Dabrafenib and trametinib

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. 

You will have:

• dabrafenib as a capsule
• trametinib as a tablet.

The nurse or pharmacist will give you these to take at home.

While you are having this treatment, your doctor will take regular blood samples to check your kidneys and liver are working properly.

If you are taking dabrafenib and trametinib after surgery to reduce the risk of melanoma coming back you have this treatment for up to 1 year.

If the cancer is advanced you take this treatment for as long as it working for you and the side effects are not causing you problems.

Your doctor, nurse or pharmacist will discuss your treatment plan with you.

The nurse or pharmacist will give you the capsules and tablets to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. 

Take the drugs on an empty stomach with a full glass of water. Do not eat for 2 hours before you take them. After taking them do not eat for 1 hour.  

They must be swallowed whole with a glass of water. They should not be chewed or crushed. Take them at the same time every day.    

Do not drink grapefruit juice or eat grapefruit or Sevillle oranges while taking this treatment. 

Dabrafenib

You usually take dabrafenib twice a day, with about 12 hours between each dose. If you forget to take it and there are more than 6 hours until your next dose, take it as soon as you remember. If there are fewer than 6 hours until the next dose, do not take it. Just take the next dose at the usual time. 

Trametinib

You usually take trametinib once a day at the same time as either the morning or the evening dose of dabrafenib. If you forget to take it and there are more than 12 hours until your next dose, take it as soon as you remember. If there are fewer than 12 hours until the next dose, do not take it. Just take the next dose at the usual time. 

Never take a double dose of either drug. If you are sick after taking either drug, do not take another dose, just take the next dose at the usual time.

• Keep dabrafenib in the original package and at room temperature, away from heat and direct sunlight. 
• Keep trametinib in the original package and store it in a refrigerator until you open it. Once opened, you can keep it for up to 30 days at room temperature not higher than 30°C. 
• Keep them safe and out of the sight and reach of children. 
• If your treatment is stopped, return any unused capsules or tablets to the pharmacist. 

This treatment can cause high temperatures. This usually starts in the first month of treatment. A high temperature can cause symptoms such as: 

• night sweats
• feeling hot or cold
• feeling shivery
• feeling achy

Contact the hospital if you have these symptoms. You will usually be told to check your temperature. A high temperature can also be caused by infection so your doctor or nurse may ask you to come to the hospital for a check-up. 

If the treatment is causing a high temperature, your doctor may tell you to stop taking dabrafenib for a while, or to take a lower dose of it. 

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.

Feeling sick is a common side effect but it is usually mild and easy to control. If needed, your doctor will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains.

This treatment can cause bleeding, which may be mild or more serious. 

Contact a doctor immediately if you have any of these symptoms: 

• severe headaches or dizziness
• passing blood in your stools (poo) or black ‘tarry’ stools
• vomit that looks like ‘coffee grounds’
• sudden tummy pain
• coughing up blood
• blood in the urine (pee).

Your nose may feel stuffy or blocked and you may have sore throat when taking this treatment. 

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

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

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. 

You may have headaches or feel dizzy. If this happens, let your doctor or nurse know. They can do tests to check for the cause. If a headache or dizziness is severe contact the hospital for advice straight away.  

Do not drive or use machinery if you feel dizzy.

You may have muscle or joint pain or muscle spasms (cramps). The pain is usually mild and can be relieved with painkillers. Ask your doctor for advice. 

Rarely, this treatment can cause a condition where muscle breaks down and affects the kidneys. Always tell your doctor if:

• muscle pain does not get better
• muscle pain is causing weakness 
• your urine (pee) is darker than normal. 

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.

Dabrafenib and trametinib can affect your blood pressure. It may make cause high or sometimes low blood pressure. Your blood pressure will be checked before and during treatment.  High blood pressure can usually be controlled with tablets. 

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. 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 often causes mild skin changes. They include:

• a rash
• redness
• itching
• dry, rough or scaly skin
• small wart-like growths (called papillomas)
• infections in the skin or nails.

Tell your nurse or doctor if you have any of these changes. They can give you advice, and can prescribe creams and medicines to help. 

If you are out in the sun, use a sun cream with a high sun protection factor of at least SPF 30 to protect your skin.

Rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If you have any of these symptoms, contact your doctor or hospital immediately.

Dabrafenib and trametinib increase the risk of skin cancer. Your doctor will check your skin before and during treatment.

If a skin cancer develops it can usually be removed with surgery. Your nurse or doctor will tell you what to look for and will check your skin regularly. If you notice anything unusual between appointments, let your nurse or doctor know.

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

• be sore
• be painful, tingle, or swell
• peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

• keeping your hands and feet cool by washing in cool water
• gently moisturising your hands and feet regularly
• wearing gloves to protect your hands and nails when working in the house or garden
• wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Some people notice their hands and feet become swollen. This is caused by a build- up of fluid. Less commonly this treatment can cause swelling around the eyes. 

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

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 a while after treatment finishes. 

Birth control using hormones (contraceptive pills, injections or patches) may not work as well while you are taking this treatment. It is important to use another effective method of birth control, so you do not become pregnant.

Your doctor, nurse or pharmacist can tell you more about this.

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.

If you have sex during this treatment, your cancer team will usually advise using barrier protection such as condoms.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.