Ripretinib (Qinlock®)

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.

Alopecia is when your hair gets thin, brittle (breaks easily), or falls out. This may happen during the few weeks after treatment starts. Hair loss can be all of your body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. You may want to use scarves, wigs, hats, and hairpieces. Your hair helps keep you warm in cold weather, and it can protect you from the sun, so it is important to wear a hat if you are in cold weather or in the sun. If you are going to be out in the sun, protect your scalp by using a sunscreen with SPF 30 or higher. Wash your scalp with a mild or baby shampoo. After you are done with treatment, hair often starts to grow back.

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.

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.

Constipation is when you have less bowel movements than usual or are having trouble passing stool. To relieve constipation, you can include fiber in your diet (fruits like prunes, apples, peaches, and pear nectars/juices), drink 8 to 10 glasses of non-alcoholic fluids a day, and stay active. Taking a stool softener once or twice a day can prevent constipation. If you do not have a bowel movement for 2 to 3 days, call your provider. 

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.

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.

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.

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

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.

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. 

There is a low risk of this medication causing a secondary skin cancer. This can happen many years after your treatment is done. A secondary skin cancer happens as a result of treatment for another cancer. This is rare, but you should know your risk. 

It is important to practice sun safety:

• Stay out of the sun from 10 a.m. to 4 p.m. when the sun’s rays are strongest.
• Wear sunscreen every day and reapply when you are in the sun. The best sunscreen is SPF 30 or higher and protects against both types of sunlight, UVA and UVB.
• Wear protective clothing, like long-sleeved shirts, pants, a wide-brimmed hat, and sunglasses. You can choose clothing with built-in SPF or use a product to add SPF to clothes in the laundry. You should also use a lip balm with SPF 30 or greater.
• Stay in the shade whenever you can.

You should have your skin checked by your provider before starting treatment, then every 2 months while on therapy, and for 6 months after the medication has been stopped. Check your own skin often and tell your providers about any changes in how you feel, new growths, sores, or bumps that bleed or do not heal, or any changes in moles.

This medication can cause or worsen pre-existing heart problems, like congestive heart failure, restrictive cardiomyopathy, decreased heart function, and heart attack. Symptoms may be:

• Sudden weight gain.
• Swelling in your ankles or legs.
• Chest pain or pressure.
• Pain in your left arm, back, or jaw.
• Sweating.
• Shortness of breath.
• Clammy skin.
• Nausea.
• Dizziness or lightheadedness.

If you have any of these symptoms, call 911.

If you have a wound, this medication can affect how it heals. It can make your wound heal very slowly or not heal completely (like a surgical wound not healing or not staying closed). If you are having a procedure or surgery:

• Tell your provider that you have a surgical procedure planned.
• Tell the surgeon that you are taking this medication.
• This medication will likely be stopped before you have any surgery. 
• Any surgical incision should be fully healed before starting or restarting this medication. 

If you have a surgical wound that has not healed or starts to have signs of infection (redness, swelling, warmth), tell your provider.

This medication can make your skin more sensitive to the sun, which can result in a severe sunburn or rash. Sun sensitivity can last even after you are done with chemotherapy. Avoid the sun between 10 am and 4 pm, when it is strongest. Wear sunscreen every day and reapply when you are in the sun. The best sunscreen is SPF 30 or higher and protects against both types of sunlight, UVA and UVB. Wear sunglasses, a hat, and long sleeves/pants to protect your skin, a lip balm with SPF greater than 30, and seek out shade whenever possible.

Tell your providers if you develop red, painful, or itchy skin, sunburn, skin irritation, bumps, or thick, dry skin.