Cabozantinib – Uses, Dosage, Side Effects, Interaction

Mechanism of action

Cabozantinib inhibits specific receptor tyrosine kinases such as VEGFR-1, -2, and -3, KIT, TRKB, FLT-3, AXL, RET, MET, and TIE-2. Cabozantinib is metabolized mostly by CYP3A4 and, to a minor extent, by CYP2C9. Both enzymes produce an N-oxide metabolite.

Cabozantinib S-malate is the s-malate salt form of cabozantinib, an orally bioavailable, small molecule receptor tyrosine kinase (RTK) inhibitor with potential antineoplastic activity. Cabozantinib strongly binds to and inhibits several RTKs, which are often overexpressed in a variety of cancer cell types, including hepatocyte growth factor receptor (MET), RET (rearranged during transfection), vascular endothelial growth factor receptor types 1 (VEGFR-1), 2 (VEGFR-2), and 3 (VEGFR-3), mast/stem cell growth factor (KIT), FMS-like tyrosine kinase 3 (FLT-3), TIE-2 (TEK tyrosine kinase, endothelial), tropomyosin-related kinase B (TRKB) and AXL. This may result in an inhibition of both tumor growth and angiogenesis, and eventually, lead to tumor regression.

Cabozantinib is an orally bioavailable, small-molecule receptor tyrosine kinase (RTK) inhibitor with potential antineoplastic activity. Cabozantinib strongly binds to and inhibits several RTKs, which are often overexpressed in a variety of cancer cell types, including hepatocyte growth factor receptor (MET), RET (rearranged during transfection), vascular endothelial growth factor receptor types 1 (VEGFR-1), 2 (VEGFR-2), and 3 (VEGFR-3), mast/stem cell growth factor (KIT), FMS-like tyrosine kinase 3 (FLT-3), TIE-2 (TEK tyrosine kinase, endothelial), tropomyosin-related kinase B (TRKB) and AXL. This may result in an inhibition of both tumor growth and angiogenesis and eventually lead to tumor regression.

Use in Cancer

Cabozantinib-s-malate is approved to treat:

• Differentiated thyroid cancer that has spread. It is used in adults and children aged 12 years and older who cannot receive radioactive iodine and whose cancer got worse after VEGF receptor–targeted therapy. This use is approved for the Cabometyx brand of cabozantinib-s-malate.
• Hepatocellular carcinoma (a type of liver cancer). It is used in patients who have already been treated with sorafenib. This use is approved for the Cabometyx brand of cabozantinib-s-malate.
• Medullary thyroid cancer has gotten worse and has metastasized (spread to other parts of the body). This use is approved for the Cometriq brand of cabozantinib-s-malate.
• Renal cell carcinoma (a type of kidney cancer) is advanced. It is either used with nivolumab as the first therapy or alone. This use is approved for the Cabometyx brand of cabozantinib-s-malate.

Cabozantinib-s-malate is also being studied in the treatment of other types of cancer.

Contraindications

• a condition with low thyroid hormone levels
• low amount of calcium in the blood
• decreased blood platelets
• low levels of a type of white blood cell called neutrophils
• high blood pressure
• significant uncontrolled high blood pressure
• a localized weakening and ballooning in an artery wall called an arterial aneurysm
• obstruction of a blood vessel by a blood clot
• an occurrence of a blood clot in an artery
• blood clot formation in vein
• stomatitis is a condition with painful swelling and sores inside the mouth
• an abnormal connection between the esophagus and windpipe
• a gastrointestinal tract fistula
• bleeding of the stomach or intestines
• nephrotic syndrome, a type of kidney disorder
• coughing up blood
• elevation of proteins in the urine
• abnormal liver function tests
• impaired wound healing
• pregnancy
• a patient who is producing milk and breastfeeding
• a rupture in the wall of the stomach or intestine
• problems with wound healing after a surgery
• invasive dental procedure
• a type of brain disorder called posterior reversible encephalopathy syndrome
• dissection of artery
• Child-Pugh class A liver impairment
• Child-Pugh class B liver impairment
• Child-Pugh class C liver impairment

Dosage

Strengths: 140 mg daily-dose; 100 mg daily-dose; 60 mg daily-dose; 60 mg; 20 mg; 40 mg

Thyroid Cancer

• Capsules: 140 mg orally once a day until the patient no longer experiences clinical benefit or unacceptable toxicity occurs
• Tablets: BSA greater than or equal to 1.2 m(2): 60 mg once a day until disease progression or unacceptable toxicity
• Do not substitute tablets with capsules.
• Stop a treatment at least 3 weeks prior to scheduled surgery, including dental surgery.

Renal Cell Carcinoma

Tablets:

• As a single agent: 60 mg orally once a day until the patient no longer experiences clinical benefit or unacceptable toxicity occurs
• In combination with nivolumab: 40 mg once a day until disease progression or unacceptable toxicity
• When administering this drug in combination with nivolumab, refer to the nivolumab prescribing information.
• Do not substitute tablets with capsules.
• Stop a treatment at least 3 weeks prior to scheduled surgery, including dental surgery.

Hepatocellular Carcinoma

• Tablets: 60 mg orally once a day until the patient no longer experiences clinical benefit or unacceptable toxicity occurs
• Do not substitute tablets with capsules.
• Stop a treatment at least 3 weeks prior to scheduled surgery, including dental surgery.

Usual Pediatric Dose

Thyroid Cancer

• Tablets: BSA greater than or equal to 1.2 m(2): 60 mg once a day until disease progression or unacceptable toxicity
• Tablets: BSA less than 1.2 m(2): 40 mg once a day until disease progression or unacceptable toxicity
• Do not substitute tablets with capsules.
• Stop a treatment at least 3 weeks prior to scheduled surgery, including dental surgery.

Renal Dose Adjustments

Capsules/Tablets:

• Mild to moderate renal dysfunction: No adjustment is recommended.
• Severe renal dysfunction: Data not available

Liver Dose Adjustments

Capsule formulation (MTC):

• Mild to moderate hepatic dysfunction: 80 mg orally once a day
• Severe hepatic dysfunction: Use is not recommended.

Tablet formulation (MTC):

• Mild hepatic dysfunction: No adjustment is recommended.
• Moderate hepatic dysfunction: 40 mg daily OR 40 mg daily to 20 mg daily [for pediatric patients with BSA less than 1.2 m(2)].
• Severe hepatic dysfunction: Use is not recommended.

Tablet formulation (RCC):

• Mild to moderate hepatic dysfunction: 40 mg orally once a day
• Severe hepatic dysfunction: Use is not recommended.
• In combination with nivolumab
• If ALT or AST is greater than 3 times the upper limit of normal (ULN) but up to 10 times ULN with concurrent total bilirubin less than 2 times ULN: Withhold this drug and nivolumab until adverse reactions recover to Grades 0 or 1 and consider corticosteroid therapy as appropriate. Might rechallenge with one or both drugs after recovery.
• If ALT or AST is greater than 10 times ULN or greater than 3 times ULN with a concurrent total bilirubin of at least 2 times ULN: Permanently discontinue this drug and nivolumab. Corticosteroid therapy may be considered if an immune-mediated reaction is suspected.

