 

Fever, chills, infection

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (100.4°F) or higher for at least one hour.

While you are getting chemotherapy treatments:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
     
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines, surgeries or visiting your dentist.

If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

Get emergency medical help right away

Side effects and what to do When to contact doctor?
Less Common Side Effects, but may be Severe
Blood clot (limb pain or swelling, hardened vein in limb), may occur in lungs (sudden start of coughing, breathing problems, chest pain, coughing blood) Get emergency medical help right away
Inactive adrenal gland (muscle weakness, tiredness, darkening of skin, weight loss, not feel like eating) Contact your health care team as soon as possible

Irregular heartbeat (also chest pain, fainting, shortness of breath)

Get emergency medical help right away
Blockage of an artery (blood vessel) in your heart, brain, chest, belly, or limbs; this may result in stroke (sudden loss of vision, speech, or the use of your limb(s)) or heart attack (chest pain, shortness of breath), or pain in chest, belly or limb Get emergency medical help right away

Bleeding/clotting disorder
(may include bleeding from more than 1 site, bruising, signs of blood clots, kidney/liver/lung problems, fever, confusion)

Get emergency medical help right away

Abnormal connections forming between body organs (severe pain, sudden bowel or digestion changes)

Rupture in stomach or intestine wall (sudden, severe pain in belly or stomach area)

Get emergency medical help right away

Rapid breakdown of red blood cells, may lead to kidney failure
(yellowing of the skin or eyes and/or red-brown urine)

Get emergency medical help right away

Allergic reaction (severe rash, itchiness, swollen face, lip or tongue, chest or throat tightness; may occur during or shortly after the drug is given)

Get emergency medical help right away

Teeth, mouth or jaw pain, swelling, poor healing or unusual discharge from gums, loosening of teeth, feeling numbness or heaviness in the jaw

  • Maintain good oral hygiene with regular brushing and use of alcohol-free mouthwashes.
  • Any necessary dental work should be done before treatment with sunitinib. 
  • Avoid dental surgeries during sunitinib treatment. Check with your doctor before having any dental work.
  • Ensure dentures fit properly and remove them at night.
Contact your health care team as soon as possible

Proteins in Urine

  • Watch for any unusual body swelling or recent unusual weight gain.
  • Your doctor may monitor for proteins in the urine regularly.
Contact your health care team if no improvement or if severe

Severe skin infection (can spread rapidly and destroy layers of tissue around muscles)

  • Symptoms include high fever, red, severely painful swelling on skin that feels hot; skin may turn purplish and then die.
Get emergency medical help right away
Effects on the brain (severe headache, loss of consciousness, seizures, confusion, vision loss) Get emergency medical help right away

Clots in small blood vessels, may lead to anemia
(red dots on skin, unusual bruising, bleeding, low platelets, paleness and/or severe tiredness, passing little or no urine or dark-coloured urine)

Get emergency medical help right away

Rapid killing of cancer cells when you start treatment may lead to build up of cell waste products

  • If mild, this may cause gout, with joint pains, but if severe, may cause fevers, kidney failure, confusion and be life-threatening.
  • You MUST take the preventive medicines given by your doctor AND
  • Drink plenty of fluids (6-8 glasses per day) and void (urinate) frequently.

 

Get emergency medical help right away

Wounds that do not heal properly

  •  Check with your doctor before any surgery or dental work.
Contact your health care team if no improvement or if severe

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.