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lenvatinib

( len VA ti nib )
Funding:
Exceptional Access Program
  • For the treatment of patients with locally recurrent or metastatic, progressive, radioactive-iodine-refractory differentiated thyroid cancer (DTC) according to criteria
Other Name(s): Lenvima (Eisai)
Appearance: capsule in various strengths, shapes and colours

Medication Information Sheet
lenvatinib (len VA 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: Lenvima

Appearance:
capsule

in various strengths, shapes and colours

What is this medication for?
  • For treating a type of thyroid or kidney 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 or had:
     
    • high blood pressure, 
    • liver, kidney or heart problems (including an irregular heartbeat),
    • have diabetes or nerve problems, 
    • or any allergies.
       
  • Tell your health care team if you have an eating disorder, are following a strict diet, or have conditions that may change salt levels in your blood such as severe vomiting or diarrhea.
  • People with cancer have a higher risk of getting other cancers or developing blood clots. Some cancer medications may increase these risks, especially if used for a long period of time. Discuss any concerns about this medication with your health care team.
How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding.
     
  • 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 while taking this drug. Keep using birth control for at least 1 month after your last dose unless your health care team told you differently. Talk to your health care team to figure out the best method(s) for you and/or your partner.
     
  • Do not breastfeed while using this drug.
     
  • This medication may affect fertility (ability to get pregnant).
How is this medication given?
  • Swallow whole with a glass of water, with or without food.
  • Take the dose at about the same time each day.

  • If you miss a dose, take it if it is within 12 hours from the missed dose, otherwise skip and take your next dose as scheduled. Do not double the dose to make up for the forgotten one.

What else do I need to know while on this medication?
  • This medication often interacts with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your healthcare team knows about all your medications (prescription, over-the-counter, herbals and supplements), especially if you have taken other anticancer medications, are taking blood pressure or heart medications, water pills or antibiotics. Check with your healthcare team before starting or stopping any of them.
     
  • For mild aches and pain:
    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
    • Talk to your health care team first before starting ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), since these may increase your chance of bleeding.
    • If you are already taking aspirin regularly, such as for heart conditions; Do not stop it- talk to your health care team first.
    • If you feel unwell, take your temperature before using any of these drugs. They may hide a fever. Phone 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.
       
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.


     
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?

You may not have all of the side effects below. You may have side effects that are not listed.

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

Abnormal kidney lab tests (may rarely be severe)

  • Signs of a kidney problem include swelling, passing very little or no pee, or new unusual weight gain. If you have these signs, call your health team or go to your closest emergency department.
  • To prevent bladder or kidney problems, drink lots of water or other liquids. Your doctor may ask you to drink at least 6 to 8 cups (2 L) per day on treatment days, unless you have been told otherwise.
  • Your doctor may check your kidney function regularly.
Contact your health care team if no improvement or if severe

High blood pressure (may be severe)

  • Check your blood pressure regularly. Your doctor may prescribe medication to treat high blood pressure.
  • If you have a severe headache, severe dizziness, or if you faint get emergency help right away as it may be a sign your blood pressure is too high.
Contact your health care team if no improvement or if severe

Diarrhea (may be severe)

May happen days to weeks after you get your treatment.

If you have diarrhea :

  • Take anti-diarrhea medication if your health care team prescribed it.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “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 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.

Contact your health care team if no improvement or if severe

Changes in thyroid activity

  • May happen in weeks to months after you receive your treatment.
  • Your doctor may monitor your thyroid function regularly with a blood test.

Underactive thyroid: Look for unusual weight gain with some of the following: Feeling tired or having low energy, dry skin, nails or hair that breaks easily, and sensitivity to cold.

Contact your health care team as soon as possible

Low appetite and weight loss

  • You may not feel like eating or you may lose weight.
  • Try to eat foods that you like and 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 a low appetite.
  • See our Loss of appetite pamphlet for more information.
Contact your health care team if no improvement or if severe

High blood sugar 

  • You may feel thirsty and pee more often.
  • Your doctor may check your blood sugar level. You may be advised to change your diet or take medication to treat high blood sugar.
  • Check your blood sugar regularly if you have diabetes.
Contact your health care team as soon as possible

Abnormal liver lab tests (may be severe)

  • You may have yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. Talk to your health care team if this happens.
  • Your doctor may monitor your liver regularly with a blood test.
Contact your health care team if no improvement or if severe

 

 

 

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

Low amounts of protein (albumin) in your blood

  • It can cause muscle weakness, swelling, fatigue, cramps and poor appetite.
  • This may be caused by protein loss in your pee
  • Your doctor may monitor for protein in your pee regularly
Contact your health care team as soon as possible

Mild swelling in arms and legs; puffiness

  • To help prevent swelling, eat a low salt diet and avoid tight-fitting clothing
  • If you have swelling in your legs, keep your feet up when sitting
Contact your health care team if no improvement or if severe

Nausea and vomiting

May occur in hours to days after your treatment. 

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • 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 (e.g. coffee, tea) and alcohol.
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

Contact your healthcare team if no improvement or if severe

Fatigue (tiredness)

  • Be active and 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.
  • Eat well and stay hydrated by drinking 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

See our Fatigue pamphlet for more information. 

Contact your health care team if no improvement or if severe

Mouth sores

You may have round, painful, white or gray sores inside your mouth. They can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard swallow, eat or to brush your teeth. They usually last 1 to 2 weeks.

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often. Do not use mouthwashes with alcohol.
  • Instead, try a homemade mouthwash:
  • Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.