Dose Adjustments

CAPSULE FORMULATION (MTC):

• Adverse Reactions (Grade 4, Grade 3, or intolerable Grade 2): Withhold therapy until improvement to baseline or resolution to Grade 1; then adjust the dose as follows:
• If the previous dose was 140 mg/day: Reduce the dose to 100 mg/day
• If the previous dose was 100 mg/day: Reduce the dose to 60 mg/day
• If the previous dose is 60 mg/day: Do not dose reduce; resume at 60 mg/day if tolerated or discontinue therapy.
• Concomitant Use of Strong CYP450 3A4 Inhibitors: Use is not recommended. If concomitant use is necessary, reduce the dose of this drug by 40 mg (e.g., from 140 mg/day to 100 mg/day). Resume the dose used prior to initiation of the strong CYP450 3A4 inhibitor 2 to 3 days after discontinuation of the CYP450 3A4 inhibitor.
• Concomitant Use of Strong CYP450 3A4 Inducers: Use is not recommended. If concomitant use is necessary, increase the dose of this drug by 40 mg (e.g., from 140 mg/day to 180 mg/day) as tolerated. Resume the dose used prior to initiation of the strong CYP450 3A4 inducer 2 to 3 days after discontinuation of the CYP450 3A4 inducer. Do not exceed 180 mg/day.
• Permanently discontinue therapy for the development of perforation or fistula formation, severe hemorrhage; serious arterial thromboembolic event (e.g., myocardial infarction, cerebral infarction), nephrotic syndrome, malignant hypertension, hypertensive crisis, severe hypertension despite optimal medical management, osteonecrosis of the jaw, or reversible posterior leukoencephalopathy syndrome.

TABLET FORMULATION (RCC):

• Scheduled Surgery: Stop a treatment at least 28 days prior to scheduled surgery, including dental surgery.
• Adverse Reactions (Grade 4, Grade 3, or Intolerable Grade 2) or osteonecrosis of the jaw: Withhold therapy until improvement to baseline or resolution to Grade 1; then adjust the dose as follows:
• If the previous dose 60 mg/day: Reduce the dose to 40 mg/day
• If the previous dose was 40 mg/day: Reduce the dose to 20 mg/day
• If the previous dose is 20 mg/day: Do not dose reduce; resume at 20 mg/day if tolerated or discontinue therapy
• Concomitant Use of Strong CYP450 3A4 Inhibitors: Use is not recommended. If concomitant use is necessary, reduce the dose of this drug by 20 mg (e.g., from 60 mg/day to 40 mg/day). Resume the dose used prior to initiation of the strong CYP450 3A4 inhibitor 2 to 3 days after discontinuation of the CYP450 3A4 inhibitor.
• Concomitant Use of Strong CYP450 3A4 Inducers: Use is not recommended if alternative therapy is available. If concomitant use is necessary, increase the dose of this drug by 20 mg (e.g., from 60 mg/day to 80 mg/day) as tolerated. Resume the dose used prior to initiation of the strong CYP450 3A4 inducer 2 to 3 days after discontinuation of the 3A4 inducer. Do not exceed 80 mg/day.
• Permanently discontinue therapy for the development of unmanageable fistula or GI perforation, severe hemorrhage, arterial thromboembolic event (e.g., myocardial infarction, cerebral infarction), hypertensive crisis or severe hypertension despite optimal medical management, nephrotic syndrome, or reversible posterior leukoencephalopathy syndrome.

TABLET FORMULATION (RCC):

• Adverse Reactions (Grade 4, Grade 3, or intolerable Grade 2): Withhold therapy until improvement to baseline or resolution to Grade 1; then adjust the dose as follows:
• If the previous dose is 60 mg daily in adult and pediatric patients with BSA greater than or equal to 1.2 m(2): Reduce the dose to 40 mg/day OR if the previous dose is 20 mg every other day; do not dose reduce; resume at 20 mg every other day if tolerated or discontinue therapy
• If the previous dose is 40 mg daily in pediatric patients with BSA less than 1.2 m(2): Reduce the dose to 20 mg/day OR if the previous dose was 20 mg every other day, do not dose reduce; resume at 20 mg every other day if tolerated or discontinue therapy

TABLET FORMULATION (RCC) IN COMBINATION WITH NIVOLUMAB:

• Scheduled Surgery: Stop a treatment at least 3 weeks prior to scheduled surgery, including dental surgery.
• Adverse Reactions (Grade 4, Grade 3, or Intolerable Grade 2) or osteonecrosis of the jaw: Withhold therapy until improvement to baseline or resolution to Grade 1; then adjust the dose as follows:
• If the previous dose 40 mg/day: Reduce the dose to 20 mg once a day
• If the previous dose is 20 mg/day: Reduce the dose to 20 mg every other day
• If the previous dose is 20 mg every other day: Do not dose reduce; resume at 20 mg every other day if tolerated or discontinue therapy
• Concomitant Use of Strong CYP450 3A4 Inhibitors: Use is not recommended. If concomitant use is necessary, reduce the dose of this drug by 20 mg (e.g., from 60 mg/day to 40 mg/day). Resume the dose used prior to initiation of the strong CYP450 3A4 inhibitor 2 to 3 days after discontinuation of the CYP450 3A4 inhibitor.
• Concomitant Use of Strong CYP450 3A4 Inducers: Use is not recommended if alternative therapy is available. If concomitant use is necessary, increase the dose of this drug by 20 mg (e.g., from 60 mg/day to 80 mg/day) as tolerated. Resume the dose used prior to initiation of the strong CYP450 3A4 inducer 2 to 3 days after discontinuation of the 3A4 inducer. Do not exceed 80 mg/day.
• Permanently discontinue therapy for the development of gastrointestinal perforation or Grade 4 fistula, severe hemorrhage, acute myocardial infarction or arterial or venous thromboembolic events that require medical intervention, severe hypertension that cannot be controlled with anti-hypertensive therapy or hypertensive crisis, nephrotic syndrome, or reversible posterior leukoencephalopathy syndrome.

Administration Advice:

• Tablets and capsules are not interchangeable.
• This drug should be taken on an empty stomach at least 2 hours before or 1 hour after a meal.
• Do not open/break/crush/chew tablets or capsules; swallow whole with a full glass of water.
• Do not take a missed dose if it is less than 12 hours before the next dose.
• Do not ingest foods (e.g., grapefruit) or nutritional supplements (e.g., St. John’s Wort) that are known to inhibit or induce CYP450 activity while taking this drug.

Side Effects

The Most Common

• constipation
• nausea
• vomiting
• difficulty swallowing
• change in the ability to taste food
• hemorrhoids
• redness, swelling, sores, or pain in your mouth or throat
• loss of appetite
• weight loss
• anxiety
• tiredness or weakness
• pale skin
• dry skin
• patchy thickening of the skin
• pain in joints, arms, or legs
• voice changes or hoarseness
• hair loss
• hair color turning lighter or gray
• slowed wound healing
• fluid build-up in the abdomen (e.g., rapid weight gain, abdominal pain, shortness of breath)
• jaw pain
• high blood pressure (e.g., headache, vision changes, nausea, vomiting)
• rash or skin redness
• shortness of breath
• signs of anemia (e.g., fatigue, pale skin, shortness of breath, loss of energy, weakness)
• signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (chest pain, coughing up blood, shortness of breath)
• signs of decreased thyroid function (e.g., constipation, dry skin, tiredness, weight gain, sensitivity to the cold)
• signs of fluid build-up around the lungs (e.g., chest pain, cough, hiccups, rapid breathing)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of low electrolyte levels (e.g., muscle spasms or weakness, tingling or numbness, tiredness, twitching, or memory loss)
• sudden, severe pain in the back, chest, or abdomen

