Neratinib (The James)

Neratinib (The James)

 

What is Neratinib (ne-RA-ti-nib) and how does it work?

Neratinib is a type of oral, targeted cancer therapy called a "tyrosine kinase inhibitor". Another name for this medicine is Nerlynx. This medicine dissolves in your digestive system and gets absorbed into your blood. Neratinib finds cancer cells that have HER2 receptors. Once inside the cancer cell, it can prevent the cell from dividing and making new cancer cells. Neratinib is made in a laboratory.

 

What should I tell my doctor before I take this medicine?

Talk to your doctor about the following:

  • If you have ever had chemotherapy or anti-cancer treatment and the names of the medicines you were given.
  • If you have ever had liver problems.
  • If you are pregnant or think you may be pregnant. Your doctor will talk with you about birth control when you take this medicine.
  • If you are breastfeeding.
  • If you have been told to start a new medicine.
  • The medicines/pills you take including:
    • Medicines ordered by any of your doctors
    • Herbs and herbal supplements, including St. John’s Wort
    • Vitamins
    • Over-the-counter medicines
    • Medicines that decrease stomach acid such as proton pump inhibitors (PPIs), histamine-2 receptors antagonist (H2RAs), or antacids

 

How does my doctor decide my treatment dose?

  • To determine your treatment dose, your doctor and pharmacist will review your lab results, the medicines you take, how well your liver works and any other health problems you have.
  • This medicine is taken by mouth 1 time each day with food. At times, Neratinib is given together with other drugs. You will see your doctor or nurse practitioner about once every 4 weeks while you take this medicine.

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How do I handle, store and dispose of Neratinib?

  • There are special safe handling instructions for this medicine. Talk to your doctor, pharmacist or nurse about the precautions you need to follow when you take this medicine at home.
  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
  • Do not store in your bathroom or in your refrigerator.
  • Keep this medicine away from children and animals. Do not share it with anyone.
  • Talk to your pharmacist about how to get rid (dispose) of your prescription medicines safely.

 

How do I take Neratinib?

When starting Neratinib, you will slowly increase the amount you take.

  • For the first week, take Neratinib 120 mg (3 tablets) 1 time a day with food.
  • For the second week, take Neratinib 160 mg (4 tablets) 1 time a day with food.
  • Starting with the third week, you will take Neratinib 240 mg (6 tablets) 1 time a day with food, as directed by your doctor.
  • Do not crush, break, or chew the tablets.
  • Take this medicine with food 1 time each day, at the same time each day.
  • Swallow the tablets whole with a full glass of water.
  • If you miss a dose (three hours past your normal time to take this medicine), wait until it is time for your next dose, and skip the missed dose. Do not double up on doses.
  • Your doctor may change your dose in the future to find out what works best for you. Taking a lower dose of Neratinib does not mean the medicine will not work.
  • Do not eat grapefruit or drink grapefruit juice. Do not eat star fruit, or Seville oranges. These can increase your risk of side effects.
  • Do not take proton pump inhibitors (PPIs). Examples include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium). These antacids can affect how well Neratinib works.
  • If you take histamine-2 receptor antagonists (H2RAs), such as ranitidine (Zantac) or famotidine (Pepcid), take Neratinib 2 hours before or 10 hours after taking the H2RA.
  • If you take short-acting antacids such as Mylanta, Maalox, or Tums, or a calcium supplement for your bones, take Neratinib 3 hours before or after taking the antacid or calcium.

 

What are the side effects of this treatment?

Every person responds differently to treatment. Some of the more common side effects of this chemotherapy are:

  • Diarrhea
  • Nausea or vomiting
  • Stomach pain, bloating or feeling “full”
  • Decreased appetite and weight loss
  • Fatigue or weakness
  • Muscle spasms
  • Rash or dry skin
  • Changes in your nails (color changes or swelling around the nails)
  • Urinary tract infections

 

When should I call my doctor?

You should call your doctor right away if you have any of the following signs or symptoms:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher

A fever can be life threatening if not treated. Your doctor may ask you to go to the hospital.

  • Chills, sore throat, cough or a wound that does not get better
  • Open sores on your lips, tongue or in your mouth
  • Nausea that makes you unable to eat or drink
  • Bleeding or bruising, including bloody or black stools or blood in your urine
  • Shortness of breath or difficulty breathing
  • Yellowing of your skin or eyes
  • Chest pain, fast or irregular heartbeat
  • Diarrhea that does not go away after 24 hours of taking Loperamide (Imodium)

 

How should I manage diarrhea?

  • If diarrhea (watery, unformed stools) starts, use Loperamide as outlined below:

    • Take 2 caplets (4 mg) at the first sign of diarrhea.

    • Take 1 caplet (2 mg) every 2 hours during the day.

    • Take 2 caplets (4 mg) at bedtime, and 2 caplets (4 mg) every 4 hours until morning.

    • Stop when you have not had a bowel movement for 8 hours.

  • If diarrhea starts again, take Loperamide as directed above.
  • If Loperamide does not work to control your diarrhea, your doctor may ask you to take other medicines such as budesonide (Entocort) or diphenoxylate/atroptine (Lomotil).
  • Drink 8 to 10 cups of non-caffeinated fluid each day to stay hydrated during treatment.
  • Eat small meals or snacks often during the day. Stay away from eating big meals.
  • Do not eat foods that are high in fiber, greasy, spicy, fatty or fried.
  • Follow the BRAT diet (Bananas, Rice, Applesauce, Toast).

For more information about cancer, chemotherapy, side effects or how to take care of yourself during treatment, refer to your Chemotherapy and You book, or ask your doctor, nurse or pharmacist.

You may also find it helpful to watch The James Patient Education videos at http://cancer.osu.edu/patientedvideos to help you learn tips for managing treatment side effects.

 

 

© August 2, 2022. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.