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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.

cabozantinib (tablet)

( ka boe ZAN ti nib )
Funding:
Exceptional Access Program
  • cabozantinib - For the treatment of advanced renal cell carcinoma (RCC) according to clinical criteria
  • cabozantinib - For the treatment of unresectable, advanced hepatocellular carcinoma (HCC) according to clinical criteria
Other Name(s): Cabometyx®
Appearance: tablet

Medication Information Sheet
cabozantinib (tablet) (ka boe ZAN 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: CABOMETYX®

Appearance:
tablet

What is this medication for?

For treating a type of kidney cancer called renal cell carcinoma or a type of liver cancer called hepatocellular carcinoma.

What should I do before I have this medication?
  • Tell your health care team if you have or had significant medical condition(s), such as:

    • high blood pressure

    • heart problems (including irregular heartbeat)

    • thyroid, liver or kidney disease

    • diarrhea or inflammatory bowel disease (for example Crohn’s disease or ulcerative colitis, diverticulitis, or appendicitis)

    • any bleeding problems, blood clots, or problems with wound healing

    • any allergies
  • Tell your health care team if you plan to have any surgery, including dental surgery. Your health care team may ask you to stop cabozantinib treatment for 28 days or more before any scheduled surgery.

  • Cabozantinib tablets contains a small amount of lactose. If you cannot have lactose, talk to your healthcare team.

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 4 months after your last dose. Talk to your health care team about which birth control options are best for you.

  • This medication may make hormonal birth control, such as birth control pills, less effective (not work as well). If you choose to use a hormonal birth control, make sure you also use a barrier or non-hormonal birth control method (such as condoms). Talk to your health care team about the best birth control options for you.

  • Do not breastfeed while on this medication and until 4 months after your last treatment dose.

How is this medication given?
  • This medication is usually taken once a day by mouth, at about the same time each day.

  • Swallow whole with a full glass (at least 8 ounces) of water on an empty stomach, at least 1 hour before or at least 2 hours after food.

  • Do not crush or chew the tablets.

  • If you miss a dose and your next dose is in:

    • less than 12 hours, take your next dose at its scheduled time. Do not make up the missed dose.

    • 12 hours or more, take the missed dose as soon as you remember. Take your next dose at the normal time.

  • Do not take 2 doses at the same time or extra doses.

  • 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 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 at:
    1-800-268-9017.

 

 

To Prevent or Treat Nausea and Vomiting

You may be given medications to prevent or stop nausea (feeling like throwing up) and vomiting (throwing up) before they start. These are called anti-nausea medications.

  • Medications to prevent nausea and vomiting before they start include ondansetron (Zofran®), granisetron (Kytril®), aprepitant (Emend®), or others.

 

If you already have nausea and/or vomiting, some anti-nausea medications can stop them from getting worse. You may be given these medications to have at home in case you start to feel nausea or if you vomit.

  • Medications to stop nausea and vomiting include prochlorperazine (Stemetil®), metoclopramide (Maxeran®), or others.

 

To Treat Diarrhea

Diarrhea is when you have loose bowel movements (watery poo) or you need to go poo (have bowel movements) more often than usual. Diarrhea may start a few days after your treatment.

You may be given a medication called loperamide (Imodium®) to help treat your diarrhea. Take this medication only if you need it. Keep your loperamide with you all the time. When diarrhea starts, take the loperamide right away.

If you start to have diarrhea:

  • Take 2 tablets (4mg) of loperamide right away.

  • Take 1 tablet (2mg) after each episode of diarrhea up to a maximum of 8 tablets (16 mg) per day.

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 cannabis/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.
       

  • 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.

 

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. 

  • DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel drowsy or dizzy.

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 cabozantinib. 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. Keep this paper during your treatment so that you can refer to it if you need to.

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

Diarrhea

(May be severe)

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 it or told you to take it.
  • Do not eat 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, unless your health care team has told you to drink more or less.
  • 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 to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
  • Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea 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)

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 health care team has 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

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.

 

What to do?

To help prevent nausea:

  • It is easier to prevent nausea than to treat it once it happens.
  • If you were given anti-nausea medication(s), take them 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
    • vomiting lasts more than 24 hours or if it is 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

 

Common Side Effects (25 to 49 out of 100 people)
Side effects and what to do When to contact health care team

Low appetite, weight loss

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.

Ask your health care team for the Loss of Appetite pamphlet for more information.

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

High blood pressure

(May be severe)

What to look for?

  • There are usually no signs of high blood pressure.
  • Rarely, you may have headaches, shortness of breath or nosebleeds.
     

What to do?

