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Care During Chemotherapy and Beyond

Neratinib

(neh-RA-tih-nib)

Brand Name: Nerlynx®

Neratinib is the generic name for the trade name drug Nerlynx®. In some cases, health care professionals may use the trade name Nerlynx® when referring to the generic drug neratinib.

Drug Type:

Neratinib is an anti-cancer ("antineoplastic") chemotherapy drug. Neratinib is classified as a "Tyrosine Kinase Inhibitor." (For more information, see the "How Neratinib Works" section below).

What Neratinib Is Used For

  • Breast Cancer

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Neratinib Is Given

  • Neratinib tablets come in one strength, 40 mg.
  • Taken as a pull by mouth.
  • Take prescribed dose once daily by mouth with food.
  • Take at approximately the same time each day.
  • If you miss a dose of neratinib, resume therapy with the next scheduled daily dose; do not replace the missed dose.
  • Do not crush, chew, split, or dissolve tablets.

Side Effects

Important things to remember about the side effects of neratinib:

  • Most people will not experience all of the side effects listed for neratinib.
  • Neratinib side effects are often predictable in terms of their onset, duration, and severity.
  • Neratinib side effects will improve after therapy is complete.
  • Neratinib side effects may be manageable, there are many options to minimize or prevent the side effects of neratinib.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
  • The side effects of neratinib and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects.

The following side effects are common (occurring in greater than 30%) of patients taking neratinib:

These side effects are less common side effects (occurring in about 10-29%) of patients taking neratinib:

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Signs of an allergic reaction such as rash, hives, itching, red, swollen, blistered, or peeling skin with or without fever. Wheezing, trouble breathing, talking, or swallowing, swelling of the mouth, face, lips, tongue, or throat.
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24-hour period)
  • Diarrhea (more than 4-6 episodes in a 24-hour period)
  • Swelling of the belly
  • Black or tarry stools, or blood in your stools or urine
  • Extreme fatigue (unable to carry on self-care activities)
  • Confusion, muscle pain, weakness, abnormal heartbeat
  • Problems passing urine or a decrease in amount of urine passed
  • Signs of a urinary tract infection, burning or pain when passing urine, feeling the need to pass urine often or right away, fever.
  • Dark urine, feeling tired, not hungry, light colored stools, yellow skin or eyes.

Always inform your health care provider if you experience any unusual symptoms.

Precautions

  • Before starting neratinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
  • Avoid taking H2-receptor antagonists (famotidine, cimetidine, ranitidine), proton pump inhibitors (omeprazole, lansoprazole, pantoprazole), colchicine, clotrimazole, or ciprofloxacin with neratinib. If needed, take antacids 3 hours before taking neratinib.
  • Avoid grapefruit juice while taking neratinib.
  • If you are taking digoxin, talk with your doctor. You may need to have your blood work checked more closely while you are taking it with this drug.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Neratinib may cause fetal harm. Women of reproductive potential should have a pregnancy test prior to treatment. Effective contraception should be used during therapy and for at least 1 month after the last dose.
  • Male patients with female partners of reproductive potential should also use effective contraception during therapy and for at least 3 months after the last dose.
  • Breastfeeding is not recommended during therapy or for at least 1 month after the last dose.

Self-Care Tips

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
  • An anti-diarrhea medication may be needed during the first two cycles of neratinib treatment. Follow regimen of anti-diarrhea medications as prescribed by your health care professional.
  • Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
  • You may experience drowsiness or fatigue; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as walking daily.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team, they can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Neratinib

You will be checked regularly by your doctor while you are taking neratinib, to monitor side effects and check your response to therapy. Periodic blood work to monitor the function of your organs (liver) will also be ordered by your doctor.

How Neratinib Works

Neratinib is considered a "targeted therapy" medication, not a chemotherapy drug. To date, cancer treatment has focused primarily on killing rapidly dividing cells. This is because a major feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too which causes chemotherapy drugs to affect these normal cells, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

Neratinib belongs to a category of medications called tyrosine kinase inhibitors. This drug works by irreversibly binding to and inhibiting specific receptors in cancer cells called HER2 and EGFR receptors. These receptors are responsible for helping cancer cells grow and multiply. By inhibiting the HER2 and EGFR receptors with neratinib, cancer cells can no longer continue growing and multiplying.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

References:

  • Lexicomp Online®. Hudson, Ohio: Lexi-Comp, Inc.; July 18, 2017.

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