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Chemotherapy and other systemic treatment regimens may change due to COVID-19. Find out more at Systemic Treatment Regimens During COVID-19.

crizotinib

( kriz-OH-ti-nib )
Funding:
Exceptional Access Program
  • crizotinib - First or second-line treatment for ALK-positive advanced NSCLC, according to specific criteria
  • crizotinib - First-line treatment for ROS1-positive locally advanced (not amenable to curative therapy) or metastatic NSCLC, according to specific criteria
Other Name(s): Xalkori®
Appearance: capsule available in various strengths

Medication Information Sheet
crizotinib (kriz-OH-ti-nib )
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: Xalkori®

Appearance:
capsule

available in various strengths

What is this medication for?

For treating specific types of lung cancer.

What should I do before I have this medication?
  • Tell your health care team if you have or had significant medical condition(s), especially if you have/had: 
     
    • kidney, liver or heart problems (including abnormal heartbeat)
    • a history of fainting spells (passing out)
    • diabetes
    • nerve problems (pain, numbness or burning sensations)
    • eye problems or
    • any allergies.
       
  • Tell your health care team if you have an eating disorder, are following a strict diet, or have conditions that could lead to salt imbalances (severe vomiting or diarrhea)

 

Remember to:

  • Tell your health care team about all of the other medications you are taking.
  • Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
How will this medication affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

  • How this medication may affect your sexual health.

  • How this medication may affect your ability to have a baby, if this applies to you.

This medication may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

  • If there is ANY chance of pregnancy happening, you and your partner together must:

    • ► Use 2 effective forms of birth control at the same time until 3 months after your last dose. Talk to your health care team about which birth control options are best for you.
  • Do not breastfeed while taking this drug.
     
  • This medication may affect fertility (ability to get pregnant)
How is this medication given?
  • This medication is usually taken twice a day by mouth. Talk to your health care team about how and when to take your medication

  • Swallow whole with a glass of water, with or without food.

  • Do not crush or open the capsules.

  • If you miss a dose, take it if it is within 6 hours of the missed dose. Do not take any crizotinib if it has been more than 6 hours since you missed your dose. Take your next dose as scheduled. Do not double the dose to make up for the forgotten one.
  • If you vomit (throw up) after taking your medication, talk to your health care team about what to do.
     
  • If you take too much of your oral anticancer medication by accident, or if you think a child or a pet may have swallowed your medication, you must call the Ontario Poison Control Center right away.


To Prevent or Treat Nausea and Vomiting

  • You may be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
  • These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), dexamethasone or others.
What else do I need to know while on this medication?

Will this medication interact with other medications or natural health products?

  • This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.

  • Tell your health care team about all of your:

    • prescription and over-the-counter (non-prescription) medications and all other drugs, such as marijuana (medical or recreational)

    • natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements

  • Check with your health care team before starting or stopping any of them.

  • If you take seizure medications (such as phenytoin), your health care team will monitor your blood levels closely and may change your dose.

 

What should I do if I feel unwell, have pain, a headache or a fever?

  • Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol) or ibuprofen (Advil)).

    • Fever can be a sign of infection that may need treatment right away.

    • If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
       

How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

  • 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.


If you do have a fever:

  • Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
  • Ask your health care team for the Fever pamphlet for more information. 

     


If you do not have a fever but have mild symptoms such as headache or mild pain:

  • Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.

  • Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.

  • Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

 

What to DO while on this medication:

  • DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
  • DO consider asking someone to drive you around while you are on treatment, if your vision is blurry or you feel weak or dizzy during your treatment.

What NOT to DO while on this medication:

  • DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
  • DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while taking this drug. They may increase the amount of drug in your blood and increase side effects. 
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.

  • How to safely touch oral anti-cancer medications

    If you are a patient:

    • Wash your hands before and after touching your oral anti-cancer medication.

    • Swallow each pill whole. Do not crush or chew your pills.
       

    If you are a caregiver:

    • Wear nitrile or latex gloves when touching tablets, capsules or liquids.
       

    • Wash your hands before putting on your gloves and after taking them off, even if your skin did not touch the oral anti-cancer medication.
       

    • Throw out your gloves after each use. Do not re-use gloves.
       

    • Do not touch oral anti-cancer medications if you are pregnant or breastfeeding.
       

  • What to do if oral anti-cancer medication gets on your skin or in your eyes

    If medication gets on your skin:

    • Wash your skin with a lot of soap and water. .

    • If your skin gets red or irritated, talk to your health care team.


    If medication gets in your eyes:

    • Rinse your eyes with running water right away. Keep water flowing over your open eyes for at least 15 minutes.

What are the side effects of this medication?

The following table lists side effects that you may have when getting crizotinib. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on crizotinib.

Side effects and what to do When to contact doctor?
Very Common Side Effects (50 or more out of 100 people)

Eye problems 

(may be severe)

What to look for?

  • Your eyes may feel dry, irritated, or painful.
  • They may look red and have a lot of tears.
  • They may feel sensitive to light and your vision may be blurry.
     

What to do?

  • Avoid wearing contact lenses.
  • Wear sunglasses with UV protection.
  • Use protective eyewear (goggles or helmet with face mask) when playing sports, mowing the lawn or doing anything that may get particles or fumes in your eyes.
  • You may try artificial tears (eye drops) or ointment.
Talk to your health care team as soon as possible

Diarrhea

What to look for?

  • Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.

 

What to do?

If you have diarrhea 

  • Take anti-diarrhea medication if your health care team prescribed or recommended it.
  • Avoid foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day.
  • Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.
  • Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day.


Ask your health care team for the Diarrhea pamphlet for more information.

Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day)

Nausea and vomiting 

(generally mild)

What to look for?

  • Nausea is feeling like you need to throw up, you may also feel light-headed.
  • You may feel nausea within hours to days after your treatment.


To help prevent nausea:

  • It is easier to prevent nausea than to treat it once it happens.
  • Take your preventative anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (like coffee, tea) and avoid alcohol.


If you have nausea or vomiting:

  • Take your rescue (as-needed) anti-nausea medication(s) as prescribed.
  • Ask your health care team for the Nausea & Vomiting pamphlet for more information.
  • Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe.


 

Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe

 

Side effects and what to do When to contact doctor?
Common Side Effects (25 to 49 out of 100 people)

Mild swelling

What to look for?

  • You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe.

 

What to do?

To help prevent swelling:

  • Eat a low-salt diet.


If you have swelling:

  • Wear loose-fitting clothing.
  • For swollen legs or feet, keep your feet up when sitting.
Talk to your health care team if it does not improve or if it is severe

Constipation

What to look for?

  • Having bowel movements (going poo) less often than normal.
  • Small hard stools (poo) that look like pellets.
  • The need to push hard and strain to have any stool (poo) come out.
  • Stomach ache or cramps.
  • A bloated belly, feeling of fullness, or discomfort.
  • Leaking of watery stools (poo).
  • Lots of gas or burping.
  • Nausea or vomiting.
     

What to do?

To help prevent constipation:

  • Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains.
  • Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less.
  • Be Active. Exercise can help to keep you regular.
  • If you take opioid pain medication, ask your health care team if eating more fibre is right for you.
     

To help treat constipation:

  • If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do.

Ask your health care team for the Constipation Pamphlet for more information.

Talk to your health care team if it does not improve or if it is severe

Liver problems

(may be severe)

Your doctor may check your liver function with a blood test. The liver changes do not usually cause any symptoms.


What to look for?

  • Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe.


What to do?

If you have any symptoms of liver problems, get emergency medical help right away.

Get emergency medical help right away

Low appetite

What to look for?

  • Loss of interest in food or not feeling hungry
  • Weight loss


What to do?

  • Try to eat your favourite foods
  • Eat small meals throughout the day.
  • You may need to take meal supplements to help keep your weight up.
  • Talk to your health care team if you have no appetite
Talk to your health care team if it does not improve or if it is severe

Fatigue 

What to look for?

  • Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.

 

What to do?

  • Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
  • Check with your health care team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Ask family or friends to help you with things like housework, shopping, and child or pet care.
  • Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your doctor told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired.

Ask your health care team for the Fatigue pamphlet for more information. 

Talk to your health care team if it does not improve or if it is severe

Pains or cramps in the belly

What to look for?

  • Pain or cramps in your belly.
  • Constipation and diarrhea can cause pain in your belly.


What to do?

  • If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.
Talk to your health care team if it does not improve or if it is severe

Taste changes

What to look for?

  • Food and drinks may taste different than usual.


What to do?

  • Eat foods that are easy to chew, such as scrambled eggs, pasta, soups, cooked vegetables
  • Taste foods at different temperatures, since the flavour may change.
  • Try different forms of foods, like fresh, frozen or canned.
  • Experiment with non-spicy foods, spices and seasonings.
Talk to your health care team if it does not improve or if it is severe

Low neutrophils (white blood cells) in the blood (neutropenia)

(may be severe)

When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information.

What to look for?

  • If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever.
  • Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
  • Do not eat or drink anything hot or cold right before taking your temperature.

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.
     

What to do?

If you have low neutrophils

  • Wash your hands often to prevent infection.
  • Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.
  • Keep a digital thermometer at home so you can easily check for a fever.
     

