Lenvatinib - Uses, Dosage, Side Effects, Interaction

Lenvatinib is orally available multi-kinase inhibitor and antineoplastic agent that is used in treatment of advanced, metastatic medullary thyroid cancer and refractory renal cell carcinoma. Lenvatinib is associated with a modest rate of serum enzyme elevations during treatment and has been implicated to rare instances of clinically apparent, acute liver injury some of which have been fatal.

Lenvatinib is a member of the class of quinolines that is the carboxamide of 4-{3-chloro-4-[(cyclopropylcarbamoyl)amino]phenoxy}-7-methoxyquinoline-6-carboxylic acid. A multi-kinase inhibitor and orphan drug used (as its mesylate salt) for the treatment of various types of thyroid cancer that do not respond to radioiodine. It has a role as a vascular endothelial growth factor receptor antagonist, an orphan drug, an antineoplastic agent, an EC 2.7.10.1 (receptor protein-tyrosine kinase) inhibitor and a fibroblast growth factor receptor antagonist. It is a member of quinolines, an aromatic ether, a monocarboxylic acid amide, an aromatic amide, a member of monochlorobenzenes, a member of cyclopropanes and a member of phenylureas. It is a conjugate base of a lenvatinib(1+).

Lenvatinib is a synthetic, orally available inhibitor of vascular endothelial growth factor receptor 2 (VEGFR2, also known as KDR/FLK-1) tyrosine kinase with potential antineoplastic activity. Lenvatinib blocks VEGFR2 activation by VEGF, resulting in inhibition of the VEGF receptor signal transduction pathway, decreased vascular endothelial cell migration and proliferation, and vascular endothelial cell apoptosis.

Lenvatinib Mesylate is a synthetic, orally available inhibitor of vascular endothelial growth factor receptor 2 (VEGFR2, also known as KDR/FLK-1) tyrosine kinase with potential antineoplastic activity. E7080 blocks VEGFR2 activation by VEGF, resulting in inhibition of the VEGF receptor signal transduction pathway, decreased vascular endothelial cell migration and proliferation, and vascular endothelial cell apoptosis.

Lenvatinib mesylate is a methanesulfonate salt obtained by reaction of lenvatinib with one molar equivalent of methanesulfonic acid. A multi-kinase inhibitor and orphan drug used (as its mesylate salt) for the treatment of various types of thyroid cancer that do not respond to radioiodine. It has a role as an EC 2.7.10.1 (receptor protein-tyrosine kinase) inhibitor, a fibroblast growth factor receptor antagonist, an orphan drug, a vascular endothelial growth factor receptor antagonist and an antineoplastic agent. It contains a lenvatinib(1+).

Lenvatinib is approved (since 2015) for the treatment of differentiated thyroid cancer that is either locally recurrent or metastatic, progressive, and did not respond to treatment with radioactive iodine (radioiodine).^[rx]^[rx]

In May 2016, the U.S. Food and Drug Administration (FDA) approved it (in combination with everolimus) for the treatment of advanced renal cell carcinoma following one prior anti-angiogenic therapy.^[rx]

The drug is also approved in the US and in the European Union for hepatocellular carcinoma that cannot be removed surgically in patients who have not received cancer therapy by mouth or injection.^[5]^[6]

Mechanism of Action

Lenvatinib is a receptor tyrosine kinase (RTK) inhibitor that inhibits the kinase activities of vascular endothelial growth factor (VEGF) receptors VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). Lenvatinib also inhibits other RTKs that have been implicated in pathogenic angiogenesis, tumor growth, and cancer progression in addition to their normal cellular functions, including fibroblast growth factor (FGF) receptors FGFR1, 2, 3, and 4; the platelet derived growth factor receptor alpha (PDGFRα), KIT, and RET.

Lenvatinib acts as a multiple kinase inhibitor. It inhibits the three main vascular endothelial growth factor receptors VEGFR1, 2 and 3, as well as fibroblast growth factor receptors (FGFR) 1, 2, 3 and 4, platelet-derived growth factor receptor (PDGFR) alpha, c-Kit, and the RET proto-oncogene. Some of these proteins play roles in cancerogenic signalling pathways. VEGFR2 inhibition is thought to be the main reason for the most common side effect, hypertension.^[rx]

Based on x-ray crystallography and kinetic interaction studies, lenvatinib binds to the adenosine 5′-triphosphate binding site of VEGFR2 and to a neighbouring region via a cyclopropane ring and thereby inhibits tyrosine kinase activity and associated signalling pathways.

Indications

Lenvatinib is indicated for the treatment of the following cancerous conditions: **Differentiated Thyroid Cancer (DTC)** – Treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer **Renal Cell Carcinoma (RCC)** – First-line treatment, in combination with [pembrolizumab], in adult patients with advanced renal cell carcinoma (RCC) – Treatment of advanced renal cell carcinoma, in combination with [everolimus], in adult patients who have previously tried ≥1 anti-angiogenic therapy **Hepatocellular Carcinoma (HCC)** – First-line treatment of patients with unresectable hepatocellular carcinoma **Endometrial Carcinoma** – Treatment of advanced endometrial carcinoma that is not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), in combination with [pembrolizumab], in patients who have experienced disease progression following prior systemic therapy and are not candidates for curative surgery or radiation
Lenvima is indicated as monotherapy for the treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine (RAI).
Lenvima is indicated as monotherapy for the treatment of adult patients with advanced or unresectable hepatocellular carcinoma (HCC) who have received no prior systemic therapy. Kisplyx is indicated for the treatment of adults with advanced renal cell carcinoma (RCC): in combination with pembrolizumab, as first-line treatment. in combination with everolimus, following one prior vascular endothelial growth factor (VEGF)-targeted therapy.
Treatment of follicular thyroid cancer , Treatment of osteosarcoma, Treatment of papillary thyroid cancer
Treatment of all conditions included in the category of malignant neoplasms except haematopoietic and lymphoid tissue neoplasms, papillary thyroid cancer , follicular thyroid cancer and osteosarcoma.
Lenvima is indicated as monotherapy for the treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine (RAI).
Lenvima is indicated as monotherapy for the treatment of adult patients with advanced or unresectable hepatocellular carcinoma (HCC) who have received no prior systemic therapy.
Lenvatinib mesylate is approved to be used alone or with other drugs to treat: Endometrial carcinoma that is advanced and got worse after other systemic therapies. It is used with pembrolizumab in patients whose cancer is not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) and cannot be treated with surgery or radiation therapy. Hepatocellular carcinoma (a type of liver cancer). It is used as the first treatment in patients whose cancer cannot be removed by surgery. Renal cell carcinoma (a type of kidney cancer) that is advanced. It is used: With everolimus in adults who have received angiogenesis inhibitor therapy. With pembrolizumab as the first treatment in adults. Thyroid cancer in certain patients with progressive, recurrent, or metastatic cancer that does not respond to treatment with radioactive iodine.
Lenvatinib, is an anti-cancer medication for the treatment of certain kinds of thyroid cancer and for other cancers as well. It was developed by Eisai Co. and acts as a multiple kinase inhibitor against the VEGFR1, VEGFR2 and VEGFR3 kinases.
Advanced Renal Cell Carcinoma
Endometrial Carcinoma
Unresectable Hepatocellular Carcinoma (HCC)
Progressive, locally advanced radioactive iodine-refractory Differentiated Thyroid Cancer (DTC)
Progressive, metastatic radioactive iodine-refractory Differentiated Thyroid Cancer (DTC)

Use in Cancer

Lenvatinib mesylate is approved to be used alone or with other drugs to treat:

Endometrial carcinoma is advanced and got worse after other systemic therapies. It is used with pembrolizumab in patients whose cancer is not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) and cannot be treated with surgery or radiation therapy.
Hepatocellular carcinoma (a type of liver cancer). It is used as the first treatment in patients whose cancer cannot be removed by surgery.
Renal cell carcinoma (a type of kidney cancer) is advanced. It is used:
- With everolimus in adults who have received angiogenesis inhibitor therapy.
- With pembrolizumab as the first treatment in adults.
Thyroid cancer in certain patients with progressive, recurrent, or metastatic cancer that does not respond to treatment with radioactive iodine. Lenvatinib mesylate is also being studied in the treatment of other types of cancer.

Contraindications

Bleeding, thyroid cancer.
Hypertension.
Cardiomyopathy, heart failure.
Cardiac disease, coronary artery disease, myocardial infarction, stroke, thromboembolic disease.
Hepatic disease, hepatotoxicity.
Dehydration, hypovolemia, renal disease, renal failure, renal impairment
a condition with low thyroid hormone levels
low amount of calcium in the blood
low amount of potassium in the blood
high blood pressure
prolonged QT interval on EKG
chronic heart failure
abnormal EKG with QT changes from birth
a localized weakening and ballooning in an artery wall called an arterial aneurysm
obstruction of a blood vessel by a blood clot
bleeding
a gastrointestinal tract fistula
recent operation
elevation of proteins in the urine
pregnancy
a patient who is producing milk and breastfeeding
chronic kidney disease stage 4 (severe)
kidney disease with likely reduction in kidney function
dissection of artery
Child-Pugh class C liver impairment

Dosage

Strengths: 4 mg daily-dose; 8 mg daily-dose; 10 mg daily-dose; 12 mg daily-dose; 14 mg daily-dose; 18 mg daily-dose; 20 mg daily-dose; 24 mg daily-dose

Lenvaitnib is available in 4 mg and 10 mg capsule dosages for oral consumption.[rx]

Radioactive Iodine-refractory Differentiated Thyroid Cancer (DTC)

24 mg orally once a day.

Advanced Renal Cell Carcinoma (RCC)

First-line treatment: 20 mg orally once a day in combination with pembrolizumab for up to two years; then can be given as monotherapy.
Previously treated disease: 18 mg orally once daily in combination with everolimus.

Unresectable Hepatocellular Carcinoma (HCC)

The suggested dose should be determined based on the patient’s body weight:

12 mg orally once a day for patients’ body weight greater than or equal to 60 kg.
8 mg orally once a day for patients weighing less than 60 kg.

Advanced Endometrial Carcinoma

20 mg orally once daily; for patients with non-microsatellite instability-high (MSI-H) or non-mismatch repair deficient (dMMR) progressive disease who are not candidates for X-ray therapy or curative surgery, use with pembrolizumab.

Thyroid Cancer

24 mg orally once a day
Treatment should be continued until disease progression or unacceptable toxicity.
For the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC)

Renal Cell Carcinoma

First-Line Treatment of Patients with Advanced Renal Cell Carcinoma:

20 mg orally once a day given in combination with 200 mg IV pembrolizumab over 30 minutes every 3 weeks

Previously Treated Renal Cell Carcinoma:

18 mg orally once a day given in combination with 5 mg everolimus orally once a day
Refer to everolimus prescribing information for recommended dosing information.
Refer to pembrolizumab prescribing information for recommended dosing information
Treatment with everolimus should be continued until disease progression or unacceptable toxicity.
Treatment with pembrolizumab should be continued until disease progression or unacceptable toxicity or up to 2 years.
After 2 years of combination with pembrolizumab, this drug may be administered as a single agent until disease progression or unacceptable toxicity.
In combination with everolimus for the treatment of patients with advanced renal cell carcinoma following one prior anti-angiogenic therapy
In combination with pembrolizumab for the first-line treatment of adult patients with advanced renal cell carcinoma

Hepatocellular Carcinoma

Weight less than 60 kg: 8 mg orally once a day
Weight 60 kg or greater: 12 mg orally once a day
Treatment should be continued until disease progression or unacceptable toxicity.
For the first-line treatment of patients with unresectable hepatocellular carcinoma (HCC)

Endometrial Carcinoma

20 mg orally once daily in combination with pembrolizumab 200 mg IV over 30 minutes every 3 weeks
Refer to the pembrolizumab prescribing information for other dosing information.
Treatment should be continued until disease progression or unacceptable toxicity.65483

Renal Dose Adjustments

Mild (CrCl 60-89 mL/min) or moderate renal impairment (CrCl 30-59 mL/min): No dose adjustment recommended

Severe renal impairment (CrCl less than 30 mL/min):

Differentiated thyroid cancer (DTC): Reduce the starting dose to 14 mg orally once a day
Renal cell carcinoma (RCC): Reduce the starting dose to 10 mg orally once a day
Endometrial carcinoma: Reduce the starting dose to 10 mg orally once a day
Hepatocellular Carcinoma (HCC): Data not available
End stage renal disease: Data not available

Liver Dose Adjustments

Mild (Child-Pugh A) to moderate (Child-Pugh B) hepatic impairment: No dose adjustment recommended

Severe hepatic impairment (Child-Pugh C):

Differentiated thyroid cancer (DTC): Reduce the starting dose to 14 mg orally once a day
Renal cell carcinoma (RCC): Reduce the starting dose to 10 mg orally once a day
Endometrial carcinoma: Reduce the starting dose to 10 mg orally once a day
Hepatocellular Carcinoma (HCC): Data not available

Dose Adjustments

When administering this drug in combination with everolimus, reduce the dose of this drug first and then the everolimus dose for adverse reactions of both drugs. Refer to the everolimus prescribing information for additional dose modification information.
When administering this drug in combination with pembrolizumab, modify the dosage of one or both drugs as appropriate, interrupt, or reduce of discontinue the dose of this drug as appropriate. Refer to pembrolizumab prescribing information for additional dose modification information.

DOSE REDUCTION BASED ON THE PREVIOUS DOSE LEVEL:
DIFFERENTIATED THYROID CANCER (DTC):
Initial dose level of 24 mg orally once a day:

First occurrence: Reduce dose to 20 mg orally once a day.
Second occurrence: Reduce dose to 14 mg orally once a day.
Third occurrence: Reduce dose to 10 mg orally once a day.

RENAL CELL CARCINOMA (RCC):
Initial dose level of 18 mg orally once a day:

First occurrence: Reduce dose to 14 mg orally once a day.
Second occurrence: Reduce dose to 10 mg orally once a day.
Third occurrence: Reduce dose to 8 mg orally once a day.

ENDOMETRIAL CARCINOMA:
Initial dose level of 20 mg orally once a day:

First occurrence: Reduce dose to 14 mg orally once a day.
Second occurrence: Reduce dose to 10 mg orally once a day.
Third occurrence: Reduce dose to 8 mg orally once a day.

HEPATOCELLULAR CARCINOMA (HCC):
Initial dose level of 12 mg orally once a day:

First occurrence: Reduce dose to 8 mg orally once a day.
Second occurrence: Reduce dose to 4 mg orally once a day.
Third occurrence: Reduce dose to 4 mg orally every other day.

Initial dose level of 8 mg orally once a day:

First occurrence: Reduce dose to 4 mg orally once a day.
Second occurrence: Reduce dose to 4 mg orally every other day.
Third occurrence: Discontinue therapy.

RECOMMENDED DOSE MODIFICATIONS FOR ADVERSE REACTIONS:
HYPERTENSION:
Grade 3:

Withhold for Grade 3 that persists despite optimal antihypertensive therapy.
Resume at reduced dose when hypertension is controlled at Grade 2 or less.

Grade 4:

Permanently discontinue therapy.

CARDIAC DYSFUNCTION:
Grade 3:

Withhold until improves to Grade 0 to 1 or baseline.
Resume at reduced dose or discontinue depending on the severity and persistence of adverse reaction.

Grade 4:

Permanently discontinue therapy.

ARTERIAL THROMBOEMBOLIC EVENT:
Any Grade:

Permanently discontinue therapy.

HEPATOTOXICITY:
Grade 3 or 4:

Withhold until improves to Grade 0 to 1 or baseline.
Either resume at a reduced dose or discontinue depending on severity and persistence of hepatotoxicity.
Permanently discontinue for hepatic failure.

RENAL IMPAIRMENT OR FAILURE:
Grade 3 or 4:

Withhold until improves to Grade 0 to 1 or baseline.
Resume at a reduced dose or discontinue depending on severity and persistence of renal impairment.

PROTEINURIA:
2 grams or greater proteinuria in 24 hours:

Withhold until less than or equal to 2 grams of proteinuria per 24 hours.
Resume at a reduced dose.
Permanently discontinue for nephrotic syndrome.

GI PERFORATION:
Any Grade:

Permanently discontinue therapy.

FISTULA FORMATION:
Grade 3 or 4:

Permanently discontinue therapy.

QT PROLONGATION:
Greater than 500 ms or greater than 60 ms increase from baseline:

Withhold until improves to less than or equal to 480 ms or baseline.
Resume at a reduced dose.

REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME (RPLS):
Any Grade:

Withhold until fully resolved.
Resume at a reduced dose or discontinue depending on severity and persistence of neurologic symptoms.

OTHER ADVERSE REACTIONS:
Persistent or intolerable Grade 2 or 3 adverse reaction or Grade 4 laboratory abnormality:

Withhold until improves to Grade 0 to 1 or baseline.
Resume at reduced dose.

Grade 4 adverse reaction:

Permanently discontinue therapy.

Administration advice:

Capsules can be swallowed whole or dissolved in a small glass of liquid.
This drug can be given with or without food.
This drug should be taken at the same time each day.
If a dose is missed and cannot be taken within 12 hours, skip that dose and take the next dose at the usual time.
Cardiovascular: Blood pressure, bleeding, signs and symptoms of cardiac dysfunction, ECG
Endocrine: TSH levels
Hepatic: ALT, AST
Metabolic: Serum electrolytes, blood calcium levels
Neurologic: New onset or worsening neurological function
Renal: Proteinuria, regular laboratory renal tests
Advise the patient to read the FDA-approved patient labeling.
Advise patients regarding good oral hygiene practices and to have preventive dentistry performed prior to and throughout treatment.
Advise patients that this drug can increase the risk for bleeding.
Advise patients that this drug can increase the risk of fistula formation or gastrointestinal perforation and to seek immediate medical attention for severe abdominal pain.
Advise patients that this drug to report any clinical symptom of cardiac dysfunction.
Advise patients to inform their healthcare provider of any planned surgical procedure.
Advise females of reproductive potential to use effective contraception during treatment and for at least 30 days after the last dose.
Advise women to discontinue breastfeeding during treatment and for at least 1 week after the last dose.

Side Effects

The Most Common

fatigue or tiredness
rash, redness, itching, or peeling of skin on palms and sole(s) of the feet
diarrhea
nausea
constipation
heartburn
decreased appetite
weight loss
change in ability to taste food
cough
hoarseness
mouth sores
dry mouth
headache
joint and muscle pain
difficulty falling asleep or staying asleep
hair loss
fever
burning during urination
rash
shortness of breath or trouble breathing
swelling of legs and ankles
chest pain
numbness or weakness of the face, arm, or leg on one side of your body
pain in arms, back, neck, or jaw
sudden, severe headache
slow or difficult speech
sudden changes in vision
yellowing of the skin or eyes
stomach pain
dark (tea-colored) urine
light-colored stools
seizures
weakness
confusion
severe and persistent nose bleeds
bloody vomit
black, tarry, or bloody stools
coughing up blood or blood clots
heavy menstrual bleeding
vomiting, diarrhea, or signs of dehydration
wounds that do not heal

More common

Bladder pain
bleeding gums
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine or stools
blurred vision or other change in vision
chest pain or discomfort
chills
cloudy urine
confusion
constipation
cough
coughing up blood
decreased frequency or amount of urine
depressed mood
diarrhea
difficulty with breathing or swallowing
dilated neck veins
dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position
dry skin and hair
feeling cold
fever
hair loss
heavy jaw feeling
hoarseness or husky voice
increase in heart rate
increased menstrual flow or vaginal bleeding
loosening of a tooth
lower back or side pain
muscle cramps in the hands, arms, feet, legs, or face
muscle stiffness
nervousness
nosebleeds
numbness and tingling around the mouth, fingertips, or feet
pain, swelling, or numbness in the mouth, or jaw
painful or difficult urination
pale skin
paralysis
pinpoint red spots on the skin
pounding in the ears
prolonged bleeding from cuts
rapid or irregular breathing
rapid weight gain
red or black, tarry stools
red or dark brown urine
redness, swelling, or pain of the skin
scaling of the skin on the hands and feet
severe headache
slow or fast heartbeat
sore throat
stomach pain and bloating
swelling of the face, fingers, feet, or lower legs
tingling of the hands or feet
tremor
ulceration of the skin
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
vomiting
wrinkled skin

Rare

Clay-colored stools
difficulty with speaking
heartburn or indigestion
inability to move the arms, legs, or facial muscles
pain or discomfort in the arms, jaw, back, or neck
severe stomach pain, cramping, or burning
stomach tenderness
vomiting of material that looks like coffee grounds
yellow eyes or skin
Abnormal small opening
loss of appetite
severe nausea or vomiting
slow wound healing
Belching
change or loss of taste
decreased weight
dry mouth
hair loss or thinning of the hair
itching, skin rash
muscle or joint pain
swelling or inflammation of the mouth
trouble sleeping
voice changes

Drug Interactions

DRUG	INTERACTION
Abemaciclib	Abemaciclib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Abrocitinib	The serum concentration of Lenvatinib can be increased when it is combined with Abrocitinib.
Acamprosate	The excretion of Acamprosate can be decreased when combined with Lenvatinib.
Acetaminophen	The serum concentration of Acetaminophen can be increased when it is combined with Lenvatinib.
Acrivastine	The risk or severity of QTc prolongation can be increased when Acrivastine is combined with Lenvatinib.
Acyclovir	The excretion of Acyclovir can be decreased when combined with Lenvatinib.
Adefovir dipivo	The excretion of Adefovir dipivoxil can be decreased when combined with Lenvatinib.
Adenosine	The risk or severity of QTc prolongation can be increased when Adenosine is combined with Lenvatinib.
Afatinib	Afatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Ajmaline	The risk or severity of QTc prolongation can be increased when Ajmaline is combined with Lenvatinib.
Alectinib	Alectinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Alfuzosin	The risk or severity of QTc prolongation can be increased when Alfuzosin is combined with Lenvatinib.
Alimemazine	The risk or severity of QTc prolongation can be increased when Alimemazine is combined with Lenvatinib.
Allopurinol	The excretion of Allopurinol can be decreased when combined with Lenvatinib.
Alprostadil	The excretion of Alprostadil can be decreased when combined with Lenvatinib.
Amantadine	The serum concentration of Amantadine can be increased when it is combined with Lenvatinib.
Ambrisentan	The serum concentration of Lenvatinib can be increased when it is combined with Ambrisentan.
Amifampridine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Amifampridine.
Aminohippuric a	The excretion of Aminohippuric acid can be decreased when combined with Lenvatinib.
Amiodarone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Amiodarone.
Amisulpride	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Amisulpride.
Amitriptyline	The risk or severity of QTc prolongation can be increased when Amitriptyline is combined with Lenvatinib.
Amodiaquine	The risk or severity of QTc prolongation can be increased when Amodiaquine is combined with Lenvatinib.
Amoxapine	The risk or severity of QTc prolongation can be increased when Amoxapine is combined with Lenvatinib.
Anagrelide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Anagrelide.
Antazoline	The risk or severity of QTc prolongation can be increased when Antazoline is combined with Lenvatinib.
Apalutamide	The serum concentration of Lenvatinib can be decreased when it is combined with Apalutamide.
Apixaban	The serum concentration of Lenvatinib can be increased when it is combined with Apixaban.
Apomorphine	The risk or severity of QTc prolongation can be increased when Apomorphine is combined with Lenvatinib.
Arformoterol	The risk or severity of QTc prolongation can be increased when Arformoterol is combined with Lenvatinib.
Aripiprazole	The risk or severity of QTc prolongation can be increased when Aripiprazole is combined with Lenvatinib.
Aripiprazole lauroxil	The risk or severity of QTc prolongation can be increased when Aripiprazole lauroxil is combined with Lenvatinib.
Arsenic trioxide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Arsenic trioxide.
Artemether	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Artemether.
Articaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Articaine.
Asciminib	The serum concentration of Lenvatinib can be increased when it is combined with Asciminib.
Asenapine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Asenapine.
Astemizole	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Astemizole.
Asunaprevir	The serum concentration of Lenvatinib can be increased when it is combined with Asunaprevir.
Atazanavir	Lenvatinib may decrease the excretion rate of Atazanavir which could result in a higher serum level.
Atenolol	Lenvatinib may decrease the excretion rate of Atenolol which could result in a higher serum level.
Atogepant	The serum concentration of Atogepant can be increased when it is combined with Lenvatinib.
Atomoxetine	The risk or severity of QTc prolongation can be increased when Atomoxetine is combined with Lenvatinib.
Atorvastatin	Lenvatinib may decrease the excretion rate of Atorvastatin which could result in a higher serum level.
Atropine	Lenvatinib may decrease the excretion rate of Atropine which could result in a higher serum level.
Avanafil	Avanafil may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Avatrombopag	Avatrombopag may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Avibactam	The excretion of Avibactam can be decreased when combined with Lenvatinib.
Axitinib	The serum concentration of Axitinib can be increased when it is combined with Lenvatinib.
Azatadine	The risk or severity of QTc prolongation can be increased when Azatadine is combined with Lenvatinib.
Azithromycin	The risk or severity of QTc prolongation can be increased when Azithromycin is combined with Lenvatinib.
Baricitinib	The serum concentration of Baricitinib can be increased when it is combined with Lenvatinib.
Beclomethasone d	Beclomethasone dipropionate may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Bedaquiline	The risk or severity of QTc prolongation can be increased when Bedaquiline is combined with Lenvatinib.
Belantamab mafo	Lenvatinib may decrease the excretion rate of Belantamab mafodotin which could result in a higher serum level.
Belinostat	The serum concentration of Lenvatinib can be increased when it is combined with Belinostat.
Belumosudil	Belumosudil may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Bendamustine	The serum concentration of Bendamustine can be increased when it is combined with Lenvatinib.
Benzatropine	The risk or severity of QTc prolongation can be increased when Benzatropine is combined with Lenvatinib.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Benzocaine.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Benzyl alcohol.
Benzylpenicillin	The excretion of Benzylpenicillin can be decreased when combined with Lenvatinib.
Bepridil	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Bepridil.
Berotralstat	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Berotralstat.
Betrixaban	The serum concentration of Betrixaban can be increased when it is combined with Lenvatinib.
Bilastine	The risk or severity of QTc prolongation can be increased when Bilastine is combined with Lenvatinib.
Binimetinib	The serum concentration of Binimetinib can be increased when it is combined with Lenvatinib.
Bisoprolol	The serum concentration of Lenvatinib can be increased when it is combined with Bisoprolol.
Bortezomib	The serum concentration of Bortezomib can be increased when it is combined with Lenvatinib.
Bosentan	The risk or severity of liver damage can be increased when Bosentan is combined with Lenvatinib.
Bosutinib	The serum concentration of Bosutinib can be increased when it is combined with Lenvatinib.
Brentuximab ve	The serum concentration of Brentuximab vedotin can be increased when it is combined with Lenvatinib.
Bretylium	The risk or severity of QTc prolongation can be increased when Bretylium is combined with Lenvatinib.
Brigatinib	Brigatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Brincidofovir	The serum concentration of Brincidofovir can be increased when it is combined with Lenvatinib.
Brompheniram	The risk or severity of QTc prolongation can be increased when Brompheniramine is combined with Lenvatinib.
Buclizine	The risk or severity of QTc prolongation can be increased when Buclizine is combined with Lenvatinib.
Budesonide	Lenvatinib may decrease the excretion rate of Budesonide which could result in a higher serum level.
Bumetanide	The excretion of Bumetanide can be decreased when combined with Lenvatinib.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Bupivacaine.
Buprenorphine	Buprenorphine may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Buserelin	The risk or severity of QTc prolongation can be increased when Buserelin is combined with Lenvatinib.
Butacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Butacaine.
Butamben	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Butamben.
Butriptyline	The risk or severity of QTc prolongation can be increased when Butriptyline is combined with Lenvatinib.
Cabazitaxel	Cabazitaxel may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Cabergoline	The serum concentration of Cabergoline can be increased when it is combined with Lenvatinib.
Caffeine	Caffeine may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Canagliflozin	The serum concentration of Lenvatinib can be increased when it is combined with Canagliflozin.
Cannabidiol	Cannabidiol may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Capmatinib	The serum concentration of Lenvatinib can be increased when it is combined with Capmatinib.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Capsaicin.
Captopril	The excretion of Captopril can be decreased when combined with Lenvatinib.
Carbimazole	The therapeutic efficacy of Carbimazole can be decreased when used in combination with Lenvatinib.
Carbinoxamine	The risk or severity of QTc prolongation can be increased when Carbinoxamine is combined with Lenvatinib.
Carfilzomib	The serum concentration of Lenvatinib can be increased when it is combined with Carfilzomib.
Carvedilol	The serum concentration of Lenvatinib can be increased when it is combined with Carvedilol.
Caspofungin	The excretion of Caspofungin can be decreased when combined with Lenvatinib.
Cefaclor	Lenvatinib may decrease the excretion rate of Cefaclor which could result in a higher serum level.
Cefazolin	The excretion of Cefazolin can be decreased when combined with Lenvatinib.

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Cefdinir	The excretion of Cefdinir can be decreased when combined with Lenvatinib.
Cefotiam	The excretion of Cefotiam can be decreased when combined with Lenvatinib.
Ceftibuten	The excretion of Ceftibuten can be decreased when combined with Lenvatinib.
Ceftizoxime	The excretion of Ceftizoxime can be decreased when combined with Lenvatinib.
Celecoxib	The risk or severity of liver damage can be increased when Celecoxib is combined with Lenvatinib.
Celiprolol	The risk or severity of QTc prolongation can be increased when Celiprolol is combined with Lenvatinib.
Cephalexin	The excretion of Cephalexin can be decreased when combined with Lenvatinib.
Ceritinib	The risk or severity of QTc prolongation can be increased when Ceritinib is combined with Lenvatinib.
Cerivastatin	Lenvatinib may decrease the excretion rate of Cerivastatin which could result in a higher serum level.
Cetirizine	The risk or severity of QTc prolongation can be increased when Cetirizine is combined with Lenvatinib.
Chlorcyclizine	The risk or severity of QTc prolongation can be increased when Chlorcyclizine is combined with Lenvatinib.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Chloroprocaine.
Chloroquine	The risk or severity of QTc prolongation can be increased when Chloroquine is combined with Lenvatinib.
Chlorpheniramine	The risk or severity of QTc prolongation can be increased when Chlorpheniramine is combined with Lenvatinib.
Chlorpromazine	The risk or severity of QTc prolongation can be increased when Chlorpromazine is combined with Lenvatinib.
Chlorprothixene	The risk or severity of QTc prolongation can be increased when Chlorprothixene is combined with Lenvatinib.
Cholecystokinin	The excretion of Cholecystokinin can be decreased when combined with Lenvatinib.
Cholesterol	Cholesterol may increase the excretion rate of Lenvatinib which could result in a lower serum level and potentially a reduction in efficacy.
Cholic Acid	Lenvatinib may decrease the excretion rate of Cholic Acid which could result in a higher serum level.
Choline	The serum concentration of Choline can be increased when it is combined with Lenvatinib.
Choline salicylate	The serum concentration of Choline salicylate can be increased when it is combined with Lenvatinib.
Cidofovir	The excretion of Cidofovir can be decreased when combined with Lenvatinib.
Cilostazol	The risk or severity of QTc prolongation can be increased when Cilostazol is combined with Lenvatinib.
Cimetidine	The excretion of Cimetidine can be decreased when combined with Lenvatinib.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Cinchocaine.
Cinnarizine	The risk or severity of QTc prolongation can be increased when Cinnarizine is combined with Lenvatinib.
Cinoxacin	The risk or severity of QTc prolongation can be increased when Cinoxacin is combined with Lenvatinib.
Ciprofloxacin	The risk or severity of QTc prolongation can be increased when Ciprofloxacin is combined with Lenvatinib.
Cisapride	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Cisapride.
Cisplatin	The serum concentration of Cisplatin can be increased when it is combined with Lenvatinib.
Citalopram	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Citalopram.
Clarithromycin	Lenvatinib may decrease the excretion rate of Clarithromycin which could result in a higher serum level.
Clemastine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Clemastine.
Clobazam	The serum concentration of Lenvatinib can be increased when it is combined with Clobazam.
Clofarabine	The serum concentration of Clofarabine can be increased when it is combined with Lenvatinib.
Clofazimine	Clofazimine may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Clomifene	The serum concentration of Lenvatinib can be increased when it is combined with Clomifene.
Clomipramine	The risk or severity of QTc prolongation can be increased when Clomipramine is combined with Lenvatinib.
Clozapine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Clozapine.
Cobicistat	Cobicistat may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Cobimetinib	The serum concentration of Cobimetinib can be increased when it is combined with Lenvatinib.
Cocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Cocaine.
Colchicine	The serum concentration of Lenvatinib can be increased when it is combined with Colchicine.
Conivaptan	The serum concentration of Lenvatinib can be increased when it is combined with Conivaptan.
Conjugated estr	The excretion of Conjugated estrogens can be decreased when combined with Lenvatinib.
Copanlisib	The serum concentration of Copanlisib can be increased when it is combined with Lenvatinib.
Crizotinib	The risk or severity of QTc prolongation can be increased when Crizotinib is combined with Lenvatinib.
Curcumin	The serum concentration of Lenvatinib can be increased when it is combined with Curcumin.
Cyclizine	The risk or severity of QTc prolongation can be increased when Cyclizine is combined with Lenvatinib.
Cyclosporine	Cyclosporine may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Cyproheptadine	The risk or severity of QTc prolongation can be increased when Cyproheptadine is combined with Lenvatinib.
Dabigatran etexilate	The serum concentration of Lenvatinib can be increased when it is combined with Dabigatran etexilate.
Dabrafenib	Dabrafenib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Daclatasvir	Daclatasvir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Dacomitinib	Dacomitinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Dactinomycin	The serum concentration of Dactinomycin can be increased when it is combined with Lenvatinib.
Dalfampridine	The serum concentration of Dalfampridine can be increased when it is combined with Lenvatinib.
Daptomycin	The serum concentration of Lenvatinib can be increased when it is combined with Daptomycin.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lenvatinib.
Darolutamide	The serum concentration of Lenvatinib can be increased when it is combined with Darolutamide.
Darunavir	The serum concentration of Lenvatinib can be increased when it is combined with Darunavir.
Dasabuvir	Dasabuvir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Dasatinib	Dasatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Daunorubicin	Lenvatinib may decrease the excretion rate of Daunorubicin which could result in a higher serum level.
Degarelix	The risk or severity of QTc prolongation can be increased when Degarelix is combined with Lenvatinib.
Delafloxacin	The risk or severity of QTc prolongation can be increased when Delafloxacin is combined with Lenvatinib.
Delamanid	Lenvatinib may increase the QTc-prolonging activities of Delamanid.
Desflurane	The risk or severity of QTc prolongation can be increased when Desflurane is combined with Lenvatinib.
Desipramine	The risk or severity of QTc prolongation can be increased when Desipramine is combined with Lenvatinib.
Desloratadine	The risk or severity of QTc prolongation can be increased when Desloratadine is combined with Lenvatinib.
Deutetrabenazine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Deutetrabenazine.
Dexamethasone	The excretion of Dexamethasone can be decreased when combined with Lenvatinib.
Dexamethasone ace	The excretion of Dexamethasone acetate can be decreased when combined with Lenvatinib.
Dexbromphenirami	The risk or severity of QTc prolongation can be increased when Dexbrompheniramine is combined with Lenvatinib.
Dexchlorphenirami	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Dexchlorpheniramine maleate.
Diclofenac	Lenvatinib may decrease the excretion rate of Diclofenac which could result in a higher serum level.
Didanosine	The excretion of Didanosine can be decreased when combined with Lenvatinib.
Diethylstilbestrol	Lenvatinib may decrease the excretion rate of Diethylstilbestrol which could result in a higher serum level.
Digitoxin	The serum concentration of Digitoxin can be increased when it is combined with Lenvatinib.
Digoxin	Lenvatinib may decrease the excretion rate of Digoxin which could result in a higher serum level.
Dihydroergocrist	Lenvatinib may decrease the excretion rate of Dihydroergocristine which could result in a higher serum level.
Diltiazem	The risk or severity of QTc prolongation can be increased when Diltiazem is combined with Lenvatinib.
Dimenhydrinate	The risk or severity of QTc prolongation can be increased when Dimenhydrinate is combined with Lenvatinib.
Dinoprostone	The excretion of Dinoprostone can be decreased when combined with Lenvatinib.
Diosmin	The serum concentration of Lenvatinib can be increased when it is combined with Diosmin.
Diphenhydramine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Diphenhydramine.
Dipyridamole	Lenvatinib may decrease the excretion rate of Dipyridamole which could result in a higher serum level.
Disopyramide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Disopyramide.
Disulfiram	Lenvatinib may decrease the excretion rate of Disulfiram which could result in a higher serum level.
Dofetilide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Dofetilide.
Dolasetron	The risk or severity of QTc prolongation can be increased when Dolasetron is combined with Lenvatinib.
Dolutegravir	The serum concentration of Lenvatinib can be increased when it is combined with Dolutegravir.
Domperidone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Domperidone.
Dopamine	The serum concentration of Dopamine can be increased when it is combined with Lenvatinib.
Doripenem	The excretion of Doripenem can be decreased when combined with Lenvatinib.
Dosulepin	The risk or severity of QTc prolongation can be increased when Dosulepin is combined with Lenvatinib.
Doxepin	The risk or severity of QTc prolongation can be increased when Doxepin is combined with Lenvatinib.
Doxorubicin	Lenvatinib may decrease the excretion rate of Doxorubicin which could result in a higher serum level.
Doxylamine	The risk or severity of QTc prolongation can be increased when Doxylamine is combined with Lenvatinib.
Dronedarone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Dronedarone.