More Common

• chest pain, pressure, or tightness
• coughing up blood or blood clots
• vomiting material that is bloody or looks like coffee grounds
• menstrual bleeding that is heavier than usual
• red or black, tarry stool
• nose bleed
• diarrhea
• unusual or heavy bleeding or bruising
• tender or painful stomach area
• swelling around eyes, arms, hands, legs, feet, or ankles
• foamy urine
• shortness of breath or cough
• trouble breathing
• fast, pounding, or irregular heartbeat
• sudden severe headache
• lightheadedness or fainting
• seizures
• numbness or weakness of the face, arm, or leg on one side of your body
• sudden trouble walking
• sudden vision problems
• confusion
• sudden difficulty thinking or speaking clearly
• sudden difficulty with balance or coordination
• dizziness
• sweating more than usual
• jaw pain
• toothache
• loosening of the teeth
• swollen or painful gums
• rash
• redness, pain, swelling or blistering on the palms or the soles
• extreme tiredness, dizziness, fainting, weakness, nausea, or vomiting
• yellowing of skin or eyes, extreme tiredness, bleeding or bruising easily, nausea or vomiting, right-sided-stomach pain, dark-colored urine, decreased appetite
• muscle stiffness or spasms
• sudden weight gain
• numbness, burning or tingling in the hands, arms, feet, legs, or around the mouth

Rare

• decreased appetite
• diarrhea
• dizziness
• dry mouth
• dry skin
• fatigue
• hair loss
• hand-foot skin reaction (e.g., redness, blisters, and pain on the palms of hands or soles of feet)
• headache
• heartburn
• hoarseness
• mouth sores or mouth pain
• muscle spasms
• nausea
• pain in arms, legs, and joints
• signs of electrolyte imbalance (e.g., muscle pain or cramps, weakness, irregular heartbeat, lack of coordination, thirst, confusion)
• stomach pain
• trouble sleeping
• vomiting
• weakness
• weight loss
• dehydration (e.g., headache, thirst, loss of appetite, tiredness, weakness, dark or decreased urine)
• difficulty speaking
• fainting
• swelling in the hands, feet, or face
• symptoms of a fistula (e.g., anal bleeding, pain with bowel movements, fever, chills, foul-smelling discharge from the anus)
• symptoms of irregular heartbeat (e.g., chest pain; dizziness; rapid, pounding heartbeat; shortness of breath)
• wounds that do not heal
• aneurysm (weakened blood vessel; cough, coughing up blood, sharp unexpected pain, hoarseness, unusual sensation in chest or abdomen)
• decreased brain function due to liver problems (e.g., change in alertness, confusion, mood or personality changes, changes in sleep, loss of consciousness)
• seizures
• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• signs of reversible posterior leukoencephalopathy syndrome (e.g., headache, seizures, weakness, confusion, high blood pressure, vision changes, difficulty thinking clearly)
• symptoms of severely increased blood pressure (e.g., chest pain, blurred vision, dizziness, excessive tiredness, headache, stronger or faster heartbeat)
• symptoms of a blood clot in the lungs (difficulty breathing, sharp chest pain that is worse when breathing in, coughing, coughing up blood, sweating, or passing out)

Drug Interaction

DRUG	INTERACTION
Abaloparatide	The therapeutic efficacy of Abaloparatide can be decreased when used in combination with Cabozantinib.
Abametapir	The serum concentration of Cabozantinib can be increased when it is combined with Abametapir.
Abatacept	The metabolism of Cabozantinib can be increased when combined with Abatacept.
Abrocitinib	The metabolism of Abrocitinib can be decreased when combined with Cabozantinib.
Acenocoumarol	The metabolism of Cabozantinib can be decreased when combined with Acenocoumarol.
Acetaminophen	The serum concentration of Acetaminophen can be increased when it is combined with Cabozantinib.
Acetohexamide	The metabolism of Cabozantinib can be decreased when combined with Acetohexamide.
Acetyl sulfisoxazole	The metabolism of Cabozantinib can be decreased when combined with Acetyl sulfisoxazole.
Acetylsalicylic acid	The metabolism of Cabozantinib can be decreased when combined with Acetylsalicylic acid.
Adalimumab	The metabolism of Cabozantinib can be increased when combined with Adalimumab.
Agomelatine	The metabolism of Cabozantinib can be decreased when combined with Agomelatine.
Almotriptan	The metabolism of Almotriptan can be decreased when combined with Cabozantinib.
Alosetron	The metabolism of Cabozantinib can be decreased when combined with Alosetron.
Alpelisib	The serum concentration of Cabozantinib can be decreased when it is combined with Alpelisib.
Aminophenazone	The metabolism of Aminophenazone can be decreased when combined with Cabozantinib.
Amiodarone	The metabolism of Cabozantinib can be decreased when combined with Amiodarone.
Amitriptyline	The metabolism of Amitriptyline can be decreased when combined with Cabozantinib.
Amodiaquine	The metabolism of Cabozantinib can be decreased when combined with Amodiaquine.
Amprenavir	The metabolism of Cabozantinib can be decreased when combined with Amprenavir.
Anakinra	The metabolism of Cabozantinib can be increased when combined with Anakinra.
Anastrozole	The metabolism of Anastrozole can be decreased when combined with Cabozantinib.
Antipyrine	The metabolism of Antipyrine can be decreased when combined with Cabozantinib.
Apalutamide	The metabolism of Cabozantinib can be increased when combined with Apalutamide.
Apixaban	The metabolism of Apixaban can be decreased when combined with Cabozantinib.
Apomorphine	The metabolism of Apomorphine can be decreased when combined with Cabozantinib.
Apremilast	The metabolism of Cabozantinib can be increased when combined with Apremilast.
Aprepitant	The metabolism of Cabozantinib can be decreased when combined with Aprepitant.
Arformoterol	The metabolism of Cabozantinib can be decreased when combined with Arformoterol.
Armodafinil	The metabolism of Cabozantinib can be decreased when combined with Armodafinil.
Artemether	The metabolism of Cabozantinib can be decreased when combined with Artemether.
Articaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Articaine.
Asciminib	The serum concentration of Cabozantinib can be increased when it is combined with Asciminib.
Asunaprevir	The metabolism of Asunaprevir can be decreased when combined with Cabozantinib.
Atazanavir	The metabolism of Cabozantinib can be decreased when combined with Atazanavir.
Atorvastatin	The metabolism of Atorvastatin can be decreased when combined with Cabozantinib.
Atovaquone	The metabolism of Cabozantinib can be decreased when combined with Atovaquone.
Avanafil	The serum concentration of Avanafil can be increased when it is combined with Cabozantinib.
Avapritinib	The metabolism of Cabozantinib can be decreased when combined with Avapritinib.
Avatrombopag	The metabolism of Cabozantinib can be increased when combined with Avatrombopag.
Azelastine	The metabolism of Azelastine can be decreased when combined with Cabozantinib.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Benzocaine.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Benzyl alcohol.
Berotralstat	The metabolism of Cabozantinib can be decreased when combined with Berotralstat.
Betamethasone	The metabolism of Cabozantinib can be increased when combined with Betamethasone.
Bexarotene	The metabolism of Cabozantinib can be decreased when combined with Bexarotene.
Bimekizumab	The metabolism of Cabozantinib can be increased when combined with Bimekizumab.
Boceprevir	The metabolism of Cabozantinib can be decreased when combined with Boceprevir.
Bortezomib	The metabolism of Cabozantinib can be decreased when combined with Bortezomib.
Bosentan	The metabolism of Cabozantinib can be increased when combined with Bosentan.
Brigatinib	The metabolism of Brigatinib can be decreased when combined with Cabozantinib.
Brivaracetam	The metabolism of Cabozantinib can be decreased when combined with Brivaracetam.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Bupivacaine.
Buprenorphine	The metabolism of Buprenorphine can be decreased when combined with Cabozantinib.
Bupropion	The metabolism of Cabozantinib can be decreased when combined with Bupropion.
Butacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Butacaine.
Butamben	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Butamben.
Cabazitaxel	The metabolism of Cabazitaxel can be decreased when combined with Cabozantinib.
Canakinumab	The metabolism of Cabozantinib can be increased when combined with Canakinumab.
Candesartan cilexetil	The metabolism of Cabozantinib can be decreased when combined with Candesartan cilexetil.
Cannabidiol	The metabolism of Cabozantinib can be decreased when combined with Cannabidiol.
Capecitabine	The metabolism of Cabozantinib can be decreased when combined with Capecitabine.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Capsaicin.
Carbamazepine	The metabolism of Cabozantinib can be increased when combined with Carbamazepine.
Carbimazole	The therapeutic efficacy of Carbimazole can be decreased when used in combination with Cabozantinib.
Carvedilol	The metabolism of Cabozantinib can be decreased when combined with Carvedilol.
Celecoxib	The metabolism of Celecoxib can be decreased when combined with Cabozantinib.
Cenobamate	The serum concentration of Cabozantinib can be decreased when it is combined with Cenobamate.
Ceritinib	The metabolism of Cabozantinib can be decreased when combined with Ceritinib.
Cerivastatin	The metabolism of Cabozantinib can be decreased when combined with Cerivastatin.
Certolizumab pegol	The metabolism of Cabozantinib can be increased when combined with Certolizumab pegol.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Chloroprocaine.
Chloroquine	The metabolism of Chloroquine can be decreased when combined with Cabozantinib.
Chlorpropamide	The metabolism of Cabozantinib can be decreased when combined with Chlorpropamide.
Cimetidine	The metabolism of Cabozantinib can be decreased when combined with Cimetidine.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Cinchocaine.
Cinnarizine	The metabolism of Cabozantinib can be decreased when combined with Cinnarizine.
Ciprofloxacin	The metabolism of Cabozantinib can be decreased when combined with Ciprofloxacin.
Cisapride	The metabolism of Cisapride can be decreased when combined with Cabozantinib.
Clarithromycin	The metabolism of Cabozantinib can be decreased when combined with Clarithromycin.
Clevidipine	The metabolism of Cabozantinib can be decreased when combined with Clevidipine.
Clopidogrel	The metabolism of Cabozantinib can be decreased when combined with Clopidogrel.
Clozapine	The metabolism of Cabozantinib can be decreased when combined with Clozapine.
Cobicistat	The metabolism of Cabozantinib can be decreased when combined with Cobicistat.
Cocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Cocaine.
Conivaptan	The metabolism of Cabozantinib can be decreased when combined with Conivaptan.
Crizotinib	The metabolism of Cabozantinib can be decreased when combined with Crizotinib.
Curcumin	The metabolism of Cabozantinib can be decreased when combined with Curcumin.
Cyclizine	The metabolism of Cabozantinib can be decreased when combined with Cyclizine.
Cyclophosphamide	The metabolism of Cyclophosphamide can be decreased when combined with Cabozantinib.
Cyclosporine	The metabolism of Cabozantinib can be decreased when combined with Cyclosporine.
Dabrafenib	The serum concentration of Cabozantinib can be decreased when it is combined with Dabrafenib.
Dacomitinib	The metabolism of Dacomitinib can be decreased when combined with Cabozantinib.
Danazol	The metabolism of Cabozantinib can be decreased when combined with Danazol.
Dapagliflozin	The metabolism of Cabozantinib can be decreased when combined with Dapagliflozin.
Dapsone	The metabolism of Cabozantinib can be increased when combined with Dapsone.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cabozantinib.
Darunavir	The metabolism of Cabozantinib can be decreased when combined with Darunavir.
Dasabuvir	The metabolism of Dasabuvir can be decreased when combined with Cabozantinib.
Delafloxacin	The metabolism of Cabozantinib can be increased when combined with Delafloxacin.
Delavirdine	The metabolism of Cabozantinib can be decreased when combined with Delavirdine.

