Classification: Hedgehog Pathway Inhibitor
About Vismodegib (Erivedge®)
Vismodegib is a type of targeted therapy called a hedgehog pathway inhibitor. This means it works by targeting a pathway (series of signals or events) that drives cancer growth. Disrupting the Hedgehog signal prevents the cancer from growing.
How to take Vismodegib
Vismodegib comes in a capsule form to be swallowed and is taken once a day. The capsule should be swallowed whole with a glass of water; do not break, chew or open the capsule. You can take it with or without food. If you miss a dose, skip the missed dose and take your next dose at the usual time.
You should not take vismodegib at the same time as "heartburn" medications (including proton pump inhibitors such as prilosec, nexium, protonix; H2 blockers, such as tagamet, zantac; and antacids, such as Tums, Rolaids) as these may effect how vismodegib is absorbed. If needed, take these medications 2 hours before or after vismodegib.
Certain medications can also increase your incidence of side effects. These medications include clarithromycin, erythromycin and azithromycin. Ensure that your provider is aware of all medications and supplements you are taking prior to starting treatment with vismodegib.
Storage and Handling
Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Vismodegib is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment directly to your home.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Vismodegib
There are a number of things you can do to manage the side effects of vismodegib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Muscle spasms and pain can occur when taking this medication. Talk to your provider if you require medication to treat this pain. Drink plenty of fluids. Applying heat to the muscle when a spasm begins, and ice after it has passed, may be helpful.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Loss or Thinning of Scalp and Body Hair (Alopecia)
Your hair may become thin, brittle, or may fall out. This typically begins two to three weeks after treatment starts. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. The use of scarves, wigs, hats and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather or to protect you from the sun.
Decrease in AppetiteNutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
- Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.
Blood & Sperm Donation
Patients should not donate blood while receiving this medication and for at least 7 months after stopping the medication. Men should not donate sperm while receiving this medication and for at least 3 months after the final dose.
Reproductive ConcernsExposure of an unborn child to this medication could cause severe birth defects.
- Women should have a negative pregnancy test obtained within 7 days prior to starting the medication. Women should not become pregnant while on therapy and for at least 7 months after the last dose. Effective birth control is necessary, even if your menstrual cycle stops.
- Women should not breastfeed while on treatment, or for 7 months after the last dose of this medication.
- This medication can cause a woman’s menstrual cycle to become irregular or stop permanently. As a result, women may experience menopausal effects including hot flashes and vaginal dryness.
- Men should not father a child while on this medication and for at least 3 months after the last dose. Men should always use a condom (even if you have had a vasectomy) to protect your partner from exposure to the medication- or yourself, if your partner is taking the medication. Effective birth control is necessary during treatment, even if you believe you are sterile.
- You may want to consider sperm banking or egg harvesting if you may wish to have a child in the future. Discuss these options with your oncology team.