Dabrafenib and trametinib

Dabrafenib is taken as capsules and trametinib is taken as tablets. The nurse or pharmacist will give you the capsules and tablets to take at home. 

During treatment, you usually see a: 

• cancer doctor 
• cancer nurse or specialist nurse 
• specialist pharmacist.  

This is who we mean when we mention doctor, nurse or pharmacist in this information. 

During treatment, a nurse or person trained to take blood (phlebotomist) will take regular blood samples from you. This is to check that it is safe for you to keep taking your treatment.

You will speak to a doctor, nurse or pharmacist regularly during treatment. They will ask how you have been feeling and check your blood results are okay. 

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 cannot be removed with surgery or is advanced, you take this treatment for as long as it is working for you and any side effects can be managed. Do not stop taking your treatment unless your doctor tells you to. 

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

The nurse or pharmacist will give you the dabrafenib capsules and trametinib 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. 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, broken, opened or crushed. Take them at the same times every day. 

While taking this treatment, you should not have grapefruit or Seville oranges. This means eating them, drinking the juice or taking any supplements that might contain them. This is because it may increase the amount of dabrafenib in your body and may cause more side effects. 

Dabrafenib 

You usually take dabrafenib capsules twice a day, 12 hours apart.

If you forget to take dabrafenib 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 your next dose, do not take it. Just take the next dose at the usual time. Do not take a double dose to make up for any missed ones.

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 trametinib 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. Do not take a double dose to make up for any missed ones.

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. You can contact the hospital for advice.

Other things to remember about your capsules and tablets:

• Keep dabrafenib capsules in the original package with the lid tightly closed. Store at room temperature, away from heat, moisture and direct sunlight. There is a small cylinder container in the bottle to help keep the capsules dry. This must stay in the bottle with the capsules.
• Keep trametinib tablets in the original package with the lid tightly closed. Store at room temperature (not higher than 30°C) away from heat, moisture and direct sunlight. Once a new bottle is opened, you can keep it for up to 30 days. There is a small cylinder container in the bottle to help keep the tablets dry. This must stay in the bottle with the tablets.
• Keep them safe, somewhere children cannot see or reach them.
• If your treatment is stopped, return any unused capsules or tablets to the hospital 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 straight away 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.

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.

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 dark and grainy like coffee grounds
• sudden tummy pain
• coughing up blood
• blood in the urine (pee).

When taking this treatment, your nose may feel stuffy or blocked, and you may have a sore throat.

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.

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

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. You should tell your doctor if any existing cough or breathing problems get worse, or you develop new symptoms such as:

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

If you develop new or worsening symptoms, 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
• reddening of the skin – if you have black or brown skin, this can be harder to notice
• 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 cancers. 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. If you notice this, tell your doctor or nurse so they can give you advice and treatment to help. 

Less commonly, this treatment can cause redness or swelling around the eyes. Contact the hospital straight away if you notice this.

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.

Cancer doctors usually recommend that people with cancer have vaccinations for flu and coronavirus (covid). They may also recommend other vaccines, such as Shingrix^® for shingles. These all help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

You should not have live vaccines if your immune system is weak. This includes if you are having or recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system. Live vaccines can make you unwell because they contain a very weak version of the illness they protect you against. There are several live vaccines. These include the yellow fever vaccine and Zostavax^®, which is a different type of shingles 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 up to 16 weeks after treatment finishes. Your doctor, nurse or pharmacist can advise you about this. 

This treatment may affect hormonal contraceptives such as hormonal pills, injections or patches. It is important to use another effective method of contraception (such as a barrier method) while you are on this treatment. 

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 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.