Dexamethasone	The metabolism of Cabozantinib can be increased when combined with Dexamethasone.
Dexibuprofen	The metabolism of Dexibuprofen can be decreased when combined with Cabozantinib.
Dextromethorphan	The metabolism of Cabozantinib can be decreased when combined with Dextromethorphan.
Diacerein	The metabolism of Cabozantinib can be decreased when combined with Diacerein.
Diazepam	The metabolism of Cabozantinib can be decreased when combined with Diazepam.
Diclofenac	The metabolism of Diclofenac can be decreased when combined with Cabozantinib.
Dicoumarol	The metabolism of Cabozantinib can be decreased when combined with Dicoumarol.
Diethylstilbestrol	The metabolism of Cabozantinib can be decreased when combined with Diethylstilbestrol.
Diltiazem	The metabolism of Cabozantinib can be decreased when combined with Diltiazem.
Diosmin	The metabolism of Cabozantinib can be decreased when combined with Diosmin.
Diphenhydramine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Diphenhydramine.
Doconexent	The metabolism of Cabozantinib can be decreased when combined with Doconexent.
Domperidone	The metabolism of Domperidone can be decreased when combined with Cabozantinib.
Donepezil	The metabolism of Cabozantinib can be decreased when combined with Donepezil.
Doxazosin	The metabolism of Cabozantinib can be decreased when combined with Doxazosin.
Doxepin	The metabolism of Cabozantinib can be decreased when combined with Doxepin.
Dronabinol	The metabolism of Cabozantinib can be decreased when combined with Dronabinol.
Dronedarone	The metabolism of Cabozantinib can be decreased when combined with Dronedarone.
Duloxetine	The metabolism of Cabozantinib can be decreased when combined with Duloxetine.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Dyclonine.
Efavirenz	The metabolism of Cabozantinib can be decreased when combined with Efavirenz.
Elagolix	The metabolism of Elagolix can be decreased when combined with Cabozantinib.
Eletriptan	The metabolism of Cabozantinib can be decreased when combined with Eletriptan.
Eltrombopag	The metabolism of Eltrombopag can be decreased when combined with Cabozantinib.
Elvitegravir	The metabolism of Cabozantinib can be decreased when combined with Elvitegravir.
Emapalumab	The metabolism of Cabozantinib can be increased when combined with Emapalumab.
Enasidenib	The metabolism of Enasidenib can be decreased when combined with Cabozantinib.
Enzalutamide	The metabolism of Cabozantinib can be increased when combined with Enzalutamide.
Epinephrine	The metabolism of Cabozantinib can be decreased when combined with Epinephrine.
Erdafitinib	The metabolism of Erdafitinib can be decreased when combined with Cabozantinib.
Ergotamine	The metabolism of Cabozantinib can be decreased when combined with Ergotamine.
Erlotinib	The metabolism of Erlotinib can be decreased when combined with Cabozantinib.
Erythromycin	The metabolism of Cabozantinib can be decreased when combined with Erythromycin.
Erythropoietin	The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Cabozantinib.
Esketamine	The metabolism of Esketamine can be decreased when combined with Cabozantinib.
Estradiol	The metabolism of Estradiol can be decreased when combined with Cabozantinib.
Estradiol acetate	The metabolism of Estradiol acetate can be decreased when combined with Cabozantinib.
Estradiol benzoate	The metabolism of Estradiol benzoate can be decreased when combined with Cabozantinib.
Estradiol cypionate	The metabolism of Estradiol cypionate can be decreased when combined with Cabozantinib.
Estradiol dienanthate	The metabolism of Estradiol dienanthate can be decreased when combined with Cabozantinib.
Estradiol valerate	The metabolism of Estradiol valerate can be decreased when combined with Cabozantinib.
Estrone sulfate	The metabolism of Cabozantinib can be decreased when combined with Estrone sulfate.
Eszopiclone	The metabolism of Eszopiclone can be decreased when combined with Cabozantinib.
Etanercept	The metabolism of Cabozantinib can be increased when combined with Etanercept.
Ethambutol	The metabolism of Cabozantinib can be decreased when combined with Ethambutol.
Ethanol	The metabolism of Cabozantinib can be decreased when combined with Ethanol.
Ethinylestradiol	The metabolism of Ethinylestradiol can be decreased when combined with Cabozantinib.
Ethyl chloride	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Ethyl chloride.
Etidocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Etidocaine.
Etodolac	The metabolism of Cabozantinib can be decreased when combined with Etodolac.
Etoricoxib	The metabolism of Cabozantinib can be decreased when combined with Etoricoxib.
Etravirine	The metabolism of Cabozantinib can be decreased when combined with Etravirine.
Felbamate	The metabolism of Cabozantinib can be decreased when combined with Felbamate.
Felodipine	The metabolism of Cabozantinib can be decreased when combined with Felodipine.
Fenofibrate	The metabolism of Cabozantinib can be decreased when combined with Fenofibrate.
Finerenone	The metabolism of Finerenone can be decreased when combined with Cabozantinib.
Flecainide	The metabolism of Cabozantinib can be decreased when combined with Flecainide.
Floxuridine	The metabolism of Cabozantinib can be decreased when combined with Floxuridine.
Fluconazole	The metabolism of Cabozantinib can be decreased when combined with Fluconazole.
Fluindione	The metabolism of Fluindione can be decreased when combined with Cabozantinib.
Flunarizine	The metabolism of Cabozantinib can be decreased when combined with Flunarizine.
Flunitrazepam	The metabolism of Cabozantinib can be decreased when combined with Flunitrazepam.
Fluorouracil	The metabolism of Fluorouracil can be decreased when combined with Cabozantinib.
Fluoxetine	The metabolism of Cabozantinib can be decreased when combined with Fluoxetine.
Flurbiprofen	The metabolism of Cabozantinib can be decreased when combined with Flurbiprofen.
Fluvastatin	The metabolism of Cabozantinib can be decreased when combined with Fluvastatin.
Fluvoxamine	The metabolism of Cabozantinib can be decreased when combined with Fluvoxamine.
Follitropin	The therapeutic efficacy of Follitropin can be decreased when used in combination with Cabozantinib.
Formoterol	The metabolism of Cabozantinib can be decreased when combined with Formoterol.
Fosaprepitant	The metabolism of Cabozantinib can be increased when combined with Fosaprepitant.
Fosnetupitant	The metabolism of Cabozantinib can be decreased when combined with Fosnetupitant.
Fosphenytoin	The metabolism of Cabozantinib can be increased when combined with Fosphenytoin.
Fusidic acid	The metabolism of Cabozantinib can be decreased when combined with Fusidic acid.
Gemfibrozil	The metabolism of Cabozantinib can be decreased when combined with Gemfibrozil.
Ginkgo biloba	The metabolism of Cabozantinib can be decreased when combined with Ginkgo biloba.
Glasdegib	The metabolism of Glasdegib can be decreased when combined with Cabozantinib.
Gliclazide	The metabolism of Cabozantinib can be decreased when combined with Gliclazide.
Glimepiride	The metabolism of Cabozantinib can be decreased when combined with Glimepiride.
Glipizide	The metabolism of Cabozantinib can be decreased when combined with Glipizide.
Gliquidone	The metabolism of Cabozantinib can be decreased when combined with Gliquidone.
Glyburide	The metabolism of Cabozantinib can be decreased when combined with Glyburide.
Golimumab	The metabolism of Cabozantinib can be increased when combined with Golimumab.
Halofantrine	The metabolism of Halofantrine can be decreased when combined with Cabozantinib.
Haloperidol	The serum concentration of Haloperidol can be increased when it is combined with Cabozantinib.
Halothane	The metabolism of Cabozantinib can be decreased when combined with Halothane.
Hydrocortisone	The metabolism of Cabozantinib can be increased when combined with Hydrocortisone.
Hydromorphone	The metabolism of Cabozantinib can be decreased when combined with Hydromorphone.
Hydroxychloroquine	The metabolism of Hydroxychloroquine can be decreased when combined with Cabozantinib.
Ibuprofen	The metabolism of Ibuprofen can be decreased when combined with Cabozantinib.
Idarubicin	The metabolism of Cabozantinib can be decreased when combined with Idarubicin.
Ifosfamide	The metabolism of Ifosfamide can be decreased when combined with Cabozantinib.
Imatinib	The metabolism of Cabozantinib can be decreased when combined with Imatinib.
Indinavir	The metabolism of Cabozantinib can be decreased when combined with Indinavir.
Indomethacin	The metabolism of Cabozantinib can be decreased when combined with Indomethacin.
Infliximab	The metabolism of Cabozantinib can be increased when combined with Infliximab.
Irbesartan	The metabolism of Irbesartan can be decreased when combined with Cabozantinib.
Isavuconazole	The metabolism of Cabozantinib can be decreased when combined with Isavuconazole.
Isavuconazonium	The metabolism of Cabozantinib can be decreased when combined with Isavuconazonium.