Droperidol	The risk or severity of QTc prolongation can be increased when Droperidol is combined with Lenvatinib.
Duvelisib	The serum concentration of Duvelisib can be increased when it is combined with Lenvatinib.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Dyclonine.
Ebastine	The risk or severity of QTc prolongation can be increased when Ebastine is combined with Lenvatinib.
Edoxaban	The serum concentration of Lenvatinib can be increased when it is combined with Edoxaban.
Efavirenz	Lenvatinib may decrease the excretion rate of Efavirenz which could result in a higher serum level.
Elacestrant	The serum concentration of Lenvatinib can be increased when it is combined with Elacestrant.
Elagolix	The serum concentration of Lenvatinib can be increased when it is combined with Elagolix.
Elbasvir	Elbasvir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Eliglustat	The serum concentration of Lenvatinib can be increased when it is combined with Eliglustat.
Eltrombopag	Eltrombopag may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Eluxadoline	The serum concentration of Eluxadoline can be increased when it is combined with Lenvatinib.
Emedastine	The risk or severity of QTc prolongation can be increased when Emedastine is combined with Lenvatinib.
Enalapril	The excretion of Enalapril can be decreased when combined with Lenvatinib.
Enasidenib	Enasidenib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Encainide	The risk or severity of QTc prolongation can be increased when Encainide is combined with Lenvatinib.
Encorafenib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Encorafenib.
Enfortumab vedo	The serum concentration of Enfortumab vedotin can be increased when it is combined with Lenvatinib.
Enoxacin	The risk or severity of QTc prolongation can be increased when Enoxacin is combined with Lenvatinib.
Entrectinib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Entrectinib.
Epinastine	The risk or severity of QTc prolongation can be increased when Epinastine is combined with Lenvatinib.
Epinephrine	The serum concentration of Epinephrine can be increased when it is combined with Lenvatinib.
Erdafitinib	The serum concentration of Lenvatinib can be increased when it is combined with Erdafitinib.
Eribulin	The risk or severity of QTc prolongation can be increased when Eribulin is combined with Lenvatinib.
Erlotinib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Erlotinib.
Ertugliflozin	The serum concentration of Ertugliflozin can be increased when it is combined with Lenvatinib.
Erythromycin	Lenvatinib may decrease the excretion rate of Erythromycin which could result in a higher serum level.
Erythropoietin	The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Lenvatinib.
Escitalopram	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Escitalopram.
Esmolol	The risk or severity of QTc prolongation can be increased when Esmolol is combined with Lenvatinib.
Estradiol	The excretion of Estradiol can be decreased when combined with Lenvatinib.
Estradiol acetate	Estradiol acetate may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Estradiol benzoate	Estradiol benzoate may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Estradiol cypionate	Estradiol cypionate may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Estradiol dienanth	Estradiol dienanthate may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Estradiol valerate	Estradiol valerate may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Ethinylestradiol	The risk or severity of liver damage can be increased when Ethinylestradiol is combined with Lenvatinib.
Ethosuximide	The risk or severity of QTc prolongation can be increased when Ethosuximide is combined with Lenvatinib.
Ethyl chloride	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Ethyl chloride.
Etidocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Etidocaine.
Etoposide	The serum concentration of Etoposide can be increased when it is combined with Lenvatinib.
Everolimus	The serum concentration of Lenvatinib can be increased when it is combined with Everolimus.
Ezetimibe	Lenvatinib may decrease the excretion rate of Ezetimibe which could result in a higher serum level.
Ezogabine	The risk or severity of QTc prolongation can be increased when Ezogabine is combined with Lenvatinib.
Famotidine	The excretion of Famotidine can be decreased when combined with Lenvatinib.
Favipiravir	The serum concentration of Lenvatinib can be increased when it is combined with Favipiravir.
Febuxostat	The excretion of Lenvatinib can be decreased when combined with Febuxostat.
Fedratinib	Fedratinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Felbamate	The risk or severity of QTc prolongation can be increased when Felbamate is combined with Lenvatinib.
Felodipine	Lenvatinib may decrease the excretion rate of Felodipine which could result in a higher serum level.
Fenofibrate	Lenvatinib may decrease the excretion rate of Fenofibrate which could result in a higher serum level.
Fexinidazole	The risk or severity of adverse effects can be increased when Lenvatinib is combined with Fexinidazole.
Fexofenadine	The excretion of Fexofenadine can be decreased when combined with Lenvatinib.
Flecainide	The risk or severity of QTc prolongation can be increased when Flecainide is combined with Lenvatinib.
Flibanserin	The serum concentration of Lenvatinib can be increased when it is combined with Flibanserin.
Flucloxacillin	Lenvatinib may decrease the excretion rate of Flucloxacillin which could result in a higher serum level.
Fluconazole	The serum concentration of Lenvatinib can be increased when it is combined with Fluconazole.
Fluorescein	Lenvatinib may decrease the excretion rate of Fluorescein which could result in a higher serum level.
Fluorouracil	The risk or severity of QTc prolongation can be increased when Fluorouracil is combined with Lenvatinib.
Fluoxetine	The risk or severity of QTc prolongation can be increased when Fluoxetine is combined with Lenvatinib.
Flupentixol	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Flupentixol.
Fluspirilene	The risk or severity of QTc prolongation can be increased when Fluspirilene is combined with Lenvatinib.
Fluvastatin	The excretion of Fluvastatin can be decreased when combined with Lenvatinib.
Fluvoxamine	Lenvatinib may decrease the excretion rate of Fluvoxamine which could result in a higher serum level.
Follitropin	The therapeutic efficacy of Follitropin can be decreased when used in combination with Lenvatinib.
Formoterol	The risk or severity of QTc prolongation can be increased when Formoterol is combined with Lenvatinib.
Foscarnet	The risk or severity of QTc prolongation can be increased when Foscarnet is combined with Lenvatinib.
Fostamatinib	Fostamatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Fostemsavir	Fostemsavir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Fusidic acid	Fusidic acid may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Futibatinib	The serum concentration of Futibatinib can be increased when it is combined with Lenvatinib.
Gadobenic acid	The risk or severity of QTc prolongation can be increased when Gadobenic acid is combined with Lenvatinib.
Gadoxetic acid	The excretion of Gadoxetic acid can be decreased when combined with Lenvatinib.
Galantamine	The risk or severity of QTc prolongation can be increased when Galantamine is combined with Lenvatinib.
Gatifloxacin	The risk or severity of QTc prolongation can be increased when Gatifloxacin is combined with Lenvatinib.
Gefitinib	Gefitinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Gemcitabine	The serum concentration of Gemcitabine can be increased when it is combined with Lenvatinib.
Gemifloxacin	The risk or severity of QTc prolongation can be increased when Gemifloxacin is combined with Lenvatinib.
Gentamicin	The serum concentration of Gentamicin can be increased when it is combined with Lenvatinib.
Gilteritinib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Gilteritinib.
Glasdegib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Glasdegib.
Glecaprevir	Glecaprevir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Glimepiride	Lenvatinib may decrease the excretion rate of Glimepiride which could result in a higher serum level.
Glipizide	Lenvatinib may decrease the excretion rate of Glipizide which could result in a higher serum level.
Glyburide	Lenvatinib may decrease the excretion rate of Glyburide which could result in a higher serum level.
Glycyrrhizic acid	Lenvatinib may decrease the excretion rate of Glycyrrhizic acid which could result in a higher serum level.
Goserelin	The risk or severity of QTc prolongation can be increased when Goserelin is combined with Lenvatinib.
Granisetron	The risk or severity of QTc prolongation can be increased when Granisetron is combined with Lenvatinib.
Grazoprevir	Grazoprevir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Grepafloxacin	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Grepafloxacin.
Halofantrine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Halofantrine.
Haloperidol	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Haloperidol.
Histamine	The serum concentration of Histamine can be increased when it is combined with Lenvatinib.
Histrelin	The risk or severity of QTc prolongation can be increased when Histrelin is combined with Lenvatinib.
Hydrochlorothiazide	The excretion of Hydrochlorothiazide can be decreased when combined with Lenvatinib.
Hydrocortisone	The excretion of Hydrocortisone can be decreased when combined with Lenvatinib.
Hydroxychloroquine	The risk or severity of QTc prolongation can be increased when Hydroxychloroquine is combined with Lenvatinib.
Hydroxyzine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Hydroxyzine.
Hyoscyamine	The risk or severity of QTc prolongation can be increased when Hyoscyamine is combined with Lenvatinib.
Ibandronate	The risk or severity of QTc prolongation can be increased when Ibandronate is combined with Lenvatinib.

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Ibutilide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Ibutilide.
Idelalisib	The serum concentration of Lenvatinib can be increased when it is combined with Idelalisib.
Iloperidone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Iloperidone.
Imatinib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Imatinib.
Imipramine	The risk or severity of QTc prolongation can be increased when Imipramine is combined with Lenvatinib.
Indacaterol	The serum concentration of Lenvatinib can be increased when it is combined with Indacaterol.
Indapamide	The risk or severity of QTc prolongation can be increased when Indapamide is combined with Lenvatinib.
Indinavir	Lenvatinib may decrease the excretion rate of Indinavir which could result in a higher serum level.
Indocyanine green	Lenvatinib may decrease the excretion rate of Indocyanine green acid form which could result in a higher serum level.
Indomethacin	Lenvatinib may decrease the excretion rate of Indomethacin which could result in a higher serum level.
Inotersen	The risk or severity of QTc prolongation can be increased when Inotersen is combined with Lenvatinib.
Inotuzumab ozo	The serum concentration of Inotuzumab ozogamicin can be increased when it is combined with Lenvatinib.
Isavuconazole	The serum concentration of Lenvatinib can be increased when it is combined with Isavuconazole.
Isavuconazonium	The serum concentration of Lenvatinib can be increased when it is combined with Isavuconazonium.
Isoflurane	The risk or severity of QTc prolongation can be increased when Isoflurane is combined with Lenvatinib.
Isradipine	Lenvatinib may decrease the excretion rate of Isradipine which could result in a higher serum level.
Istradefylline	Istradefylline may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Itraconazole	Itraconazole may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Ivabradine	Ivabradine may increase the QTc-prolonging activities of Lenvatinib.
Ivacaftor	The serum concentration of Lenvatinib can be increased when it is combined with Ivacaftor.
Ivosidenib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Ivosidenib.
Ixabepilone	The serum concentration of Lenvatinib can be increased when it is combined with Ixabepilone.
Ketoconazole	Lenvatinib may decrease the excretion rate of Ketoconazole which could result in a higher serum level.
Lacidipine	The risk or severity of QTc prolongation can be increased when Lacidipine is combined with Lenvatinib.
Lamivudine	The serum concentration of Lamivudine can be increased when it is combined with Lenvatinib.
Lamotrigine	The risk or severity of QTc prolongation can be increased when Lamotrigine is combined with Lenvatinib.
Lansoprazole	Lansoprazole may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Lapatinib	The serum concentration of Lenvatinib can be increased when it is combined with Lapatinib.
Larotrectinib	The serum concentration of Larotrectinib can be increased when it is combined with Lenvatinib.
Lasmiditan	The serum concentration of Lenvatinib can be increased when it is combined with Lasmiditan.
Ledipasvir	Ledipasvir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Lefamulin	Lefamulin may increase the QTc-prolonging activities of Lenvatinib.
Lemborexant	The serum concentration of Lemborexant can be increased when it is combined with Lenvatinib.
Letermovir	Letermovir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Leucovorin	The excretion of Leucovorin can be decreased when combined with Lenvatinib.
Leuprolide	The risk or severity of QTc prolongation can be increased when Leuprolide is combined with Lenvatinib.
Levacetylmetha	The risk or severity of QTc prolongation can be increased when Levacetylmethadol is combined with Lenvatinib.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Levobupivacaine.
Levocabastine	The risk or severity of QTc prolongation can be increased when Levocabastine is combined with Lenvatinib.
Levocarnitine	The excretion of Levocarnitine can be decreased when combined with Lenvatinib.
Levocetirizine	The risk or severity of QTc prolongation can be increased when Levocetirizine is combined with Lenvatinib.
Levofloxacin	The risk or severity of QTc prolongation can be increased when Levofloxacin is combined with Lenvatinib.
Levoketoconazole	The serum concentration of Lenvatinib can be increased when it is combined with Levoketoconazole.
Levomenthol	The risk or severity of QTc prolongation can be increased when Levomenthol is combined with Lenvatinib.
Levosalbutamol	The excretion of Levosalbutamol can be decreased when combined with Lenvatinib.
Levosimendan	The risk or severity of QTc prolongation can be increased when Levosimendan is combined with Lenvatinib.
Levothyroxine	The therapeutic efficacy of Levothyroxine can be decreased when used in combination with Lenvatinib.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Lidocaine.
Lidoflazine	The risk or severity of QTc prolongation can be increased when Lidoflazine is combined with Lenvatinib.
Linagliptin	The serum concentration of Lenvatinib can be increased when it is combined with Linagliptin.
Liothyronine	The therapeutic efficacy of Liothyronine can be decreased when used in combination with Lenvatinib.
Liotrix	The therapeutic efficacy of Liotrix can be decreased when used in combination with Lenvatinib.
Lofexidine	The risk or severity of QTc prolongation can be increased when Lofexidine is combined with Lenvatinib.
Lomefloxacin	The risk or severity of QTc prolongation can be increased when Lomefloxacin is combined with Lenvatinib.
Lomitapide	The serum concentration of Lenvatinib can be increased when it is combined with Lomitapide.
Lonafarnib	The serum concentration of Lenvatinib can be increased when it is combined with Lonafarnib.
Loncastuximab	The serum concentration of Loncastuximab tesirine can be increased when it is combined with Lenvatinib.
Loperamide	The risk or severity of QTc prolongation can be increased when Loperamide is combined with Lenvatinib.
Lopinavir	The serum concentration of Lenvatinib can be increased when it is combined with Lopinavir.
Loratadine	Lenvatinib may decrease the excretion rate of Loratadine which could result in a higher serum level.
Losartan	Lenvatinib may decrease the excretion rate of Losartan which could result in a higher serum level.
Lovastatin	Lenvatinib may decrease the excretion rate of Lovastatin which could result in a higher serum level.
Loxapine	The serum concentration of Lenvatinib can be increased when it is combined with Loxapine.
Lumacaftor	The serum concentration of Lenvatinib can be decreased when it is combined with Lumacaftor.
Lumefantrine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Lumefantrine.
Lurasidone	The risk or severity of QTc prolongation can be increased when Lurasidone is combined with Lenvatinib.
Lusutrombopag	The serum concentration of Lusutrombopag can be increased when it is combined with Lenvatinib.
Macimorelin	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Macimorelin.
Mannitol	The serum concentration of Lenvatinib can be increased when it is combined with Mannitol.
Maprotiline	The risk or severity of QTc prolongation can be increased when Maprotiline is combined with Lenvatinib.
Maribavir	Maribavir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Mefloquine	The serum concentration of Lenvatinib can be increased when it is combined with Mefloquine.
Meloxicam	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Meloxicam.
Memantine	The serum concentration of Memantine can be increased when it is combined with Lenvatinib.
Mepivacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Mepivacaine.
Mepyramine	The risk or severity of QTc prolongation can be increased when Mepyramine is combined with Lenvatinib.
Mercaptopurine	The excretion of Mercaptopurine can be decreased when combined with Lenvatinib.
Mesalazine	The excretion of Mesalazine can be decreased when combined with Lenvatinib.
Mesoridazine	The risk or severity of QTc prolongation can be increased when Mesoridazine is combined with Lenvatinib.
Metformin	The serum concentration of Metformin can be increased when it is combined with Lenvatinib.
Methadone	The risk or severity of QTc prolongation can be increased when Methadone is combined with Lenvatinib.
Methimazole	The therapeutic efficacy of Methimazole can be decreased when used in combination with Lenvatinib.
Methotrexate	The excretion of Methotrexate can be decreased when combined with Lenvatinib.
Methotrimeprazine	The risk or severity of QTc prolongation can be increased when Methotrimeprazine is combined with Lenvatinib.
Methoxy p	The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Lenvatinib.
Methsuximide	The risk or severity of QTc prolongation can be increased when Methsuximide is combined with Lenvatinib.
Methylene blue	The serum concentration of Lenvatinib can be increased when it is combined with Methylene blue.
Metoclopramide	The risk or severity of QTc prolongation can be increased when Metoclopramide is combined with Lenvatinib.
Metronidazole	The risk or severity of QTc prolongation can be increased when Metronidazole is combined with Lenvatinib.
Mifepristone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Mifepristone.
Mirabegron	The serum concentration of Lenvatinib can be increased when it is combined with Mirabegron.
Mirtazapine	The risk or severity of QTc prolongation can be increased when Mirtazapine is combined with Lenvatinib.
Mitapivat	The serum concentration of Lenvatinib can be increased when it is combined with Mitapivat.
Mizolastine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Mizolastine.
Mobocertinib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Mobocertinib.
Moexipril	The risk or severity of QTc prolongation can be increased when Moexipril is combined with Lenvatinib.
Moricizine	The risk or severity of QTc prolongation can be increased when Moricizine is combined with Lenvatinib.
Morphine	The serum concentration of Lenvatinib can be increased when it is combined with Morphine.
Moxifloxacin	The risk or severity of QTc prolongation can be increased when Moxifloxacin is combined with Lenvatinib.
Mycophenolate	The excretion of Mycophenolate mofetil can be decreased when combined with Lenvatinib.