If you have a fever:

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.

 

Side effects and what to do When to contact doctor?
Less Common Side Effects (10 to 24 out of 100 people)

Tingling, numb fingers and toes (neuropathy)

What to look for?

  • Numbness or tingling of your fingers and toes
  • Sometimes it can be painful and feel like burning sensation, which may be severe.


What to do?

  • Talk to your health care team if you have symptoms of neuropathy.
  • Numbness may slowly get better after your treatment ends.


In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice.

Talk to your health care team, especially if you have trouble doing tasks like doing up buttons writing, moving, severe pain or numbness

Cough and feeling short of breath

What to look for?

  • You may have a cough and feel short of breath.
  • Symptoms that commonly occur with a cough are:
    • Wheezing or a whistling breathing
    • Runny nose
    • Sore throat
    • Heartburn
    • Weight loss
    • Fever and chills
  • Rarely this may be severe with chest pain, trouble breathing or coughing up blood.
     

What to do?

  • Check your temperature to see if you have a fever. Read the above section "What should I do if I feel unwell, have pain, a headache or a fever?".
  • If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
  • If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away.
Talk to your health care team. If you are not able to talk to your health care team for advice, and you have a fever or severe symptoms, you MUST get emergency medical help right away

Dizziness

What to look for?

  • You may feel light-headed and like you might faint (pass out).

 


What to do?

  • Lay down right away so you do not fall.
  • Slowly get up and start moving once you feel better.
  • Do not drive a motor vehicle or use machinery if you feel dizzy.
Contact your health care team if no improvement or if severe

Headache; Mild joint, muscle pain or cramps 

What to look for?

  • New pain in your muscles or joints, muscle cramps, or feeling achy.


What to do?

  • Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
  • Read the above section: "What should I do if I feel unwell, have pain, a headache or a fever?" before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding.
  • Rest often and try light exercise (such as walking) as it may help.

 

Ask your health care team for the Pain pamphlet for more information.

Contact your health care team if no improvement or if severe

Heart problems 

You may feel you have a slow heartbeat, feel dizzy or faint (pass out).

Get emergency medical help right away

Heartburn; stomach upset; bloating

What to look for?

  • Pain or burning in the middle or top part of your chest. It may get worse when you are lying down or bending over or when you swallow.
  • A bitter or acidic taste in your mouth.
     

What to do?

  • Drink clear liquids and eat small meals.
  • Do not eat acidic, fatty or spicy foods.
  • Limit caffeine (like coffee, tea) and avoid alcohol.
  • Avoid smoking or being around tobacco.
  • Sit up or stand after eating. Do not lie down.
  • Raise the head of your bed six to eight inches. You may need to use extra pillows to do this.
Talk to your health care team if it does not improve or if it is severe

Low platelets in the blood

(may be severe)

When platelets are low you are at risk for bleeding and bruising. Ask your health care team for the  Low Platelet Count pamphlet for more information.
 

What to look for?

  • Watch for signs of bleeding:
    • bleeding from your gums
    • unusual or heavy nosebleeds
    • bruising easily or more than normal
    • black coloured stools (poo) or blood in your stools
    • red or brown coloured mucus when you cough
    • dizziness, constant headache or changes in your vision
    • heavy vaginal bleeding
    • red or pink coloured urine (pee)  


What to do?

If you have low platelets

  • Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
  • Check with your healthcare team before you go to the dentist.
  • Try to prevent cuts and bruises.
  • Ask your health care team what activities are safe for you.
  • Low platelets may delay your treatment. Your health care team may recommend blood transfusion.

If you have signs of bleeding

  • If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.
  • If you have bleeding that doesn’t stop or is severe, you must get emergency medical help right away.

Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop, you must get emergency medical help right away

Rash; dry, itchy skin

What to look for?

  • You may have cracked, rough, flaking or peeling areas of the skin.
  • Your skin may look red and feel warm, like a sunburn.
  • Your skin may itch, burn, sting or feel very tender when touched.

What to do?

To prevent and treat dry skin:

  • Use fragrance-free skin moisturizer.
  • Protect your skin from the sun and the cold.
  • Use sunscreen with UVA and UVB protection and a SPF of at least 30.
  • Avoid perfumed products and lotions that contain alcohol.
  • Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less.

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Talk to your health care team if it does not improve or if it is severe

 

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

  • Body swelling, passing very little or no pee, or new unusual weight gain

  • Pain, swelling and hardening of the vein in your arm or leg

  • Chest pain, shortness of breath, new pain in your arm

  • Feeling confused, having trouble speaking or using your arms or legs

 

 

 

 

 

Who do I contact if I have questions or need help?          

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

 

Other Notes:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

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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.