Afatinib dimaleate is the dimaleate salt form of afatinib, an orally bioavailable anilino-quinazoline derivative and inhibitor of the receptor tyrosine kinase (RTK) epidermal growth factor receptor (ErbB; EGFR) family, with antineoplastic activity. Upon administration, afatinib selectively and irreversibly binds to and inhibits the epidermal growth factor receptors 1 (ErbB1; EGFR), 2 (ErbB2; HER2), and 4 (ErbB4; HER4), and certain EGFR mutants, including those caused by EGFR exon 19 deletion mutations or exon 21 (L858R) mutations. This may result in the inhibition of tumor growth and angiogenesis in tumor cells overexpressing these RTKs. Additionally, afatinib inhibits the EGFR T790M gatekeeper mutation resistant to treatment with first-generation EGFR inhibitors. EGFR, HER2, and HER4 are RTKs that belong to the EGFR superfamily; they play major roles in both tumor cell proliferation and tumor vascularization and are overexpressed in many cancer cell types.
Afatinib dimaleate is a maleate salt obtained by combining afatinib with two molar equivalents of maleic acid. Used for the first-line treatment of patients with metastatic non-small cell lung cancer. It has a role as a tyrosine kinase inhibitor and an antineoplastic agent. It contains an afatinib.
Afatinib is a quinazoline compound having a 3-chloro-4-fluoroanilino group at the 4-position, a 4-dimethylamino-trans-but-2-enamido group at the 6-position, and an (S)-tetrahydrofuran-3-yloxy group at the 7-position. Used (as its dimaleate salt) for the first-line treatment of patients with metastatic non-small cell lung cancer. It has a role as a tyrosine kinase inhibitor and an antineoplastic agent. It is a member of quinazolines, a member of furans, an organofluorine compound, an enamide, an aromatic ether, a tertiary amino compound, a member of monochlorobenzenes and a secondary carboxamide.
Mechanism of Action
Afatinib is a potent and selective, irreversible ErbB family blocker. Afatinib covalently binds to and irreversibly blocks signaling from all homo and heterodimers formed by the ErbB family members EGFR (ErbB1), HER2 (ErbB2), ErbB3 and ErbB4. In particular, afatinib covalently binds to the kinase domains of EGFR (ErbB1), HER2 (ErbB2), and HER4 (ErbB4) and irreversibly inhibits tyrosine kinase autophosphorylation, resulting in downregulation of ErbB signaling. Certain mutations in EGFR, including non-resistant mutations in its kinase domain, can result in increased autophosphorylation of the receptor, leading to receptor activation, sometimes in the absence of ligand binding, and can support cell proliferation in NSCLC. Non-resistant mutations are defined as those occurring in exons constituting the kinase domain of EGFR that lead to increased receptor activation and where efficacy is predicted by 1) clinically meaningful tumor shrinkage with the recommended dose of afatinib and/or 2) inhibition of cellular proliferation or EGFR tyrosine kinase phosphorylation at concentrations of afatinib sustainable at the recommended dosage according to validated methods. The most commonly found of these mutations are exon 21 L858R substitutions and exon 19 deletions. Moreover, afatinib demonstrated inhibition of autophosphorylation and/or in vitro proliferation of cell lines expressing wild-type EGFR and in those expressing selected EGFR exon 19 deletion mutations, exon 21 L858R mutations, or other less common non-resistant mutations, at afatinib concentrations achieved in patients. In addition, afatinib inhibited in vitro proliferation of cell lines overexpressing HER2.
The dimaleate salt form of afatinib, an orally bioavailable anilino-quinazoline derivative and inhibitor of the receptor tyrosine kinase (RTK) epidermal growth factor receptor (ErbB; EGFR) family, with antineoplastic activity. Upon administration, afatinib selectively and irreversibly binds to and inhibits the epidermal growth factor receptors 1 (ErbB1; EGFR), 2 (ErbB2; HER2), and 4 (ErbB4; HER4), and certain EGFR mutants, including those caused by EGFR exon 19 deletion mutations or exon 21 (L858R) mutations. This may result in the inhibition of tumor growth and angiogenesis in tumor cells overexpressing these RTKs. Additionally, afatinib inhibits the EGFR T790M gatekeeper mutation resistant to treatment with first-generation EGFR inhibitors. EGFR, HER2 and HER4 are RTKs that belong to the EGFR superfamily; they play major roles in both tumor cell proliferation and tumor vascularization and are overexpressed in many cancer cell types.
Indications
- Giotrif as monotherapy is indicated for the treatment of epidermal Growth Factor Receptor (EGFR) TKI-naïve adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating EGFR mutation(s); locally advanced or metastatic NSCLC of squamous histology progressing on or after platinum-based chemotherapy.
- Afatinib is a kinase inhibitor indicated as monotherapy for the first-line treatment of (a) Epidermal Growth Factor Receptor (EGFR) TKI (tyrosine kinase inhibitor)-naive adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant EGFR mutations as detected by an FDA-approved test, and (b) adult patients with locally advanced or metastatic NSCLC of squamous histology progressing on or after platinum-based chemotherapy. Recently, as of January 2018, the US FDA approved a supplemental New Drug Application for Boehringer Ingelheim’s Gilotrif (afatinib) for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant epidermal growth factor receptor (EGFR) mutations as detected by an FDA-approved test. The new label includes data on three additional EGFR mutations: L861Q, G719X, and S768I.
- Giotrif as monotherapy is indicated for the treatment of epidermal Growth Factor Receptor (EGFR) TKI-naïve adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating EGFR mutation(s); locally advanced or metastatic NSCLC of squamous histology progressing on or after platinum-based chemotherapy.
- Treatment of all conditions included in the category of malignant neoplasms (excluding central nervous system, hematopoietic and lymphoid tissue neoplasms), Treatment of malignant neoplasms of the central nervous system
- Metastatic Non-Small Cell Lung Cancer
- Refractory, metastatic squamous cell Non-small cell lung cancer
- Epidermal Growth Factor Receptor (EGFR) TKI (tyrosine kinase inhibitor)-naive adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant EGFR mutations as detected by an FDA-approved test Label, and (b) adult patients with locally advanced or metastatic NSCLC of squamous histology progressing on or after platinum-based chemotherapy
Use in Cancer
Afatinib dimaleate is approved to treat:
- Non-small cell lung cancer (NSCLC) has metastasized (spread to other body parts). It is used:
Afatinib dimaleate is also being studied in treating other types of cancer.
Contraindications
The following conditions are contraindicated with this drug. Check with your physician if you have any of the following:
- a bad infection
- low amount of albumin proteins in the blood
- excess body acid
- decreased function of bone marrow
- anemia
- decreased blood platelets
- a significant decrease in certain blood clotting cells called platelets
- low levels of white blood cells
- low levels of a type of white blood cell called neutrophils
- bleeding
- a type of inflammation of the lung called interstitial pneumonitis
- a condition where there is a formation of fibrous tissue in the lung called pulmonary fibrosis
- damage to the liver and inflammation
- pregnancy
- a patient who is producing milk and breastfeeding
- moderate to severe kidney impairment
- a significant drop in a certain type of white blood cell called a neutrophil
Dosage
Strengths: 30 mg; 40 mg; 20 mg
Non-Small Cell Lung Cancer
- 40 mg orally once a day until disease progression or intolerance by the patient
- The recommended dose of afatinib is 40 mg orally once daily.
- In patients with severe renal impairment, the recommended dose of afatinib is 30 mg orally once daily
- Take afatinib at least 1 hour before or 2 hours after a meal
Side Effects
Most common
- diarrhea,
- rash/dermatitis,
- acneiform,
- stomatitis,
- paronychia,
- dry skin,
- decreased appetite,
- pruritus.
- nausea, vomiting,
- asthenia,
- dizziness, headache,
- abdominal pain and elevated amylase (< 1.5 times ULN).
More Common
- cracking or swelling of the lips or sores in the corners of the mouth
- dry skin or itching
- loss of appetite
- nail infection
- acne
- nose bleeds
- diarrhea
- dry mouth, dark urine, decreased sweating, dry skin, and other signs of dehydration
- decreased urination
- swelling of the arms, hands, feet, ankles, or lower legs
- rash
- pain, redness, peeling, or blistering of skin
- difficulty breathing
- shortness of breath
- rapid, irregular, or pounding heartbeat
- sudden weight gain
- cough
- fever
- excessive tiredness
- pain in the right upper part of the stomach
- unusual bruising or bleeding
- nausea
- vomiting
- yellowing of the skin or eyes
- dark urine
- red, swollen, painful, or teary eyes
- sudden changes in vision, including blurred vision
- sensitivity to light
Rare
- Diarrhea
- Acneiform eruption (group of skin conditions resembling acne)
- Mouth sores
- Paronychia (infection of nails)
- Dry mouth
- Decreased appetite
- Itching
- Weight loss
- Nose bleeds
- Cystitis (bladder infection)
- Cheilitis (inflammation of the lips)
- Fever
- Hypokalemia (low potassium)
- Conjunctivitis (pink eye)
- Rhinorrhea (runny nose)
- Elevated liver enzymes
Drug Interaction
- amiodarone
- apalutamide
- “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- carbamazepine
- carvedilol
- cyclosporine
- dronedarone
- elagolix
- flibanserin
- HIV protease inhibitors (e.g., atazanavir, indinavir, lopinavir, ritonavir, saquinavir)
- lapatinib
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- phenobarbital
- phenytoin
- porfimer
- primidone
- propafenone
- quinidine
- quinine
- rifampin
- St. John’s wort
- tacrolimus
- verapamil
| DRUG | INTERACTION |
|---|---|
| Abaloparatide | The therapeutic efficacy of Abaloparatide can be decreased when used in combination with Afatinib. |
| Abemaciclib | The serum concentration of Abemaciclib can be increased when it is combined with Afatinib. |
| Abrocitinib | The serum concentration of Afatinib can be increased when it is combined with Abrocitinib. |
| Acetaminophen | The serum concentration of Acetaminophen can be increased when it is combined with Afatinib. |
| Alectinib | Alectinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Allopurinol | Afatinib may decrease the excretion rate of Allopurinol which could result in a higher serum level. |
| Alpelisib | The serum concentration of Alpelisib can be increased when it is combined with Afatinib. |
| Ambrisentan | The serum concentration of Ambrisentan can be increased when it is combined with Afatinib. |
| Amiodarone | The serum concentration of Afatinib can be increased when it is combined with Amiodarone. |
| Apalutamide | The serum concentration of Afatinib can be decreased when it is combined with Apalutamide. |
| Apixaban | Afatinib may decrease the excretion rate of Apixaban which could result in a higher serum level. |
| Arsenic trioxide | The serum concentration of Afatinib can be increased when it is combined with Arsenic trioxide. |
| Articaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Articaine. |
| Asciminib | The serum concentration of Afatinib can be increased when it is combined with Asciminib. |
| Asunaprevir | The serum concentration of Afatinib can be increased when it is combined with Asunaprevir. |
| Avanafil | Avanafil may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Avatrombopag | Avatrombopag may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Axitinib | The serum concentration of Axitinib can be increased when it is combined with Afatinib. |
| Beclomethasone dipropionate | Beclomethasone dipropionate may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Belantamab mafodotin | The serum concentration of Belantamab mafodotin can be increased when it is combined with Afatinib. |
| Belinostat | The serum concentration of Belinostat can be increased when it is combined with Afatinib. |
| Belumosudil | The serum concentration of Afatinib can be increased when it is combined with Belumosudil. |
| Bendamustine | The serum concentration of Bendamustine can be increased when it is combined with Afatinib. |
| Benzocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Benzocaine. |
| Benzyl alcohol | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Benzyl alcohol. |
| Berotralstat | The serum concentration of Berotralstat can be increased when it is combined with Afatinib. |
| Betrixaban | The serum concentration of Betrixaban can be increased when it is combined with Afatinib. |