Nalidixic acid	The risk or severity of QTc prolongation can be increased when Nalidixic acid is combined with Lenvatinib.
Naproxen	Lenvatinib may decrease the excretion rate of Naproxen which could result in a higher serum level.
Nefazodone	Lenvatinib may decrease the excretion rate of Nefazodone which could result in a higher serum level.
Nelfinavir	Lenvatinib may decrease the excretion rate of Nelfinavir which could result in a higher serum level.
Neratinib	The serum concentration of Lenvatinib can be increased when it is combined with Neratinib.
Netupitant	The serum concentration of Lenvatinib can be increased when it is combined with Netupitant.
Nicardipine	Lenvatinib may decrease the excretion rate of Nicardipine which could result in a higher serum level.
Nifedipine	Lenvatinib may decrease the excretion rate of Nifedipine which could result in a higher serum level.
Nilotinib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Nilotinib.
Nilvadipine	The risk or severity of QTc prolongation can be increased when Nilvadipine is combined with Lenvatinib.
Nimodipine	The risk or severity of QTc prolongation can be increased when Nimodipine is combined with Lenvatinib.
Nintedanib	The serum concentration of Nintedanib can be increased when it is combined with Lenvatinib.
Nitrendipine	Lenvatinib may decrease the excretion rate of Nitrendipine which could result in a higher serum level.
Nitrofurantoin	Lenvatinib may decrease the excretion rate of Nitrofurantoin which could result in a higher serum level.
Norepinephrine	The serum concentration of Norepinephrine can be increased when it is combined with Lenvatinib.
Norfloxacin	The risk or severity of QTc prolongation can be increased when Norfloxacin is combined with Lenvatinib.
Norgestimate	The serum concentration of Lenvatinib can be increased when it is combined with Norgestimate.
Nortriptyline	The serum concentration of Nortriptyline can be increased when it is combined with Lenvatinib.
Novobiocin	Novobiocin may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Obeticholic acid	The risk or severity of adverse effects can be increased when Lenvatinib is combined with Obeticholic acid.
Octreotide	The risk or severity of QTc prolongation can be increased when Octreotide is combined with Lenvatinib.
Ofloxacin	Lenvatinib may decrease the excretion rate of Ofloxacin which could result in a higher serum level.
Olanzapine	The risk or severity of QTc prolongation can be increased when Olanzapine is combined with Lenvatinib.
Olmesartan	The risk or severity of liver damage can be increased when Olmesartan is combined with Lenvatinib.
Olodaterol	The risk or severity of QTc prolongation can be increased when Olodaterol is combined with Lenvatinib.
Omadacycline	The serum concentration of Omadacycline can be increased when it is combined with Lenvatinib.
Ombitasvir	The serum concentration of Ombitasvir can be increased when it is combined with Lenvatinib.
Ondansetron	The risk or severity of QTc prolongation can be increased when Ondansetron is combined with Lenvatinib.
Orphenadrine	The risk or severity of QTc prolongation can be increased when Orphenadrine is combined with Lenvatinib.
Oseltamivir	The excretion of Oseltamivir can be decreased when combined with Lenvatinib.
Osimertinib	Osimertinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Oteseconazole	The serum concentration of Lenvatinib can be increased when it is combined with Oteseconazole.
Ouabain	The excretion of Ouabain can be decreased when combined with Lenvatinib.
Oxaliplatin	The serum concentration of Oxaliplatin can be increased when it is combined with Lenvatinib.
Oxatomide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Oxatomide.
Oxetacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Oxetacaine.
Oxybuprocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Oxybuprocaine.
Oxytetracycline	The excretion of Oxytetracycline can be decreased when combined with Lenvatinib.
Oxytocin	The risk or severity of QTc prolongation can be increased when Oxytocin is combined with Lenvatinib.
Paclitaxel	Lenvatinib may decrease the excretion rate of Paclitaxel which could result in a higher serum level.
Pacritinib	The serum concentration of Lenvatinib can be increased when it is combined with Pacritinib.
Palbociclib	Palbociclib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Paliperidone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Paliperidone.
Panobinostat	The risk or severity of QTc prolongation can be increased when Panobinostat is combined with Lenvatinib.
Pantoprazole	Pantoprazole may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Papaverine	The risk or severity of QTc prolongation can be increased when Papaverine is combined with Lenvatinib.
Parathyroid hormo	The therapeutic efficacy of Parathyroid hormone can be decreased when used in combination with Lenvatinib.
Paritaprevir	Paritaprevir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Pasireotide	The risk or severity of QTc prolongation can be increased when Pasireotide is combined with Lenvatinib.
Pazopanib	The risk or severity of QTc prolongation can be increased when Pazopanib is combined with Lenvatinib.
Pefloxacin	The risk or severity of QTc prolongation can be increased when Pefloxacin is combined with Lenvatinib.
Peginesatide	The risk or severity of Thrombosis can be increased when Peginesatide is combined with Lenvatinib.
Pemetrexed	Lenvatinib may decrease the excretion rate of Pemetrexed which could result in a higher serum level.
Penicillamine	The excretion of Penicillamine can be decreased when combined with Lenvatinib.
Pentamidine	The risk or severity of QTc prolongation can be increased when Pentamidine is combined with Lenvatinib.
Perflutren	The risk or severity of QTc prolongation can be increased when Perflutren is combined with Lenvatinib.
Perhexiline	The risk or severity of QTc prolongation can be increased when Perhexiline is combined with Lenvatinib.
Pheniramine	The risk or severity of QTc prolongation can be increased when Pheniramine is combined with Lenvatinib.
Phenol	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Phenol.
Pibrentasvir	Pibrentasvir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Pimozide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Pimozide.
Pinaverium	The risk or severity of QTc prolongation can be increased when Pinaverium is combined with Lenvatinib.
Piperacillin	The excretion of Piperacillin can be decreased when combined with Lenvatinib.
Pitavastatin	Lenvatinib may decrease the excretion rate of Pitavastatin which could result in a higher serum level.
Pitolisant	Lenvatinib may increase the QTc-prolonging activities of Pitolisant.
Polythiazide	The excretion of Polythiazide can be decreased when combined with Lenvatinib.
Pomalidomide	The serum concentration of Pomalidomide can be increased when it is combined with Lenvatinib.
Ponatinib	Ponatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Ponesimod	The risk or severity of bradycardia can be increased when Ponesimod is combined with Lenvatinib.
Posaconazole	The serum concentration of Lenvatinib can be increased when it is combined with Posaconazole.
Potassium Iodide	The therapeutic efficacy of Potassium Iodide can be decreased when used in combination with Lenvatinib.
Potassium perchlor	The therapeutic efficacy of Potassium perchlorate can be decreased when used in combination with Lenvatinib.
Pralsetinib	Pralsetinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Pramipexole	The serum concentration of Pramipexole can be increased when it is combined with Lenvatinib.
Pramocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Pramocaine.
Pravastatin	Lenvatinib may decrease the excretion rate of Pravastatin which could result in a higher serum level.
Prazosin	The serum concentration of Prazosin can be increased when it is combined with Lenvatinib.
Prednisolone phe	The excretion of Prednisolone phosphate can be decreased when combined with Lenvatinib.
Pregabalin	The risk or severity of QTc prolongation can be increased when Pregabalin is combined with Lenvatinib.
Prenylamine	The risk or severity of QTc prolongation can be increased when Prenylamine is combined with Lenvatinib.
Pretomanid	The serum concentration of Lenvatinib can be increased when it is combined with Pretomanid.
Prilocaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Prilocaine.
Primaquine	The risk or severity of QTc prolongation can be increased when Primaquine is combined with Lenvatinib.
Probucol	The risk or severity of QTc prolongation can be increased when Probucol is combined with Lenvatinib.
Procainamide	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Procainamide.
Procaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Procaine.
Prochlorperazine	The risk or severity of QTc prolongation can be increased when Prochlorperazine is combined with Lenvatinib.
Progesterone	Progesterone may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Promazine	The risk or severity of QTc prolongation can be increased when Promazine is combined with Lenvatinib.
Promethazine	The risk or severity of QTc prolongation can be increased when Promethazine is combined with Lenvatinib.
Propafenone	The risk or severity of QTc prolongation can be increased when Propafenone is combined with Lenvatinib.
Proparacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Proparacaine.
Propofol	The risk or severity of QTc prolongation can be increased when Propofol is combined with Lenvatinib.
Propoxycaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Propoxycaine.
Propylthiouracil	The therapeutic efficacy of Propylthiouracil can be decreased when used in combination with Lenvatinib.
Protirelin	The therapeutic efficacy of Protirelin can be decreased when used in combination with Lenvatinib.
Protriptyline	The risk or severity of QTc prolongation can be increased when Protriptyline is combined with Lenvatinib.
Quetiapine	The risk or severity of QTc prolongation can be increased when Quetiapine is combined with Lenvatinib.
Quinapril	The excretion of Quinapril can be decreased when combined with Lenvatinib.
Quinidine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Quinidine.

