Home Drug Guide Sunitinib Malate

Drug Guide

Generic Name

Sunitinib Malate

Brand Names Sutent

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Tyrosine kinase inhibitor

FDA Approved Indications

  • Renal cell carcinoma (advanced and metastatic)
  • Gastrointestinal stromal tumor (GIST) refractory to imatinib or imatinib-intolerant

Mechanism of Action

Sunitinib inhibits multiple receptor tyrosine kinases, including VEGFR and PDGFR, leading to angiogenesis inhibition and tumor cell proliferation suppression.

Dosage and Administration

Adult: 50 mg once daily, 4 weeks on treatment followed by 2 weeks off (6-week cycle); dose adjustments may be necessary based on tolerance and side effects.

Pediatric: Not established for pediatric use.

Geriatric: Use with caution; no specific dose adjustments required but consider renal and hepatic function.

Renal Impairment: Adjust dose based on severity; severe impairment may require dose reduction.

Hepatic Impairment: Adjust dose in patients with hepatic dysfunction.

Pharmacokinetics

Absorption: Well absorbed orally, peak plasma concentration in 6-12 hours.

Distribution: High protein binding (~95%).

Metabolism: Metabolized by the liver, primarily via CYP3A4/5.

Excretion: Excreted mainly in feces; minor urinary excretion.

Half Life: Approx. 40-86 hours, allowing for once-daily dosing.

Contraindications

  • Hypersensitivity to sunitinib or any component of the formulation.

Precautions

  • Monitor for bleeding, hypertension, hypothyroidism, hepatic impairment, cardiotoxicity, and GI perforation or fistulae. Risks during pregnancy and lactation.

Adverse Reactions - Common

  • Fatigue (Very common)
  • Nausea (Very common)
  • Diarrhea (Very common)
  • Hand-foot syndrome (Common)
  • Hypertension (Common)

Adverse Reactions - Serious

  • Cardiotoxicity (heart failure, decreased ejection fraction) (Uncommon)
  • Bleeding (hemorrhage) (Uncommon)
  • Hepatotoxicity (Uncommon)
  • GI perforation or fistulae (Rare)
  • Severe bleeding or thrombosis (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) may increase sunitinib levels.
  • CYP3A4 inducers (e.g., rifampin) may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, cardiac function, hepatic enzymes, and complete blood count.

Diagnoses:

  • Risk for bleeding
  • Impaired skin integrity due to hand-foot syndrome
  • Risk for hypertension

Implementation: Administer with or without food; monitor for side effects and toxicities.

Evaluation: Assess for tumor response, tolerance to therapy, and adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any signs of bleeding, severe fatigue, chest pain, or signs of infection.
  • Avoid grapefruit and its juice, as it may increase drug levels.

Special Considerations

Black Box Warnings:

  • Hepatotoxicity, hemorrhage, impairment of wound healing, cardiac failure.

Genetic Factors: None specified.

Lab Test Interference: May cause false-positive urine protein tests.

Overdose Management

Signs/Symptoms: Severe bleeding, hypotension, or adverse effects typical of toxicity.

Treatment: Supportive care; no specific antidote. Remove the drug and provide symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable when stored properly; check expiration date before use.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.