Isoniazid	The metabolism of Cabozantinib can be decreased when combined with Isoniazid.
Isradipine	The metabolism of Cabozantinib can be decreased when combined with Isradipine.
Istradefylline	The metabolism of Istradefylline can be decreased when combined with Cabozantinib.
Itraconazole	The metabolism of Cabozantinib can be decreased when combined with Itraconazole.
Ivosidenib	The metabolism of Cabozantinib can be increased when combined with Ivosidenib.
Ketamine	The metabolism of Ketamine can be decreased when combined with Cabozantinib.
Ketoconazole	The metabolism of Cabozantinib can be decreased when combined with Ketoconazole.
Ketorolac	The metabolism of Ketorolac can be decreased when combined with Cabozantinib.
Lacosamide	The metabolism of Cabozantinib can be decreased when combined with Lacosamide.
Lansoprazole	The metabolism of Lansoprazole can be decreased when combined with Cabozantinib.
Lapatinib	The metabolism of Lapatinib can be decreased when combined with Cabozantinib.
Leflunomide	The metabolism of Cabozantinib can be decreased when combined with Leflunomide.
Lesinurad	The metabolism of Lesinurad can be decreased when combined with Cabozantinib.
Letermovir	The metabolism of Cabozantinib can be increased when combined with Letermovir.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Levobupivacaine.
Levoketoconazole	The metabolism of Cabozantinib can be decreased when combined with Levoketoconazole.
Levomilnacipran	The metabolism of Levomilnacipran can be decreased when combined with Cabozantinib.
Levothyroxine	The therapeutic efficacy of Levothyroxine can be decreased when used in combination with Cabozantinib.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Lidocaine.
Linagliptin	The metabolism of Cabozantinib can be decreased when combined with Linagliptin.
Liothyronine	The therapeutic efficacy of Liothyronine can be decreased when used in combination with Cabozantinib.
Liotrix	The therapeutic efficacy of Liotrix can be decreased when used in combination with Cabozantinib.
Lonafarnib	The metabolism of Cabozantinib can be decreased when combined with Lonafarnib.
Loperamide	The metabolism of Loperamide can be decreased when combined with Cabozantinib.
Lopinavir	The metabolism of Cabozantinib can be decreased when combined with Lopinavir.
Lornoxicam	The metabolism of Cabozantinib can be decreased when combined with Lornoxicam.
Losartan	The metabolism of Cabozantinib can be decreased when combined with Losartan.
Lovastatin	The metabolism of Cabozantinib can be decreased when combined with Lovastatin.
Lumacaftor	The metabolism of Cabozantinib can be increased when combined with Lumacaftor.
Lumiracoxib	The metabolism of Cabozantinib can be decreased when combined with Lumiracoxib.
Lynestrenol	The metabolism of Lynestrenol can be decreased when combined with Cabozantinib.
Manidipine	The metabolism of Cabozantinib can be decreased when combined with Manidipine.
Mavacamten	The serum concentration of Cabozantinib can be decreased when it is combined with Mavacamten.
Medroxyprogesterone	The metabolism of Cabozantinib can be decreased when combined with Medroxyprogesterone acetate.
Mefenamic acid	The metabolism of Cabozantinib can be decreased when combined with Mefenamic acid.
Meloxicam	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Meloxicam.
Mephenytoin	The metabolism of Mephenytoin can be decreased when combined with Cabozantinib.
Mepivacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Mepivacaine.
Mestranol	The metabolism of Mestranol can be decreased when combined with Cabozantinib.
Methadone	The metabolism of Cabozantinib can be decreased when combined with Methadone.
Methimazole	The metabolism of Cabozantinib can be decreased when combined with Methimazole.
Methoxy polyethyl	The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Cabozantinib.
Methoxyflurane	The metabolism of Cabozantinib can be decreased when combined with Methoxyflurane.
Methylene blue	The metabolism of Cabozantinib can be decreased when combined with Methylene blue.
Metreleptin	The metabolism of Cabozantinib can be increased when combined with Metreleptin.
Metronidazole	The metabolism of Cabozantinib can be decreased when combined with Metronidazole.
Miconazole	The metabolism of Cabozantinib can be decreased when combined with Miconazole.
Midostaurin	The metabolism of Cabozantinib can be decreased when combined with Midostaurin.
Mifepristone	The metabolism of Cabozantinib can be decreased when combined with Mifepristone.
Milnacipran	The metabolism of Cabozantinib can be decreased when combined with Milnacipran.
Mitapivat	The metabolism of Cabozantinib can be increased when combined with Mitapivat.
Mitotane	The metabolism of Cabozantinib can be increased when combined with Mitotane.
Modafinil	The metabolism of Cabozantinib can be decreased when combined with Modafinil.
Montelukast	The metabolism of Montelukast can be decreased when combined with Cabozantinib.
Morphine	The metabolism of Morphine can be decreased when combined with Cabozantinib.
Mosunetuzumab	The metabolism of Cabozantinib can be decreased when combined with Mosunetuzumab.
Mycophenolate	The metabolism of Mycophenolate mofetil can be decreased when combined with Cabozantinib.
Nabilone	The metabolism of Cabozantinib can be decreased when combined with Nabilone.
Nabumetone	The metabolism of Cabozantinib can be decreased when combined with Nabumetone.
Naloxone	The metabolism of Cabozantinib can be decreased when combined with Naloxone.
Naproxen	The metabolism of Naproxen can be decreased when combined with Cabozantinib.
Nateglinide	The metabolism of Cabozantinib can be decreased when combined with Nateglinide.
Nefazodone	The metabolism of Cabozantinib can be decreased when combined with Nefazodone.
Nelfinavir	The metabolism of Cabozantinib can be decreased when combined with Nelfinavir.
Netupitant	The metabolism of Cabozantinib can be decreased when combined with Netupitant.
Nevirapine	The metabolism of Cabozantinib can be decreased when combined with Nevirapine.
Nicardipine	The metabolism of Cabozantinib can be decreased when combined with Nicardipine.
Niclosamide	The metabolism of Cabozantinib can be decreased when combined with Niclosamide.
Nilotinib	The metabolism of Cabozantinib can be decreased when combined with Nilotinib.
Nilutamide	The metabolism of Cabozantinib can be decreased when combined with Nilutamide.
Nilvadipine	The metabolism of Cabozantinib can be decreased when combined with Nilvadipine.
Norgestimate	The metabolism of Cabozantinib can be decreased when combined with Norgestimate.
Noscapine	The metabolism of Cabozantinib can be decreased when combined with Noscapine.
Olanzapine	The metabolism of Cabozantinib can be decreased when combined with Olanzapine.
Olodaterol	The metabolism of Olodaterol can be decreased when combined with Cabozantinib.
Ombitasvir	The metabolism of Ombitasvir can be decreased when combined with Cabozantinib.
Omeprazole	The metabolism of Omeprazole can be decreased when combined with Cabozantinib.
Ondansetron	The metabolism of Cabozantinib can be decreased when combined with Ondansetron.
Oritavancin	The metabolism of Cabozantinib can be decreased when combined with Oritavancin.
Ospemifene	The metabolism of Cabozantinib can be decreased when combined with Ospemifene.
Oxandrolone	The metabolism of Cabozantinib can be decreased when combined with Oxandrolone.
Oxetacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Oxetacaine.
Oxybuprocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Oxybuprocaine.
Ozanimod	The metabolism of Ozanimod can be decreased when combined with Cabozantinib.
Paclitaxel	The metabolism of Paclitaxel can be decreased when combined with Cabozantinib.
Paramethadione	The metabolism of Paramethadione can be decreased when combined with Cabozantinib.
Parathyroid	The therapeutic efficacy of Parathyroid hormone can be decreased when used in combination with Cabozantinib.
Parecoxib	The metabolism of Cabozantinib can be decreased when combined with Parecoxib.
Paroxetine	The metabolism of Cabozantinib can be decreased when combined with Paroxetine.
Pazopanib	The metabolism of Pazopanib can be decreased when combined with Cabozantinib.
Peginesatide	The risk or severity of Thrombosis can be increased when Peginesatide is combined with Cabozantinib.
Peginterferon	The metabolism of Cabozantinib can be increased when combined with Peginterferon alfa-2b.
Pentobarbital	The metabolism of Cabozantinib can be increased when combined with Pentobarbital.
Phenobarbital	The metabolism of Cabozantinib can be increased when combined with Phenobarbital.
Phenol	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Phenol.
Phenprocoumon	The metabolism of Phenprocoumon can be decreased when combined with Cabozantinib.
Phenylbutazone	The metabolism of Cabozantinib can be decreased when combined with Phenylbutazone.
Phenytoin	The metabolism of Cabozantinib can be increased when combined with Phenytoin.
Pioglitazone	The metabolism of Pioglitazone can be decreased when combined with Cabozantinib.
Piperaquine	The metabolism of Piperaquine can be decreased when combined with Cabozantinib.

