Pronounced: glas DEG ib
Classification: Hedgehog Pathway Inhibitor
About: Glasdegib (Daurismo™)
Glasdegib 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 Glasdegib
Glasdegib comes in a tablet for that is usually taken orally once daily. Take this medication with or without food. Do no split or crush the tablets. Take glasdegib at the same time each day. If you vomit a dose, do not take another pill-wait until your next schedule dose. If you miss a dose or don’t take this medication at the usual time, take it as soon as you remember, but at least 12 hours before your next scheduled dose. Do not take two doses within 12 hours.
It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.
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, amiodarone, diltiazem, fluconazole, itraconazole, ketoconazole, rifampin, phenytoin, St. John’s wort, carbamazepine, phenobarbital and modafanil, among others. This medication can also interact with other medications used that cause a heart condition called QT prolongation such as levofloxacin, ondansetron, amiodarone, sotalol, erythromycin, some antidepressants and methadone. Be sure to tell your healthcare provider about all medications and supplements you take.
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?
Glasdegib 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 Glasdegib
There are a number of things you can do to manage the side effects of glasdegib. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
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 oncology care team 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 oncology care team 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.
- Do not use a razor (an electric razor is fine).
- Avoid contact sports and activities that can result in injury or bleeding.
- Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib) etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding use of these agents and all over the counter medications/supplements while on therapy.
- Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
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:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your oncology care team before scheduling dental appointments or procedures.
- Ask your oncology care team before you, or someone you live with, has any vaccinations.
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.
Peripheral edema is swelling of the extremities caused by retention of fluid. It can cause swelling of the hands, arms, legs, ankles and feet. This medication can also cause fluid overload and fluid retention. The swelling can become uncomfortable. Notify your oncology care team if you are experiencing any new or worsening swelling.
Muscle or Joint Pain/Aches and Headache
Your healthcare provider can recommend medications and other strategies to help relieve pain.
Mouth Ulcers (Mucositis)
Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your oncology care team 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.
- Brush with a soft-bristle toothbrush or cotton swab twice a day.
- Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) is recommended 4 times daily.
- If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
- Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.
Nausea and/or Vomiting
Nausea, with or without vomiting, can be a side effect of opioid pain medications. For some patients it lasts just a few days to weeks at the start of taking the medication but for some it is a long-term side effect. Nausea and vomiting can interfere with opioid therapy and ultimately pain management if the nausea and/or vomiting affect the patient's ability to take the medication. You may find that eating or not eating when taking this medication may be helpful. Talk to your healthcare team so they can prescribe medications to help you manage nausea and vomiting.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.
Decrease in Appetite or Taste Changes
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 oncology care team 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.
Some patients may develop a rash, itching, skin redness or ulcers. Use an alcohol-free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your oncology care team can recommend a topical medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. Be sure to notify your oncology care team of any rash that develops, as this can be a reaction. They can give you more tips on caring for your skin.
This medication can cause kidney problems, including an increased creatinine level, which your oncology care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite.
This medication can cause liver toxicity, which your oncology care team may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.
This medication can affect the normal levels of electrolytes (potassium, magnesium, calcium, etc.) in your body. Your levels will be monitored using blood tests. If your levels become too low, your care team may prescribe specific electrolytes to be given by IV or taken by mouth. Do not take any supplements without first consulting with your care team.
Less common but important side effects:
- QT prolongation: This medication can cause an abnormal heart rhythm called QT prolongation. Your care team will monitor your heart rhythm through EKG and monitoring your electrolytes. Notify your oncology care team right away if you feel abnormal heartbeats or if you feel dizzy or faint.
Blood & Sperm Donation
Patients should not donate blood while receiving glasdegib and for at least 30 days after stopping the medication. Men should not donate sperm while receiving this medication and for at least 30 days 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 30 days 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 30 days 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 30 days 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.