Classification: mTOR Inhibitor
Everolimus is a type of targeted therapy. This means it works by targeting something specific to the cancer cells, therefore decreasing side effects caused by unwanted damage to the healthy cells. Everolimus is a kinase inhibitor that inhibits mTor kinase, an enzyme required for cell growth and survival. By blocking this enzyme, the medication prevents cell division and, in turn, tumor growth. The medication can also interrupt angiogenesis, the development of blood vessels to supply the tumor with nutrients, which they need to grow.
How to Take Everolimus
Everolimus is taken by mouth, in pill form. The medication comes in 2.5mg, 5 mg and 10 mg oral tablets. Specific dosage is based on the person’s size and cancer type. The tablets should be swallowed whole with a glass of water, with or without food. Do not crush, break, or chew the tablets. Take your dose around the same time every day.
Afinitor® Disperz: This medication is available in a form that can be dissolved in a liquid. If you are prescribed this type of everolimus, your pharmacist should provide you with detailed instructions on how to make the suspension (liquid form) and take the dose.
If you miss a dose and it has been less than 6 hours since your regular dose time, take it as soon as you remember. If it has been more than 6 hours, skip the dose. Do not take 2 doses at once to make up for a missed dose.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, verapamil, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.
You or anyone you live with should avoid having live or live-attenuated vaccines while receiving this medication. These include oral polio, measles/MMR, rotovirus, varicella and zoster (chicken pox and shingles), typhoid, yellow fever, or the nasal form of the flu vaccine (FluMist).
Storage and Handling
Store this medication at room temperature, in a dry place and away from light. Keep the medication in the original packaging. You should not use a pillbox for this medication. 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?
Everolimus 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, are also available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Everolimus
There are a number of things you can do to manage the side effects of Everolimus. 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:
Everolimus can suppress your immune system, putting you at higher risk of getting an infection. You should wash your hands frequently, avoid large crowds and people who are sick or have colds. You should let your healthcare team know right away if you have a fever (temperature greater than 100.4), chills, sore throat or cold, or do not feel well.
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.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
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.
Mouth Ulcers (Sores)
Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.
Decrease in Appetite
Nutrition 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.
Nail and Skin Changes
This medication can affect your nails and skin. Patients may develop a rash. The rash may appear red, bumpy, dry and feel sore. You may also develop very dry skin, which may crack, be itchy or become flaky or scaly. Skin may also appear darker. Tips for managing your skin include:
While receiving this medication, you may develop an inflammation of the skin around the nail bed/cuticle areas of toes or fingers, which is called paronychia. It can appear red, swollen or pus filled. Nails may develop "ridges" in them or fall off. You may also develop cuts or cracks that look like small paper cuts in the skin on your toes, fingers or knuckles. These side effects may appear several months after starting treatment, but can last for many months after treatment stops.
High Blood Pressure
This medication can cause high blood pressure (hypertension). Your care team will monitor your blood pressure regularly during therapy.
This medication can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that the medication be discontinued prior to any surgery. In addition, any surgical incision should be fully healed prior to starting or restarting the medication. If you have a surgical wound that has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.
Lung or Breathing Problems
Everolimus can cause pneumonitis, an inflammation of the lung tissue that is not caused by infection. You should notify your healthcare team right away if you notice worsening cough, shortness of breath or difficulty breathing or wheezing. If your healthcare provider suspects pneumonitis, he or she may decide to lower your dose or treat your symptoms with a steroid medication.
Elevated Blood Sugar, Cholesterol, and Triglycerides
This medication can cause blood sugar, cholesterol, and triglyceride levels to be elevated. Your healthcare team will monitor for this using blood tests. Let your care team know if you have diabetes or high cholesterol or triglyceride levels before starting treatment.
Everolimus can cause fluid retention (edema). Symptoms include swelling in the feet and hands, and rapid weight gain. Report any of these symptoms to your healthcare team immediately.
This medication can cause a rare allergic type reaction called angioedema when used with certain ACE inhibitor medications (for example enalapril, Lisinopril and losartan). Contact your healthcare team or go to the emergency room immediately if you experience difficulty breathing, or swelling of the tongue, mouth or throat while taking everolimus.
Sexual & Reproductive Concerns
This medication may affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. Women may experience menopausal effects including hot flashes and vaginal dryness. In addition, the desire for sex may decrease during treatment.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 8 weeks after treatment, even if your menstrual cycle stops or you believe you are not producing sperm. 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.
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