Gleevec Information and Uses

Gleevec

Gleevec Overview

Gleevec (generic: imatinib) is a prescription medication used to treat certain types of leukemia (cancer that starts in the white blood cells), cancers of the red blood cells, and certain kinds of tumors in adults. Gleevec belongs to a group of drugs called protein-kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.

This medication comes in tablet form and is taken once or twice a day, with food and a glass of water.

Common side effects of Gleevec include fluid retention, vomiting, and diarrhea. Gleevec can cause drowsiness, blurred vision, and dizziness. Do not drive or operate machinery until you know how Gleevec will affect you.

Uses of Gleevec

Gleevec is a prescription medication used to treat various types of cancers including:

certain types of leukemia (cancer that begins in the white blood cells) and other cancers of the blood cells.
gastrointestinal stromal tumors (GIST; a type of tumor that grows in the walls of the digestive passages and may spread to other parts of the body).
dermatofibrosarcoma protuberans (a tumor that forms under the top layer of skin) when the tumor cannot be removed surgically, has spread to other parts of the body, or has come back after surgery.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Side Effects of Gleevec

Almost all people taking Gleevec experience side effects. Be sure to talk to your oncologist and/or healthcare professional about any Gleevec side effects you are experiencing.

See "Drug Precautions" for serious side effects.

Some serious side effects include:

Severe fluid retention (holding water), which can cause swelling around the eyes or swelling of the lower legs, lungs, and heart (reported in 9%-13.1% of patients); fatal in rare cases
Increased pressure in the heart or brain; fatal in rare cases
Low levels of certain blood cells
Heart failure
Liver problems
Hemorrhage (abnormal bleeding); reported in 5%-12.9% of patients in clinical trials
Skin blistering
Low levels of thyroid hormone

Some common side effects are:

Fluid retention (holding water)
Muscle cramps or pain and bone pain
Abdominal pain
Vomiting
Diarrhea
Decreased hemoglobin (decrease in blood cells which carry oxygen)
Nausea
Fatigue
Skin reactions, some severe
Anorexia (loss of appetite)

Supportive care may help reduce the severity of some side effects, whereas others require discontinuation or dosage adjustment. Don't stop taking your medication or change your dose without talking to your oncologist.

Gleevec Interactions

Do not take any other medications without talking to your doctor or pharmacist first, including over-the-counter medications such as Tylenol (acetaminophen); herbal products (St. John's wort, Hypericum perforatum); or prescription medications including Coumadin (warfarin sodium); rifampin; erythromycin; metoprolol; ketoconazole; and Dilantin (phenytoin). Taking these with GLEEVEC may affect how they work, or affect how Gleevec works.

You should also tell your doctor if you are taking or plan to take iron supplements. Patients should also avoid grapefruit juice and other foods that may affect how Gleevec works.