| Binimetinib | The serum concentration of Binimetinib can be increased when it is combined with Afatinib. |
| Bisoprolol | The serum concentration of Bisoprolol can be increased when it is combined with Afatinib. |
| Bortezomib | The serum concentration of Bortezomib can be increased when it is combined with Afatinib. |
| Bosutinib | The serum concentration of Bosutinib can be increased when it is combined with Afatinib. |
| Brentuximab vedotin | The serum concentration of Brentuximab vedotin can be increased when it is combined with Afatinib. |
| Brigatinib | Afatinib may decrease the excretion rate of Brigatinib which could result in a higher serum level. |
| Bupivacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Bupivacaine. |
| Buprenorphine | Buprenorphine may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Butacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Butacaine. |
| Butamben | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Butamben. |
| Cabazitaxel | The serum concentration of Cabazitaxel can be increased when it is combined with Afatinib. |
| Cabergoline | The serum concentration of Cabergoline can be increased when it is combined with Afatinib. |
| Caffeine | Caffeine may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Canagliflozin | The serum concentration of Afatinib can be increased when it is combined with Canagliflozin. |
| Cannabidiol | Cannabidiol may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Capmatinib | The serum concentration of Afatinib can be increased when it is combined with Capmatinib. |
| Capsaicin | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Capsaicin. |
| Carbimazole | The therapeutic efficacy of Carbimazole can be decreased when used in combination with Afatinib. |
| Carfilzomib | The serum concentration of Afatinib can be increased when it is combined with Carfilzomib. |
| Carvedilol | The serum concentration of Afatinib can be increased when it is combined with Carvedilol. |
| Celecoxib | Afatinib may decrease the excretion rate of Celecoxib which could result in a higher serum level. |
| Ceritinib | The serum concentration of Ceritinib can be increased when it is combined with Afatinib. |
| Cerivastatin | Afatinib may decrease the excretion rate of Cerivastatin which could result in a higher serum level. |
| Chloroprocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Chloroprocaine. |
| Cholesterol | Cholesterol may increase the excretion rate of Afatinib which could result in a lower serum level and potentially a reduction in efficacy. |
| Cinchocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Cinchocaine. |
| Cladribine | Afatinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Clarithromycin | The serum concentration of Afatinib can be increased when it is combined with Clarithromycin. |
| Clobazam | The serum concentration of Clobazam can be increased when it is combined with Afatinib. |
| Clofarabine | Afatinib may decrease the excretion rate of Clofarabine which could result in a higher serum level. |
| Clofazimine | The serum concentration of Afatinib can be increased when it is combined with Clofazimine. |
| Clomifene | The serum concentration of Clomifene can be increased when it is combined with Afatinib. |
| Cobicistat | The serum concentration of Afatinib can be increased when it is combined with Cobicistat. |
| Cobimetinib | The serum concentration of Cobimetinib can be increased when it is combined with Afatinib. |
| Cocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Cocaine. |
| Colchicine | The serum concentration of Colchicine can be increased when it is combined with Afatinib. |
| Conivaptan | The serum concentration of Afatinib can be increased when it is combined with Conivaptan. |
| Conjugated estrogens | Afatinib may decrease the excretion rate of Conjugated estrogens which could result in a higher serum level. |
| Copanlisib | The serum concentration of Copanlisib can be increased when it is combined with Afatinib. |
| Crizotinib | The serum concentration of Afatinib can be increased when it is combined with Crizotinib. |
| Curcumin | The serum concentration of Afatinib can be increased when it is combined with Curcumin. |
| Cyclosporine | The serum concentration of Afatinib can be increased when it is combined with Cyclosporine. |
| Dabigatran etexilate | The serum concentration of Dabigatran etexilate can be increased when it is combined with Afatinib. |
| Dabrafenib | The serum concentration of Dabrafenib can be increased when it is combined with Afatinib. |
| Daclatasvir | The serum concentration of Afatinib can be increased when it is combined with Daclatasvir. |
| Dacomitinib | The serum concentration of Afatinib can be increased when it is combined with Dacomitinib. |
| Dactinomycin | The serum concentration of Dactinomycin can be increased when it is combined with Afatinib. |
| Daptomycin | The serum concentration of Daptomycin can be increased when it is combined with Afatinib. |
| Darbepoetin alfa | The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Afatinib. |
| Darolutamide | The serum concentration of Afatinib can be increased when it is combined with Darolutamide. |
| Darunavir | The serum concentration of Darunavir can be increased when it is combined with Afatinib. |
| Dasabuvir | Dasabuvir may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Dasatinib | The serum concentration of Dasatinib can be increased when it is combined with Afatinib. |
| Daunorubicin | Afatinib may decrease the excretion rate of Daunorubicin which could result in a higher serum level. |
| Delafloxacin | Afatinib may decrease the excretion rate of Delafloxacin which could result in a higher serum level. |
| Dexamethasone | Dexamethasone may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Dexamethasone acetate | The serum concentration of Afatinib can be decreased when it is combined with Dexamethasone acetate. |
| Diethylstilbestrol | Diethylstilbestrol may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Digitoxin | The serum concentration of Digitoxin can be increased when it is combined with Afatinib. |
| Digoxin | Afatinib may decrease the excretion rate of Digoxin which could result in a higher serum level. |
| Diosmin | The serum concentration of Afatinib can be increased when it is combined with Diosmin. |
| Diphenhydramine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Diphenhydramine. |
| Dolutegravir | Afatinib may decrease the excretion rate of Dolutegravir which could result in a higher serum level. |
| Donepezil | Afatinib may decrease the excretion rate of Donepezil which could result in a higher serum level. |
| Doxorubicin | The serum concentration of Doxorubicin can be increased when it is combined with Afatinib. |
| Dronedarone | The serum concentration of Afatinib can be increased when it is combined with Dronedarone. |