Pirfenidone	The metabolism of Cabozantinib can be decreased when combined with Pirfenidone.
Piroxicam	The metabolism of Piroxicam can be decreased when combined with Cabozantinib.
Pitavastatin	The metabolism of Pitavastatin can be decreased when combined with Cabozantinib.
Pitolisant	The serum concentration of Cabozantinib can be decreased when it is combined with Pitolisant.
Ponatinib	The metabolism of Ponatinib can be decreased when combined with Cabozantinib.
Posaconazole	The metabolism of Cabozantinib can be decreased when combined with Posaconazole.
Potassium Iodide	The therapeutic efficacy of Potassium Iodide can be decreased when used in combination with Cabozantinib.
Potassium	The therapeutic efficacy of Potassium perchlorate can be decreased when used in combination with Cabozantinib.
Pralsetinib	The metabolism of Cabozantinib can be decreased when combined with Pralsetinib.
Pramocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Pramocaine.
Prasugrel	The metabolism of Cabozantinib can be decreased when combined with Prasugrel.
Prednisolone	The metabolism of Cabozantinib can be increased when combined with Prednisolone phosphate.
Prilocaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Prilocaine.
Primaquine	The metabolism of Cabozantinib can be decreased when combined with Primaquine.
Primidone	The metabolism of Cabozantinib can be increased when combined with Primidone.
Probenecid	The metabolism of Cabozantinib can be decreased when combined with Probenecid.
Procaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Procaine.
Progesterone	The metabolism of Cabozantinib can be decreased when combined with Progesterone.
Proguanil	The metabolism of Cabozantinib can be decreased when combined with Proguanil.
Promazine	The metabolism of Cabozantinib can be decreased when combined with Promazine.
Promethazine	The metabolism of Cabozantinib can be decreased when combined with Promethazine.
Proparacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Proparacaine.
Propofol	The metabolism of Propofol can be decreased when combined with Cabozantinib.
Propoxycaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Propoxycaine.
Propylthiouracil	The therapeutic efficacy of Propylthiouracil can be decreased when used in combination with Cabozantinib.
Protirelin	The therapeutic efficacy of Protirelin can be decreased when used in combination with Cabozantinib.
Quazepam	The metabolism of Cabozantinib can be decreased when combined with Quazepam.
Quinidine	The metabolism of Cabozantinib can be decreased when combined with Quinidine.
Quinine	The metabolism of Quinine can be decreased when combined with Cabozantinib.
Ramelteon	The metabolism of Cabozantinib can be decreased when combined with Ramelteon.
Regorafenib	The metabolism of Cabozantinib can be decreased when combined with Regorafenib.
Repaglinide	The metabolism of Repaglinide can be decreased when combined with Cabozantinib.
Ribociclib	The metabolism of Cabozantinib can be decreased when combined with Ribociclib.
Rifabutin	The metabolism of Cabozantinib can be increased when combined with Rifabutin.
Rifampicin	The metabolism of Cabozantinib can be increased when combined with Rifampicin.
Rifamycin	The metabolism of Cabozantinib can be increased when combined with Rifamycin.
Rifapentine	The metabolism of Cabozantinib can be increased when combined with Rifapentine.
Rilonacept	The metabolism of Cabozantinib can be increased when combined with Rilonacept.
Rilpivirine	The metabolism of Cabozantinib can be decreased when combined with Rilpivirine.
Riociguat	The metabolism of Riociguat can be decreased when combined with Cabozantinib.
Ritonavir	The metabolism of Cabozantinib can be decreased when combined with Ritonavir.
Rofecoxib	The metabolism of Cabozantinib can be decreased when combined with Rofecoxib.
Ropivacaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Ropivacaine.
Rosiglitazone	The metabolism of Rosiglitazone can be decreased when combined with Cabozantinib.
Rosuvastatin	The metabolism of Cabozantinib can be decreased when combined with Rosuvastatin.
Roxadustat	The metabolism of Roxadustat can be decreased when combined with Cabozantinib.
Rucaparib	The metabolism of Cabozantinib can be decreased when combined with Rucaparib.
Rupatadine	The metabolism of Rupatadine can be decreased when combined with Cabozantinib.
Ruxolitinib	The metabolism of Ruxolitinib can be decreased when combined with Cabozantinib.
Salicylic acid	The metabolism of Cabozantinib can be decreased when combined with Salicylic acid.
Salmon calcitonin	The therapeutic efficacy of Salmon calcitonin can be decreased when used in combination with Cabozantinib.
Saquinavir	The metabolism of Cabozantinib can be decreased when combined with Saquinavir.
Satralizumab	The serum concentration of Cabozantinib can be decreased when it is combined with Satralizumab.
Secobarbital	The metabolism of Cabozantinib can be increased when combined with Secobarbital.
Secukinumab	The metabolism of Cabozantinib can be increased when combined with Secukinumab.
Selegiline	The metabolism of Selegiline can be decreased when combined with Cabozantinib.
Selexipag	The metabolism of Selexipag can be decreased when combined with Cabozantinib.
Selumetinib	The metabolism of Selumetinib can be decreased when combined with Cabozantinib.
Sertraline	The metabolism of Cabozantinib can be decreased when combined with Sertraline.
Sildenafil	The metabolism of Cabozantinib can be decreased when combined with Sildenafil.
Siltuximab	The metabolism of Cabozantinib can be increased when combined with Siltuximab.
Simeprevir	The metabolism of Cabozantinib can be decreased when combined with Simeprevir.
Simvastatin	The metabolism of Cabozantinib can be decreased when combined with Simvastatin.
Siponimod	The metabolism of Siponimod can be decreased when combined with Cabozantinib.
Sitagliptin	The metabolism of Sitagliptin can be decreased when combined with Cabozantinib.
Sitaxentan	The metabolism of Cabozantinib can be decreased when combined with Sitaxentan.
Somatrogon	The metabolism of Cabozantinib can be increased when combined with Somatrogon.
Sorafenib	The metabolism of Sorafenib can be decreased when combined with Cabozantinib.
Sotorasib	The serum concentration of Cabozantinib can be decreased when it is combined with Sotorasib.
St. John’s Wort	The metabolism of Cabozantinib can be increased when combined with St. John’s Wort.
Stiripentol	The metabolism of Cabozantinib can be decreased when combined with Stiripentol.
Sulfadiazine	The metabolism of Cabozantinib can be decreased when combined with Sulfadiazine.
Sulfamethizole	The metabolism of Cabozantinib can be decreased when combined with Sulfamethizole.
Sulfamethoxazole	The metabolism of Cabozantinib can be decreased when combined with Sulfamethoxazole.
Sulfaphenazole	The metabolism of Cabozantinib can be decreased when combined with Sulfaphenazole.
Sulfapyridine	The metabolism of Cabozantinib can be decreased when combined with Sulfapyridine.
Sulfinpyrazone	The metabolism of Cabozantinib can be decreased when combined with Sulfinpyrazone.
Sulfisoxazole	The metabolism of Cabozantinib can be decreased when combined with Sulfisoxazole.
Tamoxifen	The metabolism of Cabozantinib can be decreased when combined with Tamoxifen.
Tazarotene	The metabolism of Tazarotene can be decreased when combined with Cabozantinib.
Tegafur	The metabolism of Tegafur can be decreased when combined with Cabozantinib.
Telaprevir	The metabolism of Cabozantinib can be decreased when combined with Telaprevir.
Telithromycin	The metabolism of Cabozantinib can be decreased when combined with Telithromycin.
Telotristat ethyl	The serum concentration of Cabozantinib can be decreased when it is combined with Telotristat ethyl.
Teniposide	The metabolism of Cabozantinib can be decreased when combined with Teniposide.
Tenoxicam	The metabolism of Cabozantinib can be decreased when combined with Tenoxicam.
Tepotinib	The metabolism of Cabozantinib can be decreased when combined with Tepotinib.
Terbinafine	The metabolism of Terbinafine can be decreased when combined with Cabozantinib.
Terfenadine	The metabolism of Cabozantinib can be decreased when combined with Terfenadine.
Teriparatide	The therapeutic efficacy of Teriparatide can be decreased when used in combination with Cabozantinib.
Testosterone	The metabolism of Cabozantinib can be decreased when combined with Testosterone.
Testosterone	The metabolism of Testosterone cypionate can be decreased when combined with Cabozantinib.
Testosterone	The metabolism of Testosterone enanthate can be decreased when combined with Cabozantinib.
Tetracaine	The risk or severity of methemoglobinemia can be increased when Cabozantinib is combined with Tetracaine.
Thalidomide	The metabolism of Cabozantinib can be decreased when combined with Thalidomide.
Theophylline	The metabolism of Theophylline can be decreased when combined with Cabozantinib.
Thiamylal	The metabolism of Cabozantinib can be decreased when combined with Thiamylal.
Thyroid, porcine	The therapeutic efficacy of Thyroid, porcine can be decreased when used in combination with Cabozantinib.
Thyrotropin alfa	The therapeutic efficacy of Thyrotropin alfa can be decreased when used in combination with Cabozantinib.
Ticagrelor	The metabolism of Cabozantinib can be decreased when combined with Ticagrelor.

