Classification: Hedgehog Pathway Inhibitor
About Sonidegib (Odomzo®)
Sonidegib 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 Sonidegib
Sonidegib comes in a capsule form and is taken once a day on an empty stomach. You should take the medication at least 1 hour before, or 2 hours after eating to assure your stomach is empty. The capsule should be swallowed whole; do not break, open or chew the capsule. If you miss a dose, skip the missed dose and take your next dose at the usual time.
Certain medications, including ketoconazole, rifampin and St. John’s Wort can interfere with blood levels of bortezomib. Make sure your provider is aware of all the medications, vitamins and supplements you are taking.
Possible Side Effects
There are a number of things you can do to manage the side effects of sonidegib. 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:
Muscle spasms and pain are common when taking this medication. However, these can also be a symptom of a serious muscle condition called rhabdomyolysis. This condition is caused by injury to the muscles and can lead to kidney failure. Notify your care team right away if you develop any new or worsening muscle spasms, pain or tenderness, dark urine, or a decreased amount of urine while taking this medication.
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.
Contact your oncology team to 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.
Diarrhea can lead to serious dehydration. Call your doctor or nurse if you experience dizziness, light-headedness, fainting or muscle cramps, as these can be signs of dehydration.
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.
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.
- 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.
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.
Blood & Sperm Donation
Patients should not donate blood while receiving sonidegib and for at least 20 months after stopping the medication. Men should not donate sperm while receiving this medication and for at least 8 months after the final dose.
Exposure of an unborn child to this medication could cause severe birth defects.
- Women should have a negative pregnancy test obtained prior to starting the medication. Women should not become pregnant while on therapy and for at least 20 months after the last dose. Effective birth control is necessary during treatment, even if your menstrual cycle stops.
- Women should not breastfeed while on treatment or for 20 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 8 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.