Home Drug Guide Cabozantinib S-malate

Drug Guide

Generic Name

Cabozantinib S-malate

Brand Names Cometriq, Cabometyx

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Tyrosine kinase inhibitor

FDA Approved Indications

  • Medullary thyroid carcinoma, unresectable or metastatic
  • Renal cell carcinoma, advanced
  • Hepatocellular carcinoma, hepatocellular carcinoma (HCC)

Mechanism of Action

Cabozantinib inhibits multiple tyrosine kinases including VEGFR, MET, and AXL, which are involved in tumor growth, angiogenesis, and metastasis.

Dosage and Administration

Adult: The dose varies depending on the indication, but generally 60 mg orally once daily. Adjustments may be needed based on tolerance and side effects.

Pediatric: Safety and efficacy not established.

Geriatric: Use with caution due to potential increased sensitivity; consider dose adjustments.

Renal Impairment: Adjust dose based on severity of renal impairment.

Hepatic Impairment: Use is contraindicated in severe hepatic impairment; in mild to moderate impairment, consider dose adjustments.

Pharmacokinetics

Absorption: Bioavailability approximately 37%.

Distribution: Widely distributed in tissues; high plasma protein binding (~99%).

Metabolism: Metabolized primarily via CYP3A4; also undergoes glucuronidation.

Excretion: Excreted mainly in feces (~74%) and urine (~16%).

Half Life: Approximately 56 hours.

Contraindications

  • Hypersensitivity to cabozantinib or any component of the formulation

Precautions

  • Risk of bleeding, hypertension, gastrointestinal perforation or fistula, hepatic impairment, wound healing complications. Use in pregnancy and lactation not recommended.

Adverse Reactions - Common

  • Diarrhea (Common)
  • Fatigue (Common)
  • Elevated blood pressure (Common)
  • Nausea (Common)
  • Mucositis/stomatitis (Common)

Adverse Reactions - Serious

  • Hemorrhage (Serious)
  • Wound healing complications (Serious)
  • Hepatotoxicity (Serious)
  • Gastrointestinal perforation (Serious)
  • Hypertension, severe (Serious)

Drug-Drug Interactions

  • CYP3A4 inhibitors or inducers may alter levels of cabozantinib.
  • Anticoagulants—risk of bleeding.

Drug-Food Interactions

  • High-fat meals may increase absorption; consistent intake recommended.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, liver function tests, signs of bleeding, wound healing status, and gastrointestinal symptoms.

Diagnoses:

  • Risk for bleeding
  • Impaired tissue integrity
  • Risk for hypertension

Implementation: Administer with or without food; monitor for adverse effects; educate patient on signs of complications.

Evaluation: Regularly assess for side effects, therapeutic response, and adverse reactions.

Patient/Family Teaching

  • Report signs of bleeding, severe hypertension, wound issues, or gastrointestinal symptoms.
  • Avoid pregnancy; use contraception during treatment and for at least 4 weeks after discontinuation.
  • Monitor blood pressure regularly and maintain follow-up appointments.

Special Considerations

Black Box Warnings:

  • Wound healing complications, hemorrhage, gastrointestinal perforation, hepatotoxicity, QT interval prolongation.

Genetic Factors: Pharmacogenetic testing not routinely required.

Lab Test Interference: May alter laboratory results related to bleeding and liver function.

Overdose Management

Signs/Symptoms: Severe bleeding, hypertension, diarrhea, fatigue, mucositis.

Treatment: Supportive care; no specific antidote. Discontinue drug and provide symptomatic treatment as needed.

Storage and Handling

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

Stability: Stable under recommended conditions until expiration date.

🛡️ 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.