Everolimus

You have everolimus as a tablet, which you can take at home. It may be given on its own, or with other cancer drugs. 

During treatment you 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 are given everolimus as an outpatient. The specialist nurse or pharmacist gives you the tablets to take home. You may be given tablets of different strengths. Always take them exactly as explained. This is important to make sure they work as well as possible for you. Everolimus can reduce the number of blood cells in your blood. It may also affect your blood sugar and cholesterol levels, and your kidneys and liver. You have regular blood tests before and during treatment. This is to check for any changes and make sure that your blood test results are at a safe level to continue treatment. 

Your nurse, pharmacist or doctor will talk to you about your test results and ask you how you have been feeling. Sometimes your treatment may be delayed for a short time until side effects improve. You may also have your next dose of treatment reduced.

You keep taking everolimus for as long as it is working for you and side effects can be managed. It is important that you do not stop taking it without talking to your doctor.

Everolimus tablets must be swallowed whole with a glass of water. They should not be chewed, broken or crushed. You can take them with or without food, but do the same thing each day. Take them at the same time every day.

Do not eat grapefruit or drink grapefruit juice while you are having this treatment. This can change how effective the drug is.

Other things to remember about your tablets:

• If you forget to take the tablets, do not take the missed dose. Instead, take the next dose as usual. Do not take a double dose to make up for the tablets you did not take. Let your doctor or nurse know.
• If you are sick just after taking the tablets, contact the hospital. Do not take another dose.
• Keep the tablets 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.
• Other people should avoid direct contact with everolimus tablets. 
• It is important to get a new prescription before you run out of tablets and make sure you have plenty for holidays.
• If your treatment is stopped, return any unused tablets to the pharmacist. 

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.

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:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

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.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get an infection in your mouth or throat. 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.

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

This treatment can also affect your nails. Always tell your doctor or nurse about any changes to your skin or nails. They can give you advice and may prescribe creams or medicines to help.

Tell your doctor straight away if you have a severe rash.

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.

Everolimus can also cause problems with sleeping (insomnia). If you are having difficulty sleeping, tell your doctor.

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.

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

Some people lose their appetite while they are taking everolimus. If you have a poor appetite, try to eat small amounts as often as possible. Keep snacks, such as nuts or dried fruit, handy to eat whenever you can. If you are finding it difficult to eat or you are losing weight, ask to see the dietitian at your hospital. They can give you advice on how to boost your appetite and maintain your weight. Our information on the building-up diet has useful tips.

This treatment can cause an inflammation in the lungs, called pneumonitis. This can cause:

• breathlessness
• wheezing
• a high temperature
• a dry cough
• pain in your chest when you breathe in.

If you have any of these symptoms, contact your hospital straight away using the 24-hour contact number you have been given.

Pneumonitis can be mild and may not always need treatment. But if it is more severe your doctor may treat it with drugs that reduce inflammation (steroids).

This treatment may raise your blood sugar levels. You will have regular blood tests to check this. Symptoms of raised blood sugar include:

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

If you have these symptoms while having this treatment, tell your doctor or nurse. 

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this.

Everolimus can increase the amounts of cholesterol (fats or lipids) in your blood. Your doctor will take blood tests during your treatment to check for this.

Some people get swelling around their eyes, or in their hands, ankles or feet, because of fluid build-up. This often improves by itself but tell your doctor if you have swelling anywhere on your body. They may give you drugs to help.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

Everolimus can cause high blood pressure in some people. You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure.

If you already have high blood pressure and are on treatment to control it, you will have regular blood pressure checks. Talk to your doctor if you have any concerns.

Some people have indigestion or acid reflux (acid coming up from the stomach into the gullet) and pