Lenvatinib (Lenvima®)

Store your medication in the original container with the label. If you want to use a pillbox, talk to your pharmacist. Keep it in a dry place at room temperature unless your provider or pharmacist tells you otherwise. 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 people should not prepare the dose for you. Ask your provider where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash. 

Some cancer medications are only available through specialty pharmacies. Your provider or pharmacist will start this process. Your insurance plan may also affect where you can get your medication.  Call your prescription plan provider to find out which specialty pharmacies are in-network.

This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

This medication can cause high blood pressure (hypertension). You should have your blood pressure checked often during therapy, so that if you have high blood pressure, it can be treated. If your blood pressure cannot be controlled, your provider may want you to stop taking the medication. Tell your providers about any headaches, vision changes, or dizziness. 

Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

You may have joint or muscle pain/aches and headaches while taking this medication. Your provider can recommend medications and other ways to help relieve your pain.

Nutrition is an important part of your care. Cancer treatment can affect your appetite and make it hard to eat. Ask your provider about nutrition counseling services. Some tips you can follow are:

• Try to eat five or six small meals or snacks during the day, instead of 3 larger meals.
• Nutritional supplements may help if you are not eating enough.
• You may have a metallic taste or find that food has no taste. You may dislike foods or beverages that you liked before cancer treatment. These symptoms can last for 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 dressing.
• Use seasonings like basil, oregano, or rosemary to add flavor.

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

This medication can cause sores or soreness in your mouth and/or throat, called mucositis. Tell your providers if your mouth, tongue, inside of your cheek, or throat becomes white, has ulcers, or is painful. Medications can be used to manage pain. Regular mouth care can help prevent or manage mouth sores. Some things you can do are:

• 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) can be used a few times each day.
• If your mouth gets dry, eat moist foods, drink plenty of fluids (6 to 8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, and drinking alcoholic beverages and citrus juices.

If you notice you are bleeding more easily or for no reason, especially new bleeding from your gums or nose, call your provider right away. You may also bruise more easily.

If you have bright red or dark, tarry stool, blood in your vomit, vomit that looks like coffee grounds, or have any signs of stroke (severe headache, trouble talking, weakness on one side, confusion), call 911 right away. 

Hand-foot syndrome (HFS) is a skin reaction on the palms of your hands and/or the soles of your feet. HFS can be caused by certain chemotherapy agents being absorbed (taken in) by your skin cells. HFS can start as a mild tingling, numbness, pins-and-needles feeling, redness, or pain or swelling of your hands and/or feet. It can lead to painful swelling, blistering, or peeling skin, making it hard to do your normal activities. Tell your providers right away if you have these symptoms, as they may need to change your chemotherapy dose or take a break to let your skin heal. Some ways to help prevent HFS are:

• Keep your hands and feet clean and dry.
• Avoid tight shoes or socks.
• Avoid activities that put pressure on your palms or soles during treatment and for 1 week after treatment.
• Use an alcohol-free moisturizer often, and do not use products with perfumes or scents.
• Do not use very hot water for baths and showers

Proteinuria is when there is protein in your urine. This can be a sign of kidney damage. When the kidney’s filters are damaged, protein leaks into the urine. Often, there are no symptoms. Your provider will check your urine (called a urinalysis) and test your blood for your kidney function while you are on this medication.

This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.

Your thyroid is a gland that makes hormones. This medication can cause hypothyroidism (when your thyroid does not work as well as it should) and hyperthyroidism (when your thyroid produces too much of some thyroid hormones). Your provider will do blood tests to check your thyroid and treat this side effect if you have it. 

Symptoms of hypothyroidism include:

• Feeling cold.
• Weight gain.
• Feeling anxious.
• Changes in your voice.
• Muscle cramps.

Symptoms of hyperthyroidism include:

• Feeling hot.
• Heart beating faster than normal.
• Weight loss.
• Hair loss.

Talk to your provider about any symptoms you are having.

This medication can cause kidney problems, like an increased creatinine level. Your provider may monitor for kidney problems with blood tests. Symptoms may be:

• Less urine output than normal.
• Blood in the urine.
• Swelling in the ankles.
• Loss of appetite.

Tell your provider if you have any of these symptoms.

QT prolongation is when your heart is not working how it should, and it can cause slow or abnormal heartbeats or an abnormal heart rhythm. Tell your provider right away if you feel abnormal heartbeats or if you feel dizzy or faint.

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

This medication can put you at a higher risk for blood clots like deep vein thrombosis (DVT) or pulmonary embolism (PE). Symptoms may be:

• Swelling, redness, or pain in an arm or leg.
• Sudden shortness of breath.

If you have any of these symptoms, call 911.

This medication can cause gastrointestinal (GI) perforation, or a tear, in the wall of your intestines. Signs of this can be:

• New or worsening pain in the abdomen (belly).
• New abdominal swelling.
• Chills.
• Fever.
• Constipation.
• Nausea or vomiting.

If you have any of these symptoms, call your provider.

This medication can cause a neurological (brain) disorder called posterior reversible encephalopathy syndrome (PRES or reversible posterior leukoencephalopathy (RPLS). Symptoms of PRES/RPLS are:

• Headache.
• Seizure.
• Lethargy (feeling tired, drowsy, sluggish).
• Confusion.
• Blindness and other vision changes.
• Neurological problems.

Tell your provider about any of these symptoms right away.

Osteonecrosis of the jaw (ONJ) is a rare side effect. It happens when there is a loss of blood supply to the jawbone. This can cause the bone to become exposed (can be seen) through the gums. Symptoms of ONJ may be:

• Pain.
• Swelling.
• Infection of the gums.
• Loosening of the teeth.
• Exposed bone (often where a tooth was removed).
• Numbness or tingling in the jaw.
• A "heavy" feeling in the jaw.

Most cases of ONJ are related to a dental issue, and if these are avoided, ONJ may be as well. You should stop taking this medication at least 3 weeks before any dental work.

Some things you can do to lower your risk of ONJ are:

Before starting therapy, you should have a dental exam and cleaning. Any teeth in poor health should be removed.

• If you wear dentures, make sure they fit well.
• Brush your teeth after meals and at bedtime with a soft brush. Ask your provider if you can floss, and, if so, floss gently once a day.
• Check your teeth and gums in a mirror every day for sores, swelling, loose teeth, pain, or numbness. Tell your dentist or provider right away if you notice any changes.

Call your provider right away if you are having any symptoms of ONJ or dental issues.