Everolimus (Afinitor )

Everolimus (Afinitor®)

Pronounced: [ever-oh-lye-mus]

About Your Medication

Everolimus is an oral medicine used to treat cancer. Everolimus works by inhibiting an enzyme called mTOR that is important for cancer cell growth and survival. By blocking this enzyme, everolimus slows the growth of the cancer and also helps prevent the formationof blood vessels around the tumor that help supply it with nutrients to grow.

How to Take Your Medication

Take your everolimus at approximately the same time each day.
Swallow everolimustablets whole. Do not chew or crush the tablets
Everolimus may be taken with or without food. Be consistent with the way you choose to do this—take all doses with food or take all doses without food.
If you miss a dose of your everolimus, take the medicine as soon as possible. If more than 6 hours has passed since when you were supposed to take the everolimus, skip the dose for that day. Do not double your dose and take your everolimus at the usual time the next day.

Tell Your Healthcare Provider if you have any trouble taking your everolimus, including:

Trouble swallowing pills
Forgetting to take doses
Trouble affording your medications
Throwing up pills
Side effects

Important Precautions

Everolimus may be harmful to anunborn child. If sexually active with a partner that is pregnant or who may become pregnant during and 8 weeks after treatment, two forms of contraception must be used (a condom and another effective form of birth control)
Everolimus has been associated with a small risk of pneumonitis, or inflammation of the lung. Talk to your doctor right away if you notice worsening cough, shortness of breath, or difficulty breathing.

What foods and drugs may interact with my everolimus?

Please talk to your healthcare provider at your cancer clinic before starting or stopping any medications, vitamins, or herbal supplements, because some of these may interact with your everolimus. Some examples of products that interact with everolimus include:

Grapefruit or grapefruit juice
Certain heart medications, including verapamil (Calan®), diltiazem (Cardizem®), amiodarone (Pacerone®), and “ACE-inhibitors”, such as lisinopril (Zestril®), benazepril (Lotensin®), and enalapril (Vasotec®)
Certain cholesterol-lowering drugs, such as simvastatin (Zocor®), atorvastatin (Lipitor®), and lovastatin (Mevacor®)
The blood thinning medication warfarin (Coumadin®)
The anti-nausea medication aprepitant (Emend®)
Some medications for mood, including nefazodone (Serzone®) and St. John’s Wort
Some anti-infectives, such as fluconazole (Diflucan®), voriconazole (Vfend®), itraconazole (Sporanox®), posaconazole (Noxafil®), rifampin (Rifadin®), clarithromycin (Biaxin®), and ritonavir (Norvir®)
Certain anti-seizure medications, including carbamazepine (Tegretol®) and phenytoin (Dilantin)®

Storage, Handling, and Disposal

It is important to keep these safeguards in mind when storing and handling oral anticancer therapy to keep you and your caregivers safe.

Everolimus may be harmful to an unborn child. Women who are pregnant or who may become pregnant should not handle everolimus without proper protection (gloves).
Keep your everolimus in a safe place, away from other family members’ medications and away from any food or drinks.
Store the medication at room temperature in a dry location – avoid storing your medication in the bathroom.
Keep the medication out of reach from children and pets.
Return expired, damaged, or unused everolimus to a pharmacy or hospital for disposal. Do not discard into the garbage or toilet, or anywhere that children or pets may have access.

Everolimus (Afinitor®) Side Effect Summary

This list does not include all possible side effects of everolimus. If you have an unusual symptom, call the clinic. Below are the most common side effects:

Mucositis (mouth sores) – inflammation or sores in the mouth

Mild mucositis – little to no mouth pain /

Use a soft toothbrush
Rinse 3-4 times daily with a solution of 1 teaspoonful of baking soda + 1 teaspoonful of salt in 1 cup of warm water
Use pain medications as prescribed by the clinic

Moderate mucositis – moderate pain, but not interfering with your ability to keep up with eating; causing you to change your diet because of discomfort /

Try to manage using the measures listed above and consider taking your pain medications on a regular basis so you can eat and drink.
If it does not get better after a couple days, call the clinic

Severe mucositis – severe pain, inability to stay hydrated or keep up with eating /

Call the clinic

Swelling/Rapid Weight Gain (edema)

What are your symptoms? / What can you do…
Mild swelling, only visible when looking closely, not interfering with activities /

Ask your clinic about special stockings
Wear loose clothing and shoes that are not too tight
Keep your legs elevated when you are sitting or resting
Weigh yourself regularly
Avoid salty foods, including canned soups, chips, bacon, and ham. Don’t add extra salt or soy sauce to your food. Check food labels for sodium content, and try to limit yourself to less than 2 grams of sodium per day.

Moderate swelling, clearly visible, not interfering with daily activities /

Try to manage using the measures listed above
If you have rapid weight gain (more than 5 pounds in one week), call the clinic
If you have any difficulty breathing or chest tightness, call 911 or proceed to your local emergency room

Severe swelling, interfering with your daily activities /

Call the clinic
If you have any difficulty breathing or chest tightness, call 911 or proceed to your local emergency room

Fatigue – lack of energy or feeling sleepy

What are your symptoms? / What can you do…
Mild fatigue (slightly worse than before you started taking the drug) /

You may need to adjust your schedule to manage fatigue. Plan out the day, and prioritize activities, so you have time to rest.
You should schedule periods of rest into your day, and try to rest before you feel tired. Frequent, short rests are helpful.
Stay active – regular mild/moderate exercise can boost your energy level. Try incorporating walking or other activities into your daily routine.
Try not to over-exert yourself. Ask for help from family or friends with difficult tasks.

Moderate fatigue (difficulty performing some of your normal daily activities) /

Try to manage using the measures listed above.
If it does not get better after a few days, Call the clinic

Severe fatigue (severely interfering with your normal daily activities or inability to get out of bed) /

Call the clinic

Rash – an itchy or red appearance on the skin

Mild Rash – covering less than 10% of your body (an entire leg is about 10% of your body surface area); no symptoms such as itching, burning or tightness /

Avoid direct sunlight (cover exposed areas of skin and use sunscreen)
Use antihistamines (anti-itch) medicines prescribed by the clinic
Apply non-scented lotion to the affected areas to avoid dryness

Moderate Rash - covering about 10%-30% of your skin (an entire leg is about 10% of your body surface area); with or without symptoms such as itching, burning or tightness; limiting some of your daily activities, but able to care for yourself /

Try to manage using the measures listed above.
If not improved within a few days, or you are unable to care for yourself, Call the clinic

Severe Rash – covering more than 30% of your skin (an entire leg is about 10% of your body surface area); with or without symptoms such as itching, burning or tightness; limiting your ability to care for yourself /

Call the clinic

Increases in Blood Sugar and Lipid (Cholesterol) Levels

What Can I Do? / When to Call the Clinic?

The clinic will monitor your labs to assess
If you have diabetes or a history of heart disease or high cholesterol, talk with your cancer clinic about monitoring

If you have diabetes & measure your blood sugar, ask the clinic what blood sugar level is too high for you.
If you feel confused, have increased urination, blurry vision, or are very tired & unable to perform normal activities
If you have chest pain, chest tightness/pressure, or trouble breathing, call 911 or proceed to your local emergency room
If you have a numbness or drooping of one side of the face, weakness in an arm or leg, or slurred speech, call 911 or proceed to your local emergency room

Increased Risk of Infection

What Can I Do? / When to Call the Clinic?

Wash hands regularly
Avoid close contact with others who are sick
The clinic will monitor your labs regularly. Make sure not to miss clinic visits or lab draws

Temperature of 100.5˚F or higher- CONTACT THE CLINIC IMMEDIATELY
Any signs of infection
Unusual tiredness or weakness
Shortness of breath, difficulty breathing

Below are some less common side effects of everolimus.

Less Common Side Effects / What Can I Do? / ]When to Call the Clinic?
Kidney dysfunction /

The clinic will monitor your labs regularly. Make sure not to miss clinic visits or lab draws

Changes in urination (decrease in frequency, pain with urination, blood in your urine)

Liver dysfunction /

The clinic will monitor your labs regularly. Make sure not to miss clinic visits or lab draws
Avoid alcohol use while taking everolimus

Yellowing of the eyes or skin

Lung disease (pneumonitis) /

If you have new symptoms such as wheezing, shortness of breath, or a new cough

Who to Call With Questions?

If you are having an emergency, call 911

Who to Call With Questions?

If you are having an emergency, call 911

Who to Call With Questions?

If you are having an emergency, call 911

Who to Call With Questions?

If you are having an emergency, call 911

MOQC makes no representations or warranties and explicitly disclaims the appropriateness or applicability of the MOQC Content to any specific patient's care or treatment. Any clinician seeking to treat a patient using the MOQC Content is expected to use independent medical judgment in the context of individual clinical circumstances of a specific patient's care or treatment.