Quinine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Quinine.
Rabeprazole	Rabeprazole may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Raloxifene	The excretion of Raloxifene can be decreased when combined with Lenvatinib.
Ranitidine	The excretion of Ranitidine can be decreased when combined with Lenvatinib.
Ranolazine	The serum concentration of Lenvatinib can be increased when it is combined with Ranolazine.
Regorafenib	Regorafenib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Relebactam	The excretion of Relebactam can be decreased when combined with Lenvatinib.
Relugolix	The serum concentration of Relugolix can be increased when it is combined with Lenvatinib.
Repaglinide	Lenvatinib may decrease the excretion rate of Repaglinide which could result in a higher serum level.
Reserpine	The serum concentration of Lenvatinib can be increased when it is combined with Reserpine.
Revefenacin	Lenvatinib may decrease the excretion rate of Revefenacin which could result in a higher serum level.
Ribociclib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Ribociclib.
Rifampicin	The risk or severity of liver damage can be increased when Rifampicin is combined with Lenvatinib.
Rifamycin	The serum concentration of Lenvatinib can be increased when it is combined with Rifamycin.
Rilpivirine	Rilpivirine may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Rimegepant	The serum concentration of Rimegepant can be increased when it is combined with Lenvatinib.
Riociguat	The serum concentration of Lenvatinib can be increased when it is combined with Riociguat.
Ripretinib	Ripretinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Risperidone	The risk or severity of QTc prolongation can be increased when Risperidone is combined with Lenvatinib.
Ritonavir	Lenvatinib may decrease the excretion rate of Ritonavir which could result in a higher serum level.
Rivaroxaban	The serum concentration of Lenvatinib can be increased when it is combined with Rivaroxaban.
Rolapitant	Rolapitant may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Romidepsin	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Romidepsin.
Ropivacaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Ropivacaine.
Rosiglitazone	Lenvatinib may decrease the excretion rate of Rosiglitazone which could result in a higher serum level.
Rosoxacin	The risk or severity of QTc prolongation can be increased when Rosoxacin is combined with Lenvatinib.
Rosuvastatin	Lenvatinib may decrease the excretion rate of Rosuvastatin which could result in a higher serum level.
Roxadustat	The serum concentration of Lenvatinib can be increased when it is combined with Roxadustat.
Roxithromycin	The risk or severity of QTc prolongation can be increased when Roxithromycin is combined with Lenvatinib.
Rucaparib	Rucaparib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Rupatadine	The risk or severity of QTc prolongation can be increased when Rupatadine is combined with Lenvatinib.
Safinamide	Safinamide may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Salbutamol	The risk or severity of QTc prolongation can be increased when Salbutamol is combined with Lenvatinib.
Salmeterol	The risk or severity of QTc prolongation can be increased when Salmeterol is combined with Lenvatinib.
Salmon calcitonin	The therapeutic efficacy of Salmon calcitonin can be decreased when used in combination with Lenvatinib.
Sapropterin	The serum concentration of Lenvatinib can be increased when it is combined with Sapropterin.
Saquinavir	Lenvatinib may decrease the excretion rate of Saquinavir which could result in a higher serum level.
Sarecycline	The serum concentration of Lenvatinib can be increased when it is combined with Sarecycline.
Saxagliptin	The excretion of Saxagliptin can be decreased when combined with Lenvatinib.
Selexipag	The serum concentration of Selexipag can be increased when it is combined with Lenvatinib.
Selumetinib	The serum concentration of Selumetinib can be increased when it is combined with Lenvatinib.
Sevoflurane	The risk or severity of QTc prolongation can be increased when Sevoflurane is combined with Lenvatinib.
Sildenafil	The serum concentration of Lenvatinib can be increased when it is combined with Sildenafil.
Silodosin	The serum concentration of Lenvatinib can be increased when it is combined with Silodosin.
Simeprevir	Simeprevir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Simvastatin	Lenvatinib may decrease the excretion rate of Simvastatin which could result in a higher serum level.
Sirolimus	The serum concentration of Sirolimus can be increased when it is combined with Lenvatinib.
Sitagliptin	The excretion of Sitagliptin can be decreased when combined with Lenvatinib.
Sofosbuvir	The serum concentration of Lenvatinib can be increased when it is combined with Sofosbuvir.
Solifenacin	The risk or severity of QTc prolongation can be increased when Solifenacin is combined with Lenvatinib.
Solriamfetol	The serum concentration of Solriamfetol can be increased when it is combined with Lenvatinib.
Sorafenib	The serum concentration of Lenvatinib can be increased when it is combined with Sorafenib.
Sotagliflozin	Sotagliflozin may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Sotalol	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Sotalol.
Sotorasib	The serum concentration of Lenvatinib can be increased when it is combined with Sotorasib.
Sparfloxacin	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Sparfloxacin.
Spironolactone	Lenvatinib may decrease the excretion rate of Spironolactone which could result in a higher serum level.
Stavudine	The excretion of Stavudine can be decreased when combined with Lenvatinib.
Stiripentol	The excretion of Lenvatinib can be decreased when combined with Stiripentol.
Succinic acid	The excretion of Succinic acid can be decreased when combined with Lenvatinib.
Sulfamethoxazole	Lenvatinib may decrease the excretion rate of Sulfamethoxazole which could result in a higher serum level.
Sulfasalazine	Sulfasalazine may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Sulfinpyrazone	Lenvatinib may decrease the excretion rate of Sulfinpyrazone which could result in a higher serum level.
Sulfisoxazole	The risk or severity of QTc prolongation can be increased when Sulfisoxazole is combined with Lenvatinib.
Sulpiride	The risk or severity of QTc prolongation can be increased when Sulpiride is combined with Lenvatinib.
Sultopride	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Sultopride.
Sumatriptan	The excretion of Sumatriptan can be decreased when combined with Lenvatinib.
Sunitinib	Sunitinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Suvorexant	The serum concentration of Lenvatinib can be increased when it is combined with Suvorexant.
Tacrolimus	The serum concentration of Lenvatinib can be increased when it is combined with Tacrolimus.
Tafamidis	The serum concentration of Lenvatinib can be increased when it is combined with Tafamidis.
Talazoparib	The serum concentration of Talazoparib can be increased when it is combined with Lenvatinib.
Tamoxifen	The serum concentration of Lenvatinib can be increased when it is combined with Tamoxifen.
Taurocholic acid	Lenvatinib may decrease the excretion rate of Taurocholic acid which could result in a higher serum level.
Tazemetostat	The serum concentration of Tazemetostat can be increased when it is combined with Lenvatinib.
Tazobactam	The excretion of Tazobactam can be decreased when combined with Lenvatinib.
Technetium Tc	The excretion of Technetium Tc-99m mebrofenin can be decreased when combined with Lenvatinib.
Technetium T	The serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Lenvatinib.
Tegaserod	The serum concentration of Lenvatinib can be increased when it is combined with Tegaserod.
Telaprevir	The serum concentration of Lenvatinib can be increased when it is combined with Telaprevir.
Telavancin	The risk or severity of QTc prolongation can be increased when Telavancin is combined with Lenvatinib.
Telithromycin	The risk or severity of QTc prolongation can be increased when Telithromycin is combined with Lenvatinib.
Telmisartan	Lenvatinib may decrease the excretion rate of Telmisartan which could result in a higher serum level.
Temsirolimus	The serum concentration of Lenvatinib can be increased when it is combined with Temsirolimus.
Tenofovir alafena	The excretion of Tenofovir alafenamide can be decreased when combined with Lenvatinib.
Tenofovir disoproxil	The excretion of Tenofovir disoproxil can be decreased when combined with Lenvatinib.
Tepotinib	The serum concentration of Lenvatinib can be increased when it is combined with Tepotinib.
Terbutaline	The risk or severity of QTc prolongation can be increased when Terbutaline is combined with Lenvatinib.
Terfenadine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Terfenadine.
Teriflunomide	Teriflunomide may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Teriparatide	The therapeutic efficacy of Teriparatide can be decreased when used in combination with Lenvatinib.
Terlipressin	The risk or severity of QTc prolongation can be increased when Terlipressin is combined with Lenvatinib.
Tetrabenazine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Tetrabenazine.
Tetracaine	The risk or severity of methemoglobinemia can be increased when Lenvatinib is combined with Tetracaine.
Tetracycline	The excretion of Tetracycline can be decreased when combined with Lenvatinib.
Tezacaftor	The serum concentration of Tezacaftor can be increased when it is combined with Lenvatinib.
Thioridazine	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Thioridazine.
Thiothixene	The risk or severity of QTc prolongation can be increased when Thiothixene is combined with Lenvatinib.
Thyroid, porcine	The therapeutic efficacy of Thyroid, porcine can be decreased when used in combination with Lenvatinib.
Thyrotropin alfa	The therapeutic efficacy of Thyrotropin alfa can be decreased when used in combination with Lenvatinib.