| Duvelisib | Afatinib may decrease the excretion rate of Duvelisib which could result in a higher serum level. |
| Dyclonine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Dyclonine. |
| Edoxaban | The serum concentration of Edoxaban can be increased when it is combined with Afatinib. |
| Elagolix | The serum concentration of Afatinib can be increased when it is combined with Elagolix. |
| Elbasvir | Elbasvir may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Eliglustat | The serum concentration of Afatinib can be increased when it is combined with Eliglustat. |
| Eltrombopag | Eltrombopag may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Enasidenib | The serum concentration of Afatinib can be increased when it is combined with Enasidenib. |
| Enfortumab vedotin | The serum concentration of Enfortumab vedotin can be increased when it is combined with Afatinib. |
| Entrectinib | The serum concentration of Afatinib can be increased when it is combined with Entrectinib. |
| Erdafitinib | The serum concentration of Afatinib can be increased when it is combined with Erdafitinib. |
| Erlotinib | Erlotinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Ertugliflozin | Afatinib may decrease the excretion rate of Ertugliflozin which could result in a higher serum level. |
| Erythromycin | The serum concentration of Afatinib can be increased when it is combined with Erythromycin. |
| Erythropoietin | The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Afatinib. |
| Estradiol | Estradiol may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Estradiol acetate | Estradiol acetate may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Estradiol benzoate | Estradiol benzoate may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Estradiol cypionate | Estradiol cypionate may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Estradiol dienanthate | Estradiol dienanthate may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Estradiol valerate | Estradiol valerate may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Ethyl chloride | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Ethyl chloride. |
| Etidocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Etidocaine. |
| Etoposide | The serum concentration of Etoposide can be increased when it is combined with Afatinib. |
| Everolimus | The serum concentration of Afatinib can be increased when it is combined with Everolimus. |
| Ezetimibe | Afatinib may decrease the excretion rate of Ezetimibe which could result in a higher serum level. |
| Favipiravir | The serum concentration of Afatinib can be increased when it is combined with Favipiravir. |
| Febuxostat | The excretion of Afatinib can be decreased when combined with Febuxostat. |
| Fedratinib | The serum concentration of Afatinib can be increased when it is combined with Fedratinib. |
| Fexofenadine | The serum concentration of Fexofenadine can be increased when it is combined with Afatinib. |
| Flibanserin | The serum concentration of Afatinib can be increased when it is combined with Flibanserin. |
| Fluconazole | The serum concentration of Afatinib can be increased when it is combined with Fluconazole. |
| Fluorouracil | Afatinib may decrease the excretion rate of Fluorouracil which could result in a higher serum level. |
| Folic acid | Afatinib may decrease the excretion rate of Folic acid which could result in a higher serum level. |
| Follitropin | The therapeutic efficacy of Follitropin can be decreased when used in combination with Afatinib. |
| Fostamatinib | Fostamatinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Fostemsavir | Afatinib may decrease the excretion rate of Fostemsavir which could result in a higher serum level. |
| Fusidic acid | Fusidic acid may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Futibatinib | The serum concentration of Futibatinib can be increased when it is combined with Afatinib. |
| Gefitinib | Gefitinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Gemcitabine | The serum concentration of Gemcitabine can be increased when it is combined with Afatinib. |
| Gilteritinib | Gilteritinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Glasdegib | The serum concentration of Afatinib can be increased when it is combined with Glasdegib. |
| Glecaprevir | The serum concentration of Afatinib can be increased when it is combined with Glecaprevir. |
| Glyburide | Afatinib may decrease the excretion rate of Glyburide which could result in a higher serum level. |
| Grazoprevir | Grazoprevir may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Idelalisib | Afatinib may decrease the excretion rate of Idelalisib which could result in a higher serum level. |
| Imatinib | Imatinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Imipramine | The serum concentration of Imipramine can be increased when it is combined with Afatinib. |
| Indacaterol | The serum concentration of Indacaterol can be increased when it is combined with Afatinib. |
| Inotuzumab ozogamicin | The serum concentration of Inotuzumab ozogamicin can be increased when it is combined with Afatinib. |
| Irinotecan | Afatinib may decrease the excretion rate of Irinotecan which could result in a higher serum level. |
| Isavuconazole | The serum concentration of Afatinib can be increased when it is combined with Isavuconazole. |
| Isavuconazonium | The serum concentration of Afatinib can be increased when it is combined with Isavuconazonium. |
| Istradefylline | The serum concentration of Afatinib can be increased when it is combined with Istradefylline. |
| Itraconazole | The serum concentration of Afatinib can be increased when it is combined with Itraconazole. |
| Ivacaftor | The serum concentration of Afatinib can be increased when it is combined with Ivacaftor. |
| Ivermectin | Afatinib may decrease the excretion rate of Ivermectin which could result in a higher serum level. |
| Ixabepilone | The serum concentration of Afatinib can be increased when it is combined with Ixabepilone. |
| Ketoconazole | The serum concentration of Afatinib can be increased when it is combined with Ketoconazole. |
| Lamivudine | Afatinib may decrease the excretion rate of Lamivudine which could result in a higher serum level. |
| Lansoprazole | Lansoprazole may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Lapatinib | The serum concentration of Afatinib can be increased when it is combined with Lapatinib. |
| Larotrectinib | The serum concentration of Larotrectinib can be increased when it is combined with Afatinib. |
| Lasmiditan | The serum concentration of Afatinib can be increased when it is combined with Lasmiditan. |
| Ledipasvir | The serum concentration of Ledipasvir can be increased when it is combined with Afatinib. |