Gleevec Precautions

Gleevec is often associated with edema (swelling) and serious fluid retention (holding water). It is important that patients be weighed and monitored regularly for signs and symptoms of serious fluid retention or unexpected weight gain. Patients experiencing unexpected, rapid weight gain should speak to their doctor about appropriate supportive care treatment. Studies have shown that edema tended to occur more often among patients who are 65 and older or those taking higher doses of Gleevec. If you experience severe fluid retention, your doctor may treat you with diuretics and may stop your Gleevec treatment until the fluid retention has been managed. Treatment can be returned as appropriate depending on the initial severity of the event
Cytopenias (reduction or lack of certain cell elements in blood circulation) have occurred. Your doctor will test your blood weekly for the first month, biweekly for the second month, and periodically thereafter. In most cases, your doctor will reduce or interrupt your Gleevec therapy; in rare cases, if the cytopenia is severe, your doctor may discontinue treatment
Severe congestive heart failure (impaired ability of the heart to pump blood) and left ventricular dysfunction (impaired functioning of the left side of the heart) have been reported, particularly in patients with other health issues and risk factors. Patients with heart disease or risk factors for heart disease or history of renal failure will be monitored and treated for the condition
Severe liver problems (hepatotoxicity) may occur. Cases of fatal liver failure and severe liver injury requiring liver transplants have been reported with both short-term and long-term use of Gleevec. Your doctor will check your liver function before beginning treatment and continue to monitor liver function as needed. If you experience severe liver problems, your doctor may stop your treatment with Gleevec until the liver problem has been managed
Bleeding may occur. Severe gastrointestinal (GI) bleeding has been reported in patients with Ph+ CML and KIT+ GIST. GI tumor sites may be the cause of this bleeding; therefore, GI symptoms should be monitored at the start of treatment
GI perforation (small holes or tears in the wall of the stomach or intestine), in some cases fatal, has been reported
In patients with hypereosinophilic syndrome (a condition with increased eosinophils, which are a type of white blood cell), e.g., HES, MDS/MPD, or ASM and heart involvement, cases of heart disease have been associated with the initiation of Gleevec therapy. Speak to your doctor regarding appropriate supportive care or discontinuing Gleevec
Skin reactions, such as fluid-filled blisters, have been reported with the use of Gleevec
Clinical cases of hypothyroidism (reduction in thyroid hormones) have been reported in patients taking levothyroxine replacement during treatment with Gleevec. Your doctor should closely monitor your thyroid hormone levels
Long-term use may result in potential liver, kidney, and/or heart toxicities. Immune system suppression may also result from long-term use
Gleevec can cause harm to the unborn child when administered to a pregnant woman. Women should be aware of the potential harm to the fetus. Be sure to inform your doctor if you are or think you may be pregnant. You should not breastfeed while taking Gleevec
Growth retardation (slowing of growth) has been reported in children taking Gleevec. The long-term effects of extended treatment with Gleevec on growth in children are unknown. Growth retardation may be monitored in children receiving treatment
Cases of tumor lysis syndrome (TLS), which refers to an electrolyte disturbance caused by the breakdown of tumor cells, have been reported and can be life threatening in some cases. The patients at risk of TLS are those who have a higher number of tumor cells and whose tumors are fast growing before beginning therapy. Your doctor should monitor you closely and take appropriate precautions. Correction of clinically significant dehydration and treatment of high uric acid levels are recommended prior to initiation of Gleevec
Motor vehicle accidents involving patients receiving Gleevec have been reported. Patients should be advised that they may experience undesirable effects such as dizziness, blurred vision, or drowsiness during treatment with Gleevec. Caution should be recommended when driving a car or operating machinery

The following serious side effects have been reported by patients taking Gleevec:

Severe fluid retention (holding water), which can cause swelling around the eyes or swelling of the lower legs, lungs, and heart; fatal in rare cases
Increased pressure in the heart or brain; fatal in rare cases
Low levels of certain blood cells
Heart failure
Liver problems
Hemorrhage (abnormal bleeding)
Skin blistering
Low levels of thyroid hormone

Your doctor will check you closely for any side effects to stop more serious complications from occurring. Patients with heart disease or risk factors for heart failure should also be monitored carefully.

Gleevec is sometimes associated with stomach or intestinal irritation. Gleevec should be taken with food and a large glass of water to minimize this problem. There have been rare reports, including deaths, of stomach or intestinal perforation (a small hole or tear).

If you are experiencing any of the above-mentioned side effects, please be sure to speak with your doctor immediately.

Do not take Gleevec if you are allergic to any of the ingredients in it.

If you become pregnant while taking Gleevec tell your doctor right away. Gleevec may harm your unborn baby.

You should not breastfeed while taking Gleevec.

Do not take medicines to treat diarrhea while you are taking Gleevec without talking to your doctor.

Tell your doctor if you have ever had a heart attack, high blood pressure, or irregular heartbeat.

Tell your doctor if you have heart, lung, liver, or thyroid disease.

Tell your doctor if you drink or have ever drunk large amounts of alcohol.

Discuss the medicines you take with your doctor. Some medicines may interact with Gleevec.

Talk to your child's doctor about the effects of Gleevec on children, including growth retardation.

You may experience dizziness, blurred vision, or drowsiness while taking Gleevec. Use caution while driving a car or operating machinery.

Gleevec Food Interactions

Talk to your doctor about grapefruit and grapefruit juice. These foods can interfere with how Gleevec is absorbed by your body.

