Ribociclib (Kisqali®) is used to treat breast cancer that is oestrogen-receptor positive and HER2 negative. It may be used if the cancer has spread:
- to the tissues and lymph nodes close to the breast (locally advanced), and surgery is not possible
- from the breast to other parts of the body (metastatic).
It is best to read this information with our general information about the type of cancer you have.
Ribociclib is a type of targeted therapy drug called a cancer growth inhibitor. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
During treatment you usually see a cancer doctor, a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
You will have your blood checked regularly during treatment. A nurse or a 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 for you to have treatment. Your doctor will tell you when your blood will be checked.
Ribociclib comes in tablets, so you can take it at home. You take ribociclib with a hormonal therapy drug. Ribociclib works with the hormonal therapy drug to slow the growth and spread of the cancer.
Taking ribociclib tablets
You take ribociclib tablets once a day for 21 days. You then have a break of 7 days when you do not take any ribociclib. After this, you start taking it again in the same way. You carry on taking it in this way for as long as it is working for you.
Take the tablets at the same time each day with or without food. Swallow the tablets whole with a large glass of water. Do not crush or dissolve tablets. If you find it difficult to swallow your tablets, speak to your doctor or pharmacist.
Always take ribociclib and the hormonal therapy drug exactly as your nurse or pharmacist explains. This is important to make sure they work as well as possible for you.
Never take a double dose of ribociclib. If you are sick after taking the tablets or if you forget to take them, do not take another dose. Take the next dose at the usual time.
Other things to remember about your tablets:
- Do not eat grapefruit or drink grapefruit juice at any time during your treatment. Grapefruit may affect how ribociclib works in the body.
- Keep the tablets in the original package.
- Keep your tablets safe and out of sight and reach of children.
- If your treatment is stopped, return any unused tablets to the pharmacist.
We explain the most common side effects of this treatment here. You may get some of the side effects we mention, but you are unlikely to get all of them.
You take this treatment with a hormonal therapy drug which can cause side effects not listed here. It is best to read this information with our information about the hormonal therapy drug you are having. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes 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. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
Anaemia (low number of red blood cells)
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 have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
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. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Your doctor can prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
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 for advice. Your doctor can give you drugs called laxatives to help.
Changes in taste or loss of appetite
Indigestion or tummy pain
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.
Some people have back pain while having treatment with ribociclib. Your doctor will prescribe painkillers if this is a problem for you. Tell your doctor if these do not work. They can give you a different painkiller to try.
Your hair may get thinner but you are unlikely to lose all the hair from your head. Talk to your nurse if you are worried about this.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
This treatment may make your skin become red or feel dry. It can cause a rash, which may be itchy. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help.
Build-up of fluid (oedema)
Sometimes fluid can build up in your legs and ankles and can cause swelling. This is called oedema. Always tell your doctor if you notice any swelling in your legs or arms. Your doctor may give you drugs to help reduce the swelling.
Effects on the heart
This treatment can affect the way your heart works. Your doctor may do tests to see how well your heart is working. You may have these tests before, during, and sometimes after treatment.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms. But it is important to get them checked by a doctor.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Changes in the way the liver and kidneys work
Ribociclib may affect how your liver and kidneys work. It is important to tell your doctor before you start treatment if you have any liver or kidney conditions.
You will have blood tests to check how well your liver and kidneys are working. If you have changes to your liver, your doctor may change the dose of treatment.
Ribociclib may affect your eyes. You may notice they are dry or watery. Speak to your doctor if this is a problem. They may be able to give you something to help. Contact your doctor if you have blurry vision or vision changes.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Ribociclib tablets contain soya lecithin. If you are allergic to soya or peanuts, do not take this medication. Talk to your doctor about this.
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. 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 finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.