| Lefamulin | Afatinib may decrease the excretion rate of Lefamulin which could result in a higher serum level. |
| Leflunomide | Afatinib may decrease the excretion rate of Leflunomide which could result in a higher serum level. |
| Lemborexant | The serum concentration of Lemborexant can be increased when it is combined with Afatinib. |
| Lenvatinib | Afatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level. |
| Letermovir | Letermovir may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Levobupivacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Levobupivacaine. |
| Levoketoconazole | The serum concentration of Afatinib can be increased when it is combined with Levoketoconazole. |
| Levothyroxine | The serum concentration of Afatinib can be decreased when it is combined with Levothyroxine. |
| Lidocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Lidocaine. |
| Linagliptin | The serum concentration of Afatinib can be increased when it is combined with Linagliptin. |
| Liothyronine | The therapeutic efficacy of Liothyronine can be decreased when used in combination with Afatinib. |
| Liotrix | The therapeutic efficacy of Liotrix can be decreased when used in combination with Afatinib. |
| Lomitapide | The serum concentration of Afatinib can be increased when it is combined with Lomitapide. |
| Lonafarnib | The serum concentration of Afatinib can be increased when it is combined with Lonafarnib. |
| Loncastuximab tesirine | The serum concentration of Loncastuximab tesirine can be increased when it is combined with Afatinib. |
| Loperamide | The excretion of Loperamide can be decreased when combined with Afatinib. |
| Lopinavir | The serum concentration of Afatinib can be increased when it is combined with Lopinavir. |
| Lorlatinib | The serum concentration of Afatinib can be decreased when it is combined with Lorlatinib. |
| Loxapine | The serum concentration of Afatinib can be increased when it is combined with Loxapine. |
| Lumacaftor | The serum concentration of Afatinib can be increased when it is combined with Lumacaftor. |
| Lusutrombopag | Afatinib may decrease the excretion rate of Lusutrombopag which could result in a higher serum level. |
| Mannitol | The serum concentration of Mannitol can be increased when it is combined with Afatinib. |
| Maribavir | The serum concentration of Afatinib can be increased when it is combined with Maribavir. |
| Mefloquine | The serum concentration of Afatinib can be increased when it is combined with Mefloquine. |
| Meloxicam | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Meloxicam. |
| Mepivacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Mepivacaine. |
| Methimazole | The therapeutic efficacy of Methimazole can be decreased when used in combination with Afatinib. |
| Methotrexate | Afatinib may decrease the excretion rate of Methotrexate which could result in a higher serum level. |
| Methoxy polyethylene glycol-epoetin beta | The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Afatinib. |
| Methylene blue | The serum concentration of Afatinib can be increased when it is combined with Methylene blue. |
| Mifepristone | The serum concentration of Afatinib can be increased when it is combined with Mifepristone. |
| Mirabegron | The serum concentration of Afatinib can be increased when it is combined with Mirabegron. |
| Mitapivat | The serum concentration of Afatinib can be increased when it is combined with Mitapivat. |
| Mitoxantrone | Afatinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level. |
| Morphine | The serum concentration of Morphine can be increased when it is combined with Afatinib. |
| Mycophenolate mofetil | Afatinib may decrease the excretion rate of Mycophenolate mofetil which could result in a higher serum level. |
| Naloxegol | The serum concentration of Naloxegol can be increased when it is combined with Afatinib. |
| Nelfinavir | Nelfinavir may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Neratinib | The serum concentration of Afatinib can be increased when it is combined with Neratinib. |
| Netupitant | The serum concentration of Afatinib can be increased when it is combined with Netupitant. |
| Nilotinib | The serum concentration of Afatinib can be increased when it is combined with Nilotinib. |
| Nintedanib | The serum concentration of Nintedanib can be increased when it is combined with Afatinib. |
| Nitrofurantoin | Afatinib may decrease the excretion rate of Nitrofurantoin which could result in a higher serum level. |
| Norgestimate | The serum concentration of Afatinib can be increased when it is combined with Norgestimate. |
| Nortriptyline | The serum concentration of Nortriptyline can be increased when it is combined with Afatinib. |
| Novobiocin | Novobiocin may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Omadacycline | The serum concentration of Omadacycline can be increased when it is combined with Afatinib. |
| Ombitasvir | Afatinib may decrease the excretion rate of Ombitasvir which could result in a higher serum level. |
| Omeprazole | Omeprazole may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Osimertinib | The serum concentration of Osimertinib can be increased when it is combined with Afatinib. |
| Oteseconazole | The serum concentration of Afatinib can be increased when it is combined with Oteseconazole. |
| Oxaliplatin | Afatinib may decrease the excretion rate of Oxaliplatin which could result in a higher serum level. |
| Oxetacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Oxetacaine. |
| Oxybuprocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Oxybuprocaine. |
| Ozanimod | Afatinib may decrease the excretion rate of Ozanimod which could result in a higher serum level. |
| Pacritinib | The serum concentration of Afatinib can be increased when it is combined with Pacritinib. |
| Palbociclib | The serum concentration of Afatinib can be increased when it is combined with Palbociclib. |
| Paliperidone | The serum concentration of Afatinib can be increased when it is combined with Paliperidone. |
| Panobinostat | The serum concentration of Panobinostat can be increased when it is combined with Afatinib. |
| Pantoprazole | Pantoprazole may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Parathyroid hormone | The therapeutic efficacy of Parathyroid hormone can be decreased when used in combination with Afatinib. |
| Paritaprevir | Paritaprevir may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Pazopanib | The serum concentration of Pazopanib can be increased when it is combined with Afatinib. |
| Peginesatide | The risk or severity of Thrombosis can be increased when Peginesatide is combined with Afatinib. |
| Phenol | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Phenol. |
| Pibrentasvir | The serum concentration of Afatinib can be increased when it is combined with Pibrentasvir. |
