Ceritinib (Zykadia®)

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have treatment. The blood test will also check how well your kidneys and liver are working.

You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your targeted therapy. Your nurse will tell you when your treatment is likely to be ready.

You take ceritinib as tablets (orally).

The nurse or pharmacist will give you the ceritinib tablets to take at home. They may also give you drugs to prevent sickness, diarrhoea, or other side effects to take at home.

Take all your drugs exactly as they have been explained to you. This is important to make sure they work as well as possible. Make sure you:

• Take ceritinib once a day with food.
• Take your tablets at the same time every day.
• Swallow them whole, with a glass of water.
• Do not chew or crush them.

If you are unable to eat, you may need to take a different dose of ceritinib. Your cancer doctor will explain how and when to take your tablets. Do not change your dose unless your cancer doctor tells you to.

You should not eat grapefruit or drink grapefruit juice while you are taking ceritinib. Grapefruit can cause harmful levels of ceritinib in your blood.

You should not take drugs that treat heartburn or indigestion at the same time as ceritinib. These may stop ceritinib from working as well. Ask your doctor or pharmacist for advice about how and when to take any drugs for heartburn.

If you forget to take the tablets, you should take the missed dose as soon as possible. If more than 12 hours have passed, do not take the missed dose. Let your doctor or nurse know and take the next dose at the usual time.

Other things to remember about your tablets:

• Wash your hands after taking your tablets.
• Other people should avoid direct contact with the drugs.
• Keep them in the original package and at room temperature, away from heat and direct sunlight.
• Keep them safe and out of sight and reach of children.
• If you are sick just after taking the tablets, contact the hospital. Do not take another dose.
• If your treatment is stopped, return any unused tablets to the pharmacist.
  
  You usually keep taking ceritinib as long as it is effective and as long as its side effects are manageable.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired. 

If you feel sleepy, do not drive or use machinery.

This treatment can affect your skin. It may cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day. 

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Changes to your skin usually improve when treatment ends.

This treatment may cause severe diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. If you have a stoma, it will be more active than usual. 

Your doctor, nurse or pharmacist may give you anti-diarrhoea drugs to take at home. 

If you have diarrhoea or a mild increase in stoma activity, follow their advice about: 

• taking anti-diarrhoea drugs 
• how much and what type of fluids to drink 
• any changes to your diet that might help. 

Contact the hospital straight away on the 24-hour number if:

• you have diarrhoea at night 
• you have uncomfortable stomach cramps
• you have diarrhoea 4 or more times in a day 
• you have a moderate increase in stoma activity 
• the anti-diarrhoea drugs do not work within 24 hours.

You may need to give a stool sample, or go to hospital to have fluids through a drip or antibiotics.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

This treatment can affect your appetite. It is important to take your tablets with food. If you are unable to do this, tell your doctor or nurse as they may need to change the dose.

If your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

This treatment can cause pain in the tummy (abdomen) and heartburn (indigestion). Tell your nurse or doctor if you have pain. Ask them for advice about how and when to take any drugs for heartburn.

Your doctor may give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.

This treatment might increase certain risk factors for heart problems. Tell your doctor if you have:

• had any problems with your heart
• high blood pressure
• high levels of cholesterol – a fatty substance in your blood. 

They can monitor or treat these if needed. Talk to your doctor if you are worried about this. 

Things you can do to take care of your heart include:

• not smoking
• maintaining a healthy weight 
• being physically active.

This treatment can raise your blood sugar levels and increase the risk of diabetes. 

Signs of raised blood sugar include:

• feeling thirsty
• needing to pass urine (pee) more often than usual
• feeling more tired than usual. 

Tell your doctor or nurse if you have these symptoms. They can do tests to check your blood sugar level and give you advice.

If you already have diabetes, your blood sugars may be higher than usual. You may need to check them more often, or make changes to your diabetic treatment. Your diabetic doctor or nurse will talk to you about how to manage this.

This treatment can affect how your liver works. You will have blood tests to check how well your liver is working. Tell your doctor if you have:

• yellowing of your skin or the whites of your eyes
• pain on the right side of your tummy
• dark or brown urine
• bleeding or bruises that you cannot explain.

These may be a sign of liver problems.

This treatment can cause changes to the lungs. Tell your doctor if you develop:

• a cough
• wheezing
• a fever (high temperature)
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

If your symptoms develop suddenly, contact the hospital immediately. You may have inflammation of the lungs (pneumonitis). Your doctor can tell you more about this.

This treatment can affect how your kidneys work. You will have blood tests to check how well your kidneys are working. Tell your doctor if you stop passing urine (peeing) or are passing very little urine. This may be a sign of kidney problems.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for 3 months after treatment finishes.

Oral contraceptives such as the pill may not work while taking this treatment.

Your doctor, nurse or pharmacist can give you advice on what contraceptives will work well with this treatment.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.