  • Check your blood pressure regularly.
  • Your doctor may prescribe medication to treat high blood pressure.

If you have a severe headache get emergency help right away as it may be a sign your blood pressure is too high.

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

Rash on your hands and feet (hand-foot syndrome)

What to look for?
 

  • Tingling or swelling of the skin on the palms of your hands and the bottoms of your feet. This can become painful, red and numb.
  • In worse cases your skin may start to peel and you can get blisters or sores.
  • This may happen days or weeks after you start treatment.
     

What to do?

To help prevent Hand-foot syndrome:

  • Do not do activities that cause rubbing or pressure on your skin, like heavy-duty washing, gripping tools, typing, playing musical instruments, and driving.
  • Moisturize your hands and feet often, especially in the skin folds.
  • Wear loose, comfortable footwear and clothes.
  • Rest and try to keep off your feet.
  • Do not let your hands and feet get too hot.

Ask your health care team for the Hand-foot syndrome 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 health care team may check your liver function with a blood test. 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

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

 

 

Less Common Side Effects (10 to 24 out of 100 people)
Side effects and what to do When to contact health care team

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

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

Too much or too little salt in your body

What to look for?

  • Muscle spasms, cramping, weakness, twitching, or convulsions.
  • Irregular heartbeat, confusion or blood pressure changes.
     

What to do?

Get emergency medical help right away for severe symptoms.

Get emergency medical help right away for severe symptoms

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

Mouth sores

What to look for?

  • Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
  • In more severe cases they may make it hard to swallow, eat or brush your teeth.
  • They may last for 3 days or longer.


What to do?

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often with a homemade mouthwash.
  • To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
  • Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth.

 

 

 

 


If you have mouth sores:

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

Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information.

Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow

Changes in thyroid activity

Thyroid changes may happen weeks to months after you receive your treatment.

Your health care team may check your thyroid activity regularly with a blood test.

What to look for?

Underactive thyroid:

  • Unusual weight gain
  • A lack of energy or feeling tired
  • Getting cold easily
  • Dry skin, nails or hair that breaks easily
  • Constipation (having bowel movements (poo) less often than normal)
     

What to do?

Your health care team may give you prescription medication to treat underactive thyroid.

If you have weight changes along with any of the other symptoms listed, talk to your health care team as soon as possible.

Contact your health care team as soon as possible (office hours)

Speech problems (hoarseness)

What to look for?

  • Your voice may become hoarse or raspy.
     

What to do?

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

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

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

Anemia (low red blood cells)

What to look for?

  • You may feel more tired or weaker than normal.
  • Pale skin and cold hands and feet.
  • You may feel short of breath, dizzy or lightheaded.
  • This may occur in days to weeks after your treatment starts.
     

What to do?

If your health care team has told you that you have anemia (low red blood cells):

  • Rest often and eat well.
  • Light exercise, such as walking may help.
  • You may need medication or a blood transfusion.
  • If it is very bad, your doctor may need to make changes to your treatment regimen.
Talk to your health care team if it does not improve or if it is severe

Headache; mild joint, muscle pain or cramps 

What to look for?

  • Mild headache
  • 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.

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

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

Proteins in Urine (pee)

Your health care team may do urine tests to check for proteins in your pee.
 

What to look for?

  • Swelling in your face, legs, or belly.  
  • Recent weight gain that is not normal for you.
  • Foamy, frothy, or bubbly-looking pee.
     

What to do?

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

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

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

Low platelets in the blood

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 (poo)
    • coughing up red or brown coloured mucus
    • dizziness, constant headache or changes in your vision
    • heavy vaginal bleeding 
    • red or pink coloured urine (pee)

What to do?

If your health care team has told you that 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.
  • Take care of your mouth and use a soft toothbrush.
  • Try to prevent cuts and bruises.
  • Ask your health care team what activities are safe for you.
  • Your treatment may have to be delayed if you have low platelets. 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 does not stop or is severe (very heavy), 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 or is severe, you MUST 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:

  • pain, swelling and hardening of the vein in an arm or leg

  • weakness on one side of your body

  • sudden severe pain in your chest or upper back, that moves up your neck or down your back, when you didn’t hurt yourself

  • irregular heartbeat

  • wounds that do not heal well

  • severe belly pain

  • unexpected changes in your bowel movements (poo) or digestion, trouble swallowing

  • unusual pulsating or throbbing feeling in your chest or belly

  • yellowing of your skin or eyes

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

  • fainting (passing out), severe headache, seizures, confusion, mood or personality changes, changes in your vision.

 

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:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________


March 2022 Updated information sheet

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.