| Pitavastatin | Afatinib may decrease the excretion rate of Pitavastatin which could result in a higher serum level. |
| Pitolisant | The serum concentration of Afatinib can be increased when it is combined with Pitolisant. |
| Pomalidomide | The serum concentration of Pomalidomide can be increased when it is combined with Afatinib. |
| Ponatinib | The serum concentration of Afatinib can be increased when it is combined with Ponatinib. |
| Posaconazole | The serum concentration of Posaconazole can be increased when it is combined with Afatinib. |
| Potassium Iodide | The therapeutic efficacy of Potassium Iodide can be decreased when used in combination with Afatinib. |
| Potassium perchlorate | The therapeutic efficacy of Potassium perchlorate can be decreased when used in combination with Afatinib. |
| Pralatrexate | Afatinib may decrease the excretion rate of Pralatrexate which could result in a higher serum level. |
| Pralsetinib | The serum concentration of Pralsetinib can be increased when it is combined with Afatinib. |
| Pramocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Pramocaine. |
| Pravastatin | Pravastatin may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Prazosin | Afatinib may decrease the excretion rate of Prazosin which could result in a higher serum level. |
| Prednisolone phosphate | The serum concentration of Afatinib can be decreased when it is combined with Prednisolone phosphate. |
| Prilocaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Prilocaine. |
| Procaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Procaine. |
| Progesterone | Progesterone may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Propafenone | The serum concentration of Afatinib can be increased when it is combined with Propafenone. |
| Proparacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Proparacaine. |
| Propoxycaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Propoxycaine. |
| Propylthiouracil | The therapeutic efficacy of Propylthiouracil can be decreased when used in combination with Afatinib. |
| Protirelin | The therapeutic efficacy of Protirelin can be decreased when used in combination with Afatinib. |
| Prucalopride | The serum concentration of Prucalopride can be increased when it is combined with Afatinib. |
| Quinidine | The serum concentration of Afatinib can be increased when it is combined with Quinidine. |
| Quinine | The serum concentration of Afatinib can be increased when it is combined with Quinine. |
| Rabeprazole | Rabeprazole may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Raloxifene | Afatinib may decrease the excretion rate of Raloxifene which could result in a higher serum level. |
| Ranolazine | The serum concentration of Ranolazine can be increased when it is combined with Afatinib. |
| Regorafenib | The serum concentration of Afatinib can be increased when it is combined with Regorafenib. |
| Relugolix | The serum concentration of Relugolix can be increased when it is combined with Afatinib. |
| Reserpine | The serum concentration of Afatinib can be increased when it is combined with Reserpine. |
| Revefenacin | Afatinib may decrease the excretion rate of Revefenacin which could result in a higher serum level. |
| Rifampicin | The serum concentration of Afatinib can be decreased when it is combined with Rifampicin. |
| Rifamycin | The serum concentration of Afatinib can be increased when it is combined with Rifamycin. |
| Rifaximin | The serum concentration of Rifaximin can be increased when it is combined with Afatinib. |
| Rilpivirine | Rilpivirine may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Riluzole | Afatinib may decrease the excretion rate of Riluzole which could result in a higher serum level. |
| Rimegepant | The serum concentration of Rimegepant can be increased when it is combined with Afatinib. |
| Riociguat | Afatinib may decrease the excretion rate of Riociguat which could result in a higher serum level. |
| Ripretinib | The serum concentration of Afatinib can be increased when it is combined with Ripretinib. |
| Ritonavir | The serum concentration of Afatinib can be increased when it is combined with Ritonavir. |
| Rivaroxaban | Afatinib may decrease the excretion rate of Rivaroxaban which could result in a higher serum level. |
| Rolapitant | The serum concentration of Afatinib can be increased when it is combined with Rolapitant. |
| Romidepsin | The serum concentration of Romidepsin can be increased when it is combined with Afatinib. |
| Ropivacaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Ropivacaine. |
| Rosuvastatin | Afatinib may decrease the excretion rate of Rosuvastatin which could result in a higher serum level. |
| Roxadustat | The serum concentration of Afatinib can be increased when it is combined with Roxadustat. |
| Rucaparib | Afatinib may decrease the excretion rate of Rucaparib which could result in a higher serum level. |
| Safinamide | Safinamide may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Salmon calcitonin | The therapeutic efficacy of Salmon calcitonin can be decreased when used in combination with Afatinib. |
| Sapropterin | The serum concentration of Afatinib can be increased when it is combined with Sapropterin. |
| Saquinavir | The serum concentration of Afatinib can be increased when it is combined with Saquinavir. |
| Sarecycline | The serum concentration of Afatinib can be increased when it is combined with Sarecycline. |
| Selexipag | The serum concentration of Selexipag can be increased when it is combined with Afatinib. |
| Selumetinib | Afatinib may decrease the excretion rate of Selumetinib which could result in a higher serum level. |
| Sildenafil | The serum concentration of Afatinib can be increased when it is combined with Sildenafil. |
| Silodosin | The excretion of Silodosin can be decreased when combined with Afatinib. |
| Simeprevir | The serum concentration of Afatinib can be increased when it is combined with Simeprevir. |
| Simvastatin | The serum concentration of Afatinib can be increased when it is combined with Simvastatin. |
| Sirolimus | The serum concentration of Sirolimus can be increased when it is combined with Afatinib. |
| Sitagliptin | The serum concentration of Sitagliptin can be increased when it is combined with Afatinib. |
| Sofosbuvir | Afatinib may decrease the excretion rate of Sofosbuvir which could result in a higher serum level. |
| Sorafenib | The serum concentration of Afatinib can be increased when it is combined with Sorafenib. |
| Sotagliflozin | The serum concentration of Afatinib can be increased when it is combined with Sotagliflozin. |
| Sotorasib | The serum concentration of Afatinib can be increased when it is combined with Sotorasib. |
| St. John’s Wort | The serum concentration of Afatinib can be decreased when it is combined with St. John’s Wort. |
