Precautions and Monitoring
Before and During Treatment:
Hepatotoxicity: Monitor liver function tests (LFTs) biweekly for the first 2 months, then monthly. Adjust dose for severe impairment.
Hypertension: Check blood pressure weekly initially; manage with antihypertensives if needed.
Bleeding Risk: Avoid in patients with active hemorrhage or recent vascular events. Monitor for signs of bleeding.
Skin Reactions: Assess for hand-foot skin reaction (HFSR) and rash; recommend early dermatologic consultation.
Drug Interactions: Avoid CYP3A4 inducers (e.g., carbamazepine) or inhibitors (e.g., ketoconazole). Caution with anticoagulants (increased bleeding risk).
Pregnancy/Contraception: Contraindicated in pregnancy. Use effective contraception during and for 2 months post-treatment.
Surgery/Wound Healing: Discontinue at least 2 weeks prior to elective surgery due to impaired angiogenesis.
Daily Care Tips for Patients
Skin Care:
- Apply urea-based creams; avoid tight shoes and hot water.
- Use sunscreen and gentle skincare products.
Diet:
- Take with a low-fat meal (≤30% fat) to reduce GI upset.
- Avoid grapefruit/Seville oranges (CYP3A4 interaction).
- Stay hydrated.
Symptom Management:
- Diarrhea: Use loperamide; maintain hydration.
- Mucositis: Rinse with saline/baking soda solution; avoid alcohol mouthwashes.
- Fatigue: Prioritize rest; engage in light activity (e.g., walking).
Compliance:
- Follow the 3-weeks-on, 1-week-off schedule.
- If a dose is missed, skip it; do not double the next dose.
Self-Monitoring:
- Track blood pressure at home.
- Report severe headaches, dizziness, or bleeding.
Potential Side Effects and Management
Common Side Effects:
1. Hand-Foot Skin Reaction (HFSR):
- Management: Topical steroids, moisturizers.
- Dose reduction if severe (Grade 3).
2. Hypertension:
- Management: Initiate antihypertensives (e.g., ACE inhibitors); temporary treatment interruption for uncontrolled cases.
3. Diarrhea/Mucositis:
- Management: Antidiarrheals, oral hygiene, and dose modification for persistent symptoms.
4. Fatigue:
- Management: Optimize sleep; rule out anemia or thyroid dysfunction.
Serious Side Effects:
1. Hepatotoxicity:
- Permanently discontinue for severe liver impairment (ALT >20x ULN).
2. Severe Bleeding:
- Immediate discontinuation and emergency care for GI or CNS hemorrhage.
3. GI Perforation/Fistula:
- Discontinue therapy; surgical evaluation if suspected.
4. Cardiac Ischemia:
- Stop treatment for acute cardiac events; monitor high-risk patients closely.
Follow-Up
- Regular clinical visits for toxicity assessment and lab monitoring (CBC, LFTs, renal function).
- Dose adjustments based on tolerance: First reduction to 120 mg, then 80 mg if needed.
By adhering to precautions, proactive monitoring, and tailored symptom management, patients can optimize treatment outcomes while minimizing risks. Always consult healthcare providers for personalized guidance.