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Ticagrelor	The serum concentration of Lenvatinib can be increased when it is combined with Ticagrelor.
Timolol	The risk or severity of QTc prolongation can be increased when Timolol is combined with Lenvatinib.
Tinidazole	Lenvatinib may decrease the excretion rate of Tinidazole which could result in a higher serum level.
Tipiracil	The excretion of Tipiracil can be decreased when combined with Lenvatinib.
Tipranavir	Lenvatinib may decrease the excretion rate of Tipranavir which could result in a higher serum level.
Tivozanib	Tivozanib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Tizanidine	The risk or severity of QTc prolongation can be increased when Tizanidine is combined with Lenvatinib.
Tolterodine	The risk or severity of QTc prolongation can be increased when Tolterodine is combined with Lenvatinib.
Tolvaptan	The serum concentration of Tolvaptan can be increased when it is combined with Lenvatinib.
Topotecan	The serum concentration of Topotecan can be increased when it is combined with Lenvatinib.
Torasemide	The excretion of Torasemide can be decreased when combined with Lenvatinib.
Toremifene	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Toremifene.
Trastuzumab emtan	The serum concentration of Trastuzumab emtansine can be increased when it is combined with Lenvatinib.
Trazodone	The risk or severity of QTc prolongation can be increased when Trazodone is combined with Lenvatinib.
Treprostinil	The risk or severity of QTc prolongation can be increased when Treprostinil is combined with Lenvatinib.
Triclabendazole	The risk or severity of QTc prolongation can be increased when Triclabendazole is combined with Lenvatinib.
Trifluridine	The excretion of Trifluridine can be decreased when combined with Lenvatinib.
Trilaciclib	The serum concentration of Trilaciclib can be increased when it is combined with Lenvatinib.
Trimebutine	The risk or severity of QTc prolongation can be increased when Trimebutine is combined with Lenvatinib.
Trimethadione	The risk or severity of QTc prolongation can be increased when Trimethadione is combined with Lenvatinib.
Trimipramine	The serum concentration of Trimipramine can be increased when it is combined with Lenvatinib.
Triprolidine	The risk or severity of QTc prolongation can be increased when Triprolidine is combined with Lenvatinib.
Triptorelin	The risk or severity of QTc prolongation can be increased when Triptorelin is combined with Lenvatinib.
Troglitazone	The risk or severity of liver damage can be increased when Troglitazone is combined with Lenvatinib.
Trovafloxacin	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Trovafloxacin.
Tucatinib	Tucatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Ubrogepant	The serum concentration of Ubrogepant can be increased when it is combined with Lenvatinib.
Umbralisib	The serum concentration of Lenvatinib can be increased when it is combined with Umbralisib.
Umeclidinium	The serum concentration of Lenvatinib can be increased when it is combined with Umeclidinium.
Ursodeoxycholic	Lenvatinib may decrease the excretion rate of Ursodeoxycholic acid which could result in a higher serum level.
Valaciclovir	The excretion of Valaciclovir can be decreased when combined with Lenvatinib.
Valproic acid	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Valproic acid.
Valsartan	The excretion of Valsartan can be decreased when combined with Lenvatinib.
Vandetanib	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Vandetanib.
Vardenafil	The serum concentration of Lenvatinib can be increased when it is combined with Vardenafil.
Varenicline	The excretion of Varenicline can be decreased when combined with Lenvatinib.
Velpatasvir	Velpatasvir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Vemurafenib	The serum concentration of Lenvatinib can be increased when it is combined with Vemurafenib.
Venetoclax	Venetoclax may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Venlafaxine	Venlafaxine may increase the excretion rate of Lenvatinib which could result in a lower serum level and potentially a reduction in efficacy.
Verapamil	The serum concentration of Lenvatinib can be increased when it is combined with Verapamil.
Vernakalant	The risk or severity of QTc prolongation can be increased when Vernakalant is combined with Lenvatinib.
Vilanterol	The risk or severity of QTc prolongation can be increased when Vilanterol is combined with Lenvatinib.
Vinblastine	Lenvatinib may decrease the excretion rate of Vinblastine which could result in a higher serum level.
Vincristine	Lenvatinib may decrease the excretion rate of Vincristine which could result in a higher serum level.
Vinflunine	The serum concentration of Vinflunine can be increased when it is combined with Lenvatinib.
Vismodegib	Vismodegib may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Voclosporin	The serum concentration of Lenvatinib can be increased when it is combined with Voclosporin.
Vorapaxar	The serum concentration of Lenvatinib can be increased when it is combined with Vorapaxar.
Voriconazole	The serum concentration of Lenvatinib can be increased when it is combined with Voriconazole.
Vorinostat	The risk or severity of QTc prolongation can be increased when Vorinostat is combined with Lenvatinib.
Voxilaprevir	Voxilaprevir may decrease the excretion rate of Lenvatinib which could result in a higher serum level.
Zalcitabine	The excretion of Zalcitabine can be decreased when combined with Lenvatinib.
Zidovudine	The excretion of Zidovudine can be decreased when combined with Lenvatinib.
Ziprasidone	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Ziprasidone.
Zonisamide	The serum concentration of Lenvatinib can be increased when it is combined with Zonisamide.
Zuclopenthixol	The risk or severity of QTc prolongation can be increased when Lenvatinib is combined with Zuclopenthixol

Pregnancy and Lactation

AU TGA pregnancy category: D
US FDA pregnancy category: Not assigned.

Pregnancy

Based on its mechanism of action and data from animal reproduction studies, LENVIMA can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, oral administration of lenvatinib during organogenesis at doses below the recommended human doses resulted in embryotoxicity, fetotoxicity, and teratogenicity in rats and rabbits (see Data). There are no available human data informing the drug-associated risk. Advise pregnant women of the potential risk to a fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Lactation

No information is available on the clinical use of lenvatinib during breastfeeding. Because lenvatinib is more than 98% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 28 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during lenvatinib therapy and for at least 1 week after the last dose.

Why is this medication prescribed?

Lenvatinib is used to treat a certain type of thyroid cancer that has returned or that has spread to other parts of the body and cannot be treated with radioactive iodine. Lenvatinib is also used along with everolimus (Afinitor, Zortress) to treat renal cell carcinoma (RCC, a type of cancer that begins in the kidney) in people who have previously received treatment with another chemotherapy medication. Lenvatinib is also used along with pembrolizumab (Keytruda) as an initial treatment for advanced renal cell carcinoma. Lenvatinib is also used to treat hepatocellular carcinoma (HCC; a type of liver cancer) that cannot be treated with surgery. Lenvatinib is also used along with pembrolizumab (Keytruda) to treat a certain type of cancer of the endometrium (lining of the uterus) that has spread to other parts of the body or worsened during or after treatment with chemotherapy medications or that cannot be treated with surgery or radiation therapy. Lenvatinib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.

How should this medicine be used?

Lenvatinib comes as a capsule to take by mouth. It is usually taken once daily with or without food. Take lenvatinib at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lenvatinib exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the capsules whole; do not open, chew, or crush them.

If you are unable to swallow the capsules, put them into a small glass and add about one tablespoon of water or apple juice. Do not break or crush the capsules. Leave the capsules in the liquid for at least 10 minutes and then stir the contents for at least 3 minutes. Drink the mixture. After drinking the mixture, add another 1 tablespoon of water or apple juice to the glass. Swirl the contents a few times and swallow the mixture.

Your doctor may decrease your dose of lenvatinib or tell you to stop taking the medication for a time or permanently if you experience serious side effects. Be sure to talk to your doctor about how you are feeling during your treatment with lenvatinib.

The length of your treatment depends on how well you respond to the medication and the side effects you experience. Continue to take lenvatinib even if you feel well. Do not stop taking lenvatinib without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking lenvatinib,

tell your doctor and pharmacist if you are allergic to lenvatinib, any other medications, or any of the ingredients in lenvatinib capsules. Ask your pharmacist for a list of the ingredients.
tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain medications for irregular heartbeat including amiodarone (Nexterone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), dronedarone (Multaq), procainamide, quinidine (in Nuedexta), and sotalol (Betapace, Betapace AF, Sorine, Sotylize), ketoconazole, or rifampin (Rifadin,Rimactane). Also tell your doctor if you are taking or have taken alendronate (Binosto, Fosamax), denosumab (Prolia, Xgeva), ibandronate (Boniva), pamidronate, romosozumab-aqqg (Evenity), risedronate (Actonel, Atelvia), or zoledronic acid injection (Reclast, Zometa). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you have or have ever had seizures; high blood pressure; a stroke; a heart attack; headaches; changes in vision, especially those due to blood clots; a fistula (abnormal connection between 2 organs inside your body or between an organ and the outside of your body); a tear in the wall of your stomach or intestine; QT interval prolongation (an irregular heart rhythm that can lead to fainting, loss of consciousness, seizures, or sudden death); heart failure; low levels of calcium, potassium, or magnesium in your blood; bleeding problems; problems with your mouth, teeth, or gums; thyroid problems; or heart, kidney, or liver disease. Also tell your doctor if you have severe diarrhea or vomiting or you think you may be dehydrated.
you should know that lenvatinib may decrease fertility in men and women. However, you should not assume that you or your partner cannot become pregnant. Tell your doctor if you are pregnant or plan to become pregnant. You will need to have a pregnancy test before you begin treatment with lenvatinib. If you can become pregnant, you should use birth control during your treatment with lenvatinib and for at least 30 days after your final dose. If you become pregnant while you are taking lenvatinib, call your doctor immediately. Lenvatinib may harm the fetus.
tell your doctor if you are breastfeeding or plan to breastfeed. You should not breastfeed while taking lenvatinib
tell your doctor if you are planning to have any surgery, including dental surgery. Your doctor will probably tell you to stop your treatment with lenvatinib at least 7 days before your scheduled surgery because it can affect wound healing. Your doctor will tell you when to start taking lenvatinib again after your surgery.
you should know that your blood pressure may increase during your treatment with lenvatinib. Your doctor will probably monitor your blood pressure during your treatment.
you should know that lenvatinib may cause osteonecrosis of the jaw (ONJ, a serious condition of the jaw bone), especially if you have dental surgery or treatment while you are taking the medication. A dentist should examine your teeth and perform any needed treatments, including cleaning or fixing ill-fitted dentures, before you start to take lenvatinib. Be sure to brush your teeth and clean your mouth properly while you are taking lenvatinib. Tell your doctor or dentist if you have or have had mouth, teeth, or jaw pain; mouth sores or swelling; numbness or a feeling of heaviness in the jaw; or any loose teeth. Talk to your doctor before having any dental treatments while you are taking this medication. Your doctor will probably tell you to stop your treatment with lenvatinib at least 7 days before your scheduled dental procedure.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If your next dose is due in 12 hours or more, take the missed dose as soon as you remember it. However, if the next dose will be taken in less than 12 hours, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Lenvatinib – Uses, Dosage, Side Effects, Interaction

Mechanism of Action