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Lapatinib (Tyverb)

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This page tells you about the biological therapy lapatinib and its possible side effects. There is information about

 

What lapatinib is

Lapatinib is also known by its brand name Tyverb. In North America it is called Tykerb. It is a treatment for advanced breast cancer.

Lapatinib is a type of biological therapy called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that stimulate cells to grow. Some tyrosine kinase proteins make cancer cells grow. Lapatinib stops (inhibits) two of these proteins from working. The proteins are

  • ErbB1 (epidermal growth factor receptor – EGFR)
  • ErbB2 (HER2)

Lapatinib may be given with the chemotherapy drug capecitabine (Xeloda) or a biological therapy called trastuzumab (Herceptin). It is also sometimes used with hormone therapies called aromatase inhibitors. Researchers are looking at using it to treat other types of cancer.

 

How you have lapatinib

Lapatinib comes as tablets. You take them once a day with a glass of water, either an hour before or an hour after food. You should not eat grapefruit or drink grapefruit juice when you are taking lapatinib because it can react with the drug.

It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach, for example, can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

If you miss a dose, don't take an extra dose to catch up. Just take your next dose at the scheduled time.

The side effects of lapatinib are listed below. Remember most people only have a few and the effects can be mild. The side effects may be changed if you are also taking other cancer drugs alongside lapatinib.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • Diarrhoea affects more than 3 out of 10 people (30%) – drink plenty of fluids and tell your doctor or nurse if you have diarrhoea as you may need treatment
  • Skin changes – about 3 out of 10 people (30%) have a rash or red, dry, itchy skin
  • Feeling sick and being sick happen in about 1 in 4 people (25%) but this is usually well controlled with anti sickness medicines
  • Tiredness (fatigue) affects 1 out of 4 people (25%) during and after treatment – most people find their energy levels are back to normal a few months after treatment ends
  • Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar-plantar syndrome), which may cause tingling, numbness, pain and dryness
  • Loss of appetite
  • Indigestion
  • Difficulty sleeping
  • Muscle and joint pain or back pain – this can usually be helped with mild painkillers
  • Loss of fertility – after lapatinib treatment you may not be able to become pregnant or father a child. Talk to your doctor before starting treatment if you plan to have a baby in the future
  • A mild effect on the liver – this is unlikely to cause symptoms, and your liver will almost certainly go back to normal after the treatment ends, but you will have regular blood tests to check how your liver is working
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Some people have an allergic reaction while having lapatinib treatment, usually at the first or second treatment – let your treatment team know immediately if you have any skin rashes, itching, feeling hot, shivering, going red in the face, feeling dizzy, headaches, shortness of breath, anxiety or a sudden need to pass urine
  • Heart problems including chest pain – contact your doctor or nurse as soon as possible if you have any pain. If you have a history of heart problems you may not be able to have lapatinib
  • Brittle, chipped and ridged nails – some people have infection around the nail
  • Higher levels of bilirubin in your blood – you will have blood tests during and after treatment
 

Rare side effects

Fewer than 1 in 100 people have shortness of breath due to inflammation of the lungs. Tell your doctor or nurse if you feel breathless.

 

Important points to remember

You may only have a few of the above side effects and they may be mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines and supplements

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and any over the counter remedies – some drugs can react together and many drugs can affect how well lapatinib works. The following medicines may react with lapatinib.

  • St John’s Wort – a herb extract used to treat depression
  • Some medicines used to treat infections
  • Medicines used to suppress the immune system, for example after organ transplantations
  • Some medicines used to treat HIV
  • Some anti epileptic drugs
  • Some medicines used to treat indigestion
  • Some anti depressant drugs
  • Medicines for diabetes
  • Drugs for high blood pressure or heart problems
  • Some medicines for particular types of cancer
  • Medicines used to lower cholesterol levels

Contraception

Lapatinib could harm a developing baby. It is very important not to become pregnant or father a child during treatment and for a few months afterwards. Talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant.

Breastfeeding

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

 

Immunisations

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information on lapatinib

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 28 August 2013