Ticlopidine	The metabolism of Cabozantinib can be decreased when combined with Ticlopidine.
Tipranavir	The metabolism of Cabozantinib can be decreased when combined with Tipranavir.
Tocilizumab	The metabolism of Cabozantinib can be increased when combined with Tocilizumab.
Tolazamide	The metabolism of Cabozantinib can be decreased when combined with Tolazamide.
Tolbutamide	The metabolism of Tolbutamide can be decreased when combined with Cabozantinib.
Tolterodine	The metabolism of Cabozantinib can be decreased when combined with Tolterodine.
Torasemide	The metabolism of Cabozantinib can be decreased when combined with Torasemide.
Trabectedin	The metabolism of Cabozantinib can be decreased when combined with Trabectedin.
Tranylcypromine	The metabolism of Cabozantinib can be decreased when combined with Tranylcypromine.
Treprostinil	The metabolism of Treprostinil can be decreased when combined with Cabozantinib.
Tretinoin	The metabolism of Tretinoin can be decreased when combined with Cabozantinib.
Triclabendazole	The metabolism of Cabozantinib can be decreased when combined with Triclabendazole.
Trimethadione	The metabolism of Trimethadione can be decreased when combined with Cabozantinib.
Trimethoprim	The metabolism of Cabozantinib can be decreased when combined with Trimethoprim.
Trimipramine	The metabolism of Cabozantinib can be decreased when combined with Trimipramine.
Troglitazone	The metabolism of Cabozantinib can be decreased when combined with Troglitazone.
Troleandomycin	The metabolism of Cabozantinib can be decreased when combined with Troleandomycin.
Tucatinib	The metabolism of Tucatinib can be decreased when combined with Cabozantinib.
Valdecoxib	The metabolism of Cabozantinib can be decreased when combined with Valdecoxib.
Valproic acid	The metabolism of Cabozantinib can be decreased when combined with Valproic acid.
Valsartan	The metabolism of Cabozantinib can be decreased when combined with Valsartan.
Velpatasvir	The metabolism of Velpatasvir can be decreased when combined with Cabozantinib.
Vemurafenib	The metabolism of Cabozantinib can be decreased when combined with Vemurafenib.
Venetoclax	The metabolism of Cabozantinib can be decreased when combined with Venetoclax.
Verapamil	The metabolism of Cabozantinib can be decreased when combined with Verapamil.
Viloxazine	The metabolism of Cabozantinib can be decreased when combined with Viloxazine.
Vismodegib	The metabolism of Cabozantinib can be decreased when combined with Vismodegib.
Voriconazole	The metabolism of Cabozantinib can be decreased when combined with Voriconazole.
Vortioxetine	The metabolism of Vortioxetine can be decreased when combined with Cabozantinib.
Voxelotor	The metabolism of Voxelotor can be decreased when combined with Cabozantinib.
Voxilaprevir	The metabolism of Voxilaprevir can be decreased when combined with Cabozantinib.
Warfarin	The metabolism of Cabozantinib can be increased when combined with Warfarin.
Ximelagatran	The metabolism of Cabozantinib can be decreased when combined with Ximelagatran.
Zafirlukast	The metabolism of Cabozantinib can be decreased when combined with Zafirlukast.
Zidovudine	The metabolism of Zidovudine can be decreased when combined with Cabozantinib.
Zileuton	The metabolism of Cabozantinib can be decreased when combined with Zileuton.
Zimelidine	The metabolism of Cabozantinib can be decreased when combined with Zimelidine.
Ziprasidone	The metabolism of Cabozantinib can be decreased when combined with Ziprasidone.
Zolpidem	The metabolism of Cabozantinib can be decreased when combined with Zolpidem.
Zopiclone	The metabolism of Zopiclone can be decreased when combined with Cabozantinib.