| Stiripentol | The excretion of Afatinib can be decreased when combined with Stiripentol. |
| Sulfasalazine | Sulfasalazine may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Sumatriptan | Afatinib may decrease the excretion rate of Sumatriptan which could result in a higher serum level. |
| Sunitinib | Sunitinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Suvorexant | The serum concentration of Afatinib can be increased when it is combined with Suvorexant. |
| Tacrolimus | The serum concentration of Afatinib can be increased when it is combined with Tacrolimus. |
| Tafamidis | The serum concentration of Afatinib can be increased when it is combined with Tafamidis. |
| Talazoparib | The serum concentration of Talazoparib can be increased when it is combined with Afatinib. |
| Tamoxifen | The serum concentration of Afatinib can be increased when it is combined with Tamoxifen. |
| Taurocholic acid | Taurocholic acid may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Tazemetostat | Afatinib may decrease the excretion rate of Tazemetostat which could result in a higher serum level. |
| Technetium Tc-99m sestamibi | The serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Afatinib. |
| Tegaserod | Afatinib may decrease the excretion rate of Tegaserod which could result in a higher serum level. |
| Telaprevir | The serum concentration of Afatinib can be increased when it is combined with Telaprevir. |
| Telmisartan | Telmisartan may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Temsirolimus | The serum concentration of Afatinib can be increased when it is combined with Temsirolimus. |
| Teniposide | Afatinib may decrease the excretion rate of Teniposide which could result in a higher serum level. |
| Tenofovir alafenamide | Afatinib may decrease the excretion rate of Tenofovir alafenamide which could result in a higher serum level. |
| Tenofovir disoproxil | The serum concentration of Tenofovir disoproxil can be increased when it is combined with Afatinib. |
| Tepotinib | The serum concentration of Tepotinib can be increased when it is combined with Afatinib. |
| Teriflunomide | Teriflunomide may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Teriparatide | The therapeutic efficacy of Teriparatide can be decreased when used in combination with Afatinib. |
| Testosterone | Afatinib may decrease the excretion rate of Testosterone which could result in a higher serum level. |
| Testosterone cypionate | Afatinib may decrease the excretion rate of Testosterone cypionate which could result in a higher serum level. |
| Testosterone enanthate | Afatinib may decrease the excretion rate of Testosterone enanthate which could result in a higher serum level. |
| Tetracaine | The risk or severity of methemoglobinemia can be increased when Afatinib is combined with Tetracaine. |
| Tezacaftor | The serum concentration of Tezacaftor can be increased when it is combined with Afatinib. |
| Thyroid, porcine | The therapeutic efficacy of Thyroid, porcine can be decreased when used in combination with Afatinib. |
| Thyrotropin alfa | The therapeutic efficacy of Thyrotropin alfa can be decreased when used in combination with Afatinib. |
| Ticagrelor | The serum concentration of Afatinib can be increased when it is combined with Ticagrelor. |
| Tipranavir | The serum concentration of Afatinib can be increased when it is combined with Tipranavir. |
| Tivozanib | Tivozanib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Tolvaptan | The serum concentration of Tolvaptan can be increased when it is combined with Afatinib. |
| Topotecan | The serum concentration of Topotecan can be increased when it is combined with Afatinib. |
| Toremifene | The serum concentration of Afatinib can be increased when it is combined with Toremifene. |
| Trastuzumab emtansine | The serum concentration of Trastuzumab emtansine can be increased when it is combined with Afatinib. |
| Trazodone | The serum concentration of Afatinib can be decreased when it is combined with Trazodone. |
| Trilaciclib | Afatinib may decrease the excretion rate of Trilaciclib which could result in a higher serum level. |
| Trimipramine | The serum concentration of Trimipramine can be increased when it is combined with Afatinib. |
| Tucatinib | Tucatinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Ubrogepant | The serum concentration of Ubrogepant can be increased when it is combined with Afatinib. |
| Umbralisib | The serum concentration of Afatinib can be increased when it is combined with Umbralisib. |
| Umeclidinium | The serum concentration of Umeclidinium can be increased when it is combined with Afatinib. |
| Vandetanib | The serum concentration of Afatinib can be increased when it is combined with Vandetanib. |
| Vardenafil | The serum concentration of Afatinib can be increased when it is combined with Vardenafil. |
| Velpatasvir | The serum concentration of Afatinib can be increased when it is combined with Velpatasvir. |
| Vemurafenib | The serum concentration of Afatinib can be increased when it is combined with Vemurafenib. |
| Venetoclax | The serum concentration of Afatinib can be increased when it is combined with Venetoclax. |
| Venlafaxine | Venlafaxine may increase the excretion rate of Afatinib which could result in a lower serum level and potentially a reduction in efficacy. |
| Verapamil | The serum concentration of Afatinib can be increased when it is combined with Verapamil. |
| Vinblastine | The serum concentration of Vinblastine can be increased when it is combined with Afatinib. |
| Vincristine | The excretion of Vincristine can be decreased when combined with Afatinib. |
| Vinflunine | The serum concentration of Vinflunine can be increased when it is combined with Afatinib. |
| Vismodegib | Vismodegib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Voclosporin | The serum concentration of Afatinib can be increased when it is combined with Voclosporin. |
| Vorapaxar | The serum concentration of Afatinib can be increased when it is combined with Vorapaxar. |
| Voxilaprevir | The serum concentration of Afatinib can be increased when it is combined with Voxilaprevir. |
| Zidovudine | Afatinib may decrease the excretion rate of Zidovudine which could result in a higher serum level. |
| Zonisamide | The serum concentration of Afatinib can be increased when it is combined with Zonisamide. |
Pregnancy and Lactation
FDA Pregnancy Category D
Pregnancy
- There are no adequate studies on the use of this medication by pregnant women. This medication should not be taken during pregnancy. If you are a woman who could become pregnant, use a reliable method of birth control (e.g., condoms, birth control pill) during treatment and for at least 2 weeks after treatment is finished. If you become pregnant while taking this medication, contact your doctor immediately.