If you have mouth sores:

  • Check with your health care team as soon as you notice mouth or lip sores or if it hurts to swallow.
  • Avoid hot, spicy, acidic, hard or crunchy foods.. Your doctor may prescribe a mouthwash to relieve mouth sores and prevent infection.

See the Mouth Care pamphlet for more information.

Contact your health care team as soon as possible

Salt imbalances

It may cause muscle twitching, severe weakness or cramping, confusion and irregular heartbeat.

Get emergency medical help right away

Headache; mild joint, muscle pain or cramps 

  • Take your pain medication as prescribed by your doctor.
  • You can take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
  • Talk to your doctor or pharmacist first before taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin. These medication may increase bleeding risk.
  • Rest often and try light exercise as it may help.
Contact your health care team if no improvement or if severe

Unusual bleeding or bruising (may be severe)

  • You may have black stools (poo), cough up blood, blood in your pee, purple or red dots on your skin, or bleeding that will not stop.
  • It may happen in days to weeks after you receive your treatment.
  • It may be due to low platelets (a type of blood cell).
  • Take care of your mouth and use a soft toothbrush.
  • Be careful not to cut or hurt yourself.
  • Check with your doctor before you have any surgeries and before going to see the dentist.
  • See the low platelets pamphlet for more information.

     
Get emergency medical help right away

Hand-foot syndrome

You may have pain, thinning, reddening, tingling, numbness and peeling of the skin on your palms or the soles of your feet.

This may occur days to weeks after the dose is given or after you start treatment. 

To help prevent Hand-foot syndrome :

  • Avoid activities that cause rubbing, pressure or heat exposure to hands and feet (i.e. gripping tools, vigorous washing and hot baths).
  • Apply moisturizer often to your hands and feet, especially in the skin folds.
  • Wear loose, comfortable footwear and clothes. Rest and try to keep off your feet.

Also see Hand-Foot Syndrome pamphlet for more information.

Contact your health care team if no improvement or if severe

Pains or cramps in the belly

  • If you have constipation or diarrhea it may be causing the pain in your belly.
  • If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.
Contact your health care team if no improvement or if severe

Hoarseness (raspy voice) 

Let your doctor know if this bothers you.

Contact your health care team if no improvement or if severe

Constipation

To help prevent constipation :

  • Drink more liquids and eat well. Drink at least 6 to 8 cups of liquids each day unless you have been told otherwise.
  • Be Active. Exercise can help to keep you regular.
  • Try to eat more fiber (e.g. fruits with skin, leafy greens and whole grains). 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. Ask your health care team what to do.

See the Constipation Pamphlet for more information.

Contact your health care team if no improvement or if severe

 

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

Cough; feeling short of breath (may rarely be severe)

You may have cough and feel short of breath without any signs of infection, such as a sore throat or a stuffed nose.

Get emergency help right away if you cough up blood.

Contact your health care team if no improvement or if severe

Rash; dry, itchy skin

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.

To prevent and treat dry skin,

  • Use 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.
Contact your health care team if no improvement or if severe

Taste changes

  • Eat food that needs less chewing.
  • Taste foods at different temperatures, since the flavor may change. 
  • Try different forms of foods, like fresh, frozen or canned.
  • Experiment with non-spicy foods, spices and seasonings. 
Contact your health care team if no improvement or if severe

Dry mouth

To help prevent and treat dry mouth :

  • Use sugar-free gum or lozenges (e.g. contains xylitol) to help you make saliva.
  • Rinse your mouth with a homemade mouth rinse (1 teaspoon of salt and 1 teaspoon of baking soda in 4 cups of water) every 1 to 2 hours
  • Suck on ice chips or sugarless popsicles to help relieve dry mouth.
  • Spray your mouth with water or artificial saliva products (e.g., Moi-Stir Spray®, Biotene® products) as needed to keep it moist.
  • Speak to your health care team about the right product for you.

See our Mouth Care pamphlet for more information.

Contact your health care team if no improvement or if severe

Abnormal cholesterol or fat levels in the blood

Your doctor may check your cholesterol levels regularly with a blood test.

Contact your health care team if no improvement or if severe

Dizziness

  • You may feel light headed.
  • Lay down if this happens.
  • Get up and move slowly 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

Heartburn; stomach upset

To help prevent heartburn:

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

Abnormal levels of pancreas tests (lipase, amylase)

Your doctor may monitor these regularly.

Contact your health care team if no improvement or if severe

Hair thinning or loss 

  • Use a gentle soft brush and avoid hair sprays, bleaches, dyes and perms.
  • In most cases, your hair will grow back after treatment, but the texture or colour may change. 
 

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 (or 100.4°F) or higher for at least one hour.

While you are getting 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, medical procedures or visiting your dentist.

If you have a fever, talk to your health care team or go to the closest emergency room. 

Get emergency medical help right away

Trouble falling asleep

  • This may be caused by one of your medications and may improve once your body gets used to the medication or when your treatment ends.
  • Talk to your doctor if this bothers you.
Contact your health care team if no improvement or if severe

Irregular or slow heartbeat

  • You may have an irregular or slower than usual heartbeat
  • This may may you feel dizzy or you may faint

 

Get emergency medical help right away

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:

  • Chest pain or swelling in your legs, ankles or belly
  • Severe chest, arm or belly pain
  • Feeling confused, severe headache, problems with your vision, trouble speaking or using your arms or legs
  • Severe or unusual bone pain especially in your back, hips and wrist
  • Severe muscle pain or weakness with dark pee
  • Signs of an allergy such as fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness
  • Wounds that do not heal well or take too long to heal


For more links on how to manage your symptoms go to www.cancercare.on.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.