Inform MD

Tell your doctor if you are allergic to Gleevec or any other medications.

Tell your doctor about the medicines you take including prescription and nonprescription medications, vitamins, and herbal and nutritional supplements. Especially tell your doctor if you take:

acetaminophen (Tylenol);
certain antibiotics including erythromycin (E.E.S., E-Mycin, Erythrocin), clarithromycin (Biaxin), and rifampin (Rifadin, in Rifamate);
anticoagulants ('blood thinners') such as warfarin (Coumadin);
antifungals such as ketoconazole (Nizoral) and itraconazole (Sporanox);
calcium channel blockers such as amlodipine (Norvasc, in Caduet), diltiazem (Cardizem, Tiazac), felodipine (Plendil), isradipine (Dynacirc), nicardipine (Cardene), nifedipine (Adalat, Procardia, others), nimodipine (Nimotop), nisoldipine (Sular), or verapamil (Calan, Covera, Isoptin, Verelan);
cholesterol-lowering medications (statins) such as atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor);
cyclosporine (Neoral, Sandimmune);
dexamethasone;
hormonal contraceptives (birth control pills, patches, rings, injections or implants);
pimozide (Orap);
medications for anxiety;
medications for seizures such as carbamazepine (Tegretol), phenobarbital, and phenytoin (Dilantin);
sedatives;
sleeping pills;
tranquilizers
St. John's wort
iron supplements

Tell your doctor if you have or have ever had hypertension (high blood pressure), heart disease, irregular heart beat, or a heart attack.

Tell your doctor if you have diabetes, or lung, thyroid, or liver disease.

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are taking Gleevec (imatinib). Talk to your doctor about birth control methods that you can use during your treatment. If you become pregnant while taking Gleevec (imatinib), call your doctor. Gleevec (imatinib) may harm your unborn baby.

Tell your doctor if you are breastfeeding. You should not breastfeed while you are taking Gleevec (imatinib).

Talk to your doctor about what you should do if you develop diarrhea during your treatment. Do not take any medications to treat diarrhea without talking to your doctor.

Gleevec and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant. Gleevec may harm your unborn baby. You should avoid becoming pregnant while you are taking Gleevec by using a very effective contraception (birth control).

Gleevec and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed. Gleevec may be excreted in human breast milk and may harm your nursing baby.

Gleevec Usage

Take Gleevec exactly as your doctor prescribes it. Follow the directions on your prescription label carefully. Gleevec is taken by mouth. It is usually taken with a meal and a large glass of water once or twice a day. Take Gleevec at around the same time every day.

If you are unable to swallow Gleevec tablets, you may place all of the tablets that you need for one dose into a glass of water or apple juice. Use approximately 2 ounces of liquid for each 100 mg tablet and 100 milliliters (a little less than 4 ounces) of liquid for each 400 mg tablet. Stir with a spoon until the tablets crumble completely and drink the mixture immediately.

Because the tablet coating contains iron, never take eight of the 100 mg Gleevec tablets. You will receive too much iron. If your doctor has told you to take 800 mg of imatinib, you should take two of the 400 mg tablets.

If you forget to take a dose, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Gleevec Dosage

Take Gleevec exactly as your doctor prescribes it. Follow the directions on your prescription label carefully.

Your doctor may increase or decrease your dose of Gleevec during your treatment. This depends on how well the medication works for you and on the side effects you experience. Talk to your doctor about how you are feeling during your treatment. Continue to take Gleevec even if you feel well. Do not stop taking Gleevec without talking to your doctor.

Gleevec Overdose

If you take too much Gleevec, call your local Poison Control Center or seek emergency medical attention right away. Symptoms of overdose may include muscle cramps, and swollen or bloated stomach.

Forms of Gleevec

Gleevec is available in 100 mg and 400 mg tablets.

Active ingredient: imatinib mesylate

Inactive ingredients: silicon dioxide, crospovidone, ferric oxide red, magnesium stearate, microcrystalline cellulose, polyethylene glycols, talc, ferric oxide yellow, hypromelloses.