Nilotinib is a targeted cancer drug (biological therapy) and is also known by its brand name, Tasigna. It is a treatment for chronic myeloid leukaemia (CML).
How nilotinib works
Nilotinib is a type of targeted cancer drug called a tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that act as chemical messengers and can stimulate cancer cells to grow.
Nilotinib blocks a tyrosine kinase protein called Bcr-Abl. The protein is made by CML cells that have an abnormal chromosome called the Philadelphia chromosome. Blocking this protein stops the leukaemia cells that have the Philadelphia chromosome growing. Most people with CML have the Philadelphia chromosome.
How you have nilotinib
Nilotinib comes as capsules that you swallow whole, twice a day.
You should not take nilotinib with food. Wait at least 2 hours after eating before taking them. And don't eat for an hour after you have taken nilotinib.
If you can't swallow the capsules, you can mix the powder from the capsule with a teaspoon of apple sauce. You need to swallow it immediately and don't use any food other than apple sauce.
Taking your capsules
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
When you have nilotinib
You usually continue taking nilotinib for as long as it is helping you and the side effects aren't too bad.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:
Risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Tiredness and weakness (fatigue)
Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.
You might have muscle pain during treatment. Let your treatment team know so they can advise you on how to reduce it.
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.
Raised levels of some fats in your blood
This drug can raise the amount of cholesterol and triglycerides in your blood. You will have regular blood tests to check for this.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:
- eye problems such as blurred vision, dry eyes and inflammation of the surface of the eye
- numbness or tingling in fingers and toes that can make it difficult to do fiddly things such as doing up buttons
- constipation or diarrhoea
- pain in your bones, hands and feet or back
- fluid build up in your legs and arms
- indigestion or heartburn
- changes in blood sugar levels
- taste changes
- loss of appetite
- weight gain or weight loss
- heart palpitations and high blood pressure
- needing to pass urine frequently
- night sweats and hot flushes
- difficulty sleeping
- wind (flatulence)
- muscle spasms
- feeling more worried or panicky than usual
- changes in the levels of minerals in your body
- hair loss but you’re unlikely to lose all the hair
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include
- serious heart problems such as a heart attack
- flu like symptoms such as headaches, muscle aches, a high temperature and shivering
- red and scaly skin that is similar to psoriasis
- high uric acid levels in the blood that are due to the breakdown of tumour cells (tumour lysis syndrome)
- mouth sores and sensitive teeth
- eyesight changes and swollen eyelids
- feeling very hot or very cold
- low or high levels of thyroid hormones in your body
- problems getting an erection (impotence)
- inflammation of the pancreas that can cause sickness and tummy pain
- a build up of fatty deposits in the blood vessels which can limit the blood supply to your leg muscles
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Grapefruit and grapefruit juice
You should not eat grapefruit or drink grapefruit juice when you are taking this drug because it can react with the drug.
Loss of fertility
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Pregnancy and contraception
This drug may harm a baby developing in your womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 2 weeks afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don’t breastfeed during this treatment because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
This drug contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.