Drug-Food Interactions

Pregnancy and Lactation

FDA Pregnancy Category D

Pregnancy

The use of cabozantinib may cause harm to the developing baby if it is taken by the mother during pregnancy. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

No information is available on the clinical use of cabozantinib during breastfeeding. Because cabozantinib is more than 97% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life ranges from 55 to 99 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during cabozantinib therapy and for 4 months after the last dose.

How should this medicine be used?

Cabozantinib comes as a tablet (Cabometyx) and a capsule (Cometriq) to take by mouth. It is usually taken once a day on an empty stomach, at least 1 hour before and 2 hours after eating. Take cabozantinib at around the same time every day. The length of your treatment depends on how well your body responds to the medication and the side effects that you experience. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cabozantinib exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets and capsules whole with a full glass (8 ounces, 240 mL) of water. Do not split, chew, crush, or open them.

Your doctor may decrease your dose of cabozantinib or permanently or temporarily stop your treatment if you experience serious side effects. Be sure to talk to your doctor about how you are feeling during your treatment with cabozantinib.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

What special precautions should I follow?

Before taking cabozantinib,

• tell your doctor and pharmacist if you are allergic to cabozantinib (Cabometyx, Cometriq), any other medications, or any of the ingredients in cabozantinib tablets or capsules. Ask your pharmacist or check the Medication Guide 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: abacavir (Ziagen, in Epzicom, in Triumeq), adefovir (Hepsera), atazanavir (Reyataz), carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril), cidofovir, clarithromycin (Biaxin), furosemide (Lasix), itraconazole (Sporanox, Tolsura), ketoconazole, lamivudine (Epivir, in Combivir, in Symfi, in others), nefazodone, nelfinavir (Viracept), nevirapine (Viramune), phenobarbital, phenytoin (Dilantin, Phenytek), probenecid (Probalan), rifabutin (Mycobutin), rifampin (Rifadin, Rimactane), rifapentine (Priftin), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), telithromycin (Ketek), tenofovir (Viread), voriconazole (Vfend), and warfarin (Coumadin, Jantoven). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with cabozantinib, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor what herbal products you are taking, especially St. John’s wort.
• tell your doctor if you have recently had any unusual or severe bleeding such as coughing up blood, vomiting blood, or bloody or black tarry stools. Also tell your doctor if you have an open or healing wound, or if you have or have ever had a low level of calcium in your blood, thyroid problems, high blood pressure, or liver disease.
• tell your doctor if you are pregnant or plan to become pregnant. You will need to have a pregnancy test before you start treatment with cabozantinib. You should not become pregnant during your treatment and for 4 months after your final dose. Talk to your doctor about birth control methods that you can use during your treatment. If you become pregnant while taking cabozantinib, call your doctor immediately. Cabozantinib may harm the fetus.
• tell your doctor if you are breastfeeding. Your doctor may tell you not to breastfeed during your treatment and for 4 months after your final dose.
• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking cabozantinib.
• if you are having surgery, tell the doctor that you are taking cabozantinib. Your doctor will probably tell you to stop taking cabozantinib at least 21 days before your surgery or procedure, and will tell you when you should start taking the medication again.
• you should know that cabozantinib may cause serious problems with your jaw. A dentist should examine your teeth before you start to take cabozantinib and regularly during your treatment. Be sure to brush your teeth and clean your mouth properly while you are taking cabozantinib. Talk to your doctor before having any dental treatments while you are taking this medication. Your doctor will probably tell you to stop taking cabozantinib at least 21 days before dental surgery.
• you should know that your blood pressure may increase during your treatment with cabozantinib. Your doctor will probably monitor your blood pressure before and during your treatment.

References

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