Tivozanib (Fotivda®) is used to treat a type of kidney cancer called renal cell cancer. It is used if this cancer has spread (advanced). It is best to read this information with our general information about the type of cancer you have.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
During treatment you will 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.
Tivozanib is given as capsules. This means you can take it at home. You take it every day for 21 days. Then you have a break of 7 days when you do not take it. These 28 days are called a cycle of treatment.
Your nurse, pharmacist or doctor will discuss your treatment plan with you. Tivozanib is an ongoing treatment. You usually keep taking it as long as it is effective and the side effects are manageable. Do not stop taking tivozanib without your doctor’s advice. To help with some side effects, your doctor may tell you to stop taking tivozanib for a short time or to reduce the dose you take.
Taking tivozanib capsules
You take tivozanib once a day. Your doctor, nurse or pharmacist will tell you how many capsules to take. Always take them exactly as you are told to. This is important to make sure they work as well as possible for you.
Swallow the capsules whole with water. Do not chew, dissolve or open them. If you forget to take the capsules, or you are sick after taking your capsules do not take a double dose. Take your next dose at the usual time and let your doctor or nurse know.
Other things to remember about your capsules:
- 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 your treatment is stopped return any unused capsules to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. 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.
High blood pressure
Tivozanib can cause high blood pressure. You may need to take drugs to control this during your treatment. Tell your doctor or nurse if you have ever had problems with high blood pressure or take drugs for this.
Your doctor or nurse will check your blood pressure regularly. They may also show you how to check your blood pressure at home. Tell them if you have any headaches. Sometimes this is a symptom of high blood pressure.
If you have diarrhoea, it is important to contact the hospital for advice. Your nurse or doctor may give you anti-diarrhoea drugs to take at home if needed.
Try to drink at least 2 litres (3½ pints) of fluids every day. If you have diarrhoea, it may help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
Your voice may become hoarse or sound different to usual. This usually gets better after treatment ends. Tell your doctor or nurse if you have a sore throat.
Sore and red hands and feet
Tivozanib may cause soreness or redness of the palms of your hands and soles of your feet. This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends.
During treatment you may also find cuts or scratches take longer to heal.
You can help prevent problems by:
- Using a moisturiser regularly to prevent dry skin – especially on your hands and feet
- Protecting the skin on your hands and feet – for example, wear well-fitting shoes, use gloves when gardening.
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.
Tell your doctor or nurse if you feel sick during this treatment. They can give you anti-sickness drugs to help prevent or control sickness.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact your doctor or nurse for advice.
Sore mouth and throat
Your mouth or throat may get sore and you may get mouth ulcers. This can make you more likely to get a mouth 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.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Tummy pain and heartburn
Tivozanib can cause pain or discomfort in your tummy (abdomen). It can also cause heartburn (indigestion). Your doctor can give you drugs to help with these side effects.
Rarely tummy pain can be a sign of a more serious problem. Always tell your doctor if:
- the pain does not improve or gets worse
- you have a swollen tummy
- you feel shivery or have a high temperature.
Back, joint or muscle pain
You may get pain in your back, joints or muscles during this treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Effects on the heart
This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of drug you are having.
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
Tivozanib can increase your risk of bleeding. Rarely this can be serious. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Contact the hospital straight away if you have any bleeding that does not stop.
Effects on the brain
Rarely, tivozanib may cause symptoms because it has affected the brain. Contact the hospital straight away if you have:
- seizures (fits)
- extreme tiredness
- loss of eyesight or other eyesight changes
- weakness in an arm or leg.
Effects on the thyroid gland
Tivozanib can affect the way the thyroid gland works. It will go back to normal after treatment.
You will have regular blood tests to check your levels of hormones that are made by the thyroid. This side effect is usually mild and may not cause symptoms. Your doctor may give you drugs to take if your hormone levels are low.
Effects on the kidneys and liver
This treatment can affect the kidneys and liver. This is usually mild and goes back to normal after treatment. You will have regular blood and urine tests during your treatment to check how well your kidneys and liver are working.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
You may have difficulty sleeping while you are taking tivozanib. Talk to your doctor or nurse if this is difficult to cope with.
You may feel dizzy during this treatment. Tell your doctor or nurse if this is difficult to cope with. If you feel dizzy, do not drive or operate machinery.
Build-up of fluid
Your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if this happens.
Runny or blocked nose
Tivozanib may cause a runny or blocked nose. This is usually mild. Ask your doctor or nurse for advice if this is a problem for you.
Eyesight and hearing changes
You may notice changes to your vision during this treatment. Or you may develop mild ringing in your ears (tinnitus). Tell your doctor or nurse if this happens.
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.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks. Tell your doctor if you have these symptoms.
Constipation and wind
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.
Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.
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.
If you use a hormonal contraceptive, this may not be effective while you are taking tivozanib. You should also use a barrier contraceptive such as a condom.
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.
Tivozanib capsules contain a food colouring called tartrazine. If you are allergic to tartrazine, talk to your doctor before taking this treatment.
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.