Lactation
- No information is available on the clinical use of afatinib during breastfeeding. Because afatinib is about 95% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 37 hours and it might accumulate in the infant. the manufacturer recommends that breastfeeding be discontinued during afatinib therapy and for 2 weeks after the last dose.
Breast-feeding: It is not known if afatinib passes into breast milk. If you are a breastfeeding mother and are taking this medication, it may affect your baby. Due to the potential for serious harm to a baby, if they are exposed to this medication, breastfeeding mothers are advised not to use this medication.
Children: The safety and effectiveness of this medication have not been established for children.
Seniors: People over the age of 65 may be at risk of a higher incidence of side effects, particularly diarrhea. Talk to your doctor if you have any concerns.
What special precautions should I follow?
Before taking afatinib,
- tell your doctor and pharmacist if you are allergic to afatinib, any other medications, or any of the ingredients in afatinib tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); certain antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral); cyclosporine (Gengraf, Neoral, Sandimmune); erythromycin (E.E.S., Erythrocin, others); certain medications for human immunodeficiency virus (HIV) such as nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Invirase); certain medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenobarbital, and phenytoin (Dilantin); quinidine (in Nuedexta); rifampin (Rimactane, Rifadin, in Rifater); tacrolimus (Prograf); and verapamil (Calan, Covera, Isoptin, Verelan). Many other medications may also interact with afatinib, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John’s wort.
- tell your doctor if you are of Asian descent or have or have ever had lung or breathing problems (other than lung cancer); eye problems, including dry eyes; heart problems; liver or kidney disease; or any other medical condition. Also, tell your doctor if you wear contact lenses.
- tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are taking afatinib and for at least 2 weeks after your treatment. Talk to your doctor about birth control methods that you can use during your treatment. If you become pregnant while taking afatinib, call your doctor immediately. Afatinib may harm the fetus.
- tell your doctor if you are breastfeeding. You should not breastfeed while you are taking afatinib.
- plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Afatinib may make your skin sensitive to sunlight. Exposure to sunlight increases the risk that you will develop a rash or acne during your treatment with afatinib.
When to contact your doctor or health care provider:
Contact your healthcare provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.4° F (38° C or higher, chills)
- Shortness of breath, cough or trouble breathing
- Chest pain or feeling that your heart is pounding or racing (palpitations)
The following symptoms require medical attention but are not an emergency. Contact your doctor or health care provider within 24 hours of noticing any of the following:
- Diarrhea (4-6 episodes in a 24-hour period).
- Nausea (interferes with the ability to eat and is unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24-hour period).
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness.
- Skin or the whites of your eyes turn yellow
- Urine turns dark or brown (tea color)
- Decreased appetite
- Pain on the right side of your stomach
- Bleed or bruise more easily than normal
- Any skin or nail changes (rash, itching, severe dryness, blisters, nail infection, inflammation of the lips, etc.)
- Cough with or without mucus
- Mouth sores
- Pain or burning with urination
- Eye inflammation, watering, redness, pain, blurred vision, light sensitivity
- Extreme fatigue (unable to carry on self-care activities)
- Swelling of your ankles, feet or legs
- Sudden weight gain
Always inform your doctor or healthcare provider if you experience any unusual symptoms.
Afatinib Precautions:
- Before starting afatinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
- While taking afatinib, do not receive any kind of immunization or vaccination without your doctor’s approval.
- Limit your time in the sun. Afatinib can make your skin sensitive to sunlight. A severe sunburn, rash or worsening acne can occur with too much exposure. Remember to use sunscreen and wear a hat and clothes that cover as much of your skin as possible while taking afatinib.
- Inform your healthcare professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
- For both men and women: Barrier methods of contraception, such as condoms, are recommended during therapy and for at least 2 weeks after treatment is complete. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breastfeed while taking afatinib.
Self-Care Tips While Taking Afatinib:
- While taking afatinib, drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- Wash your hands often and after taking each dose of afatinib.
- You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your healthcare provider.
- To help treat/prevent mouth sores while taking afatinib, use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals while taking afatinib.
- Eat foods that may help reduce diarrhea-see
- Follow the regimen of anti-diarrhea medication as prescribed by your health care professional.
- Managing Side Effects – Diarrhea
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. Afatinib may make you more sensitive to the sun and you may sunburn more easily.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely while you are taking afatinib. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition while being treated with afatinib.
- If you experience symptoms or side effects while being treated with afatinib, be sure to discuss them with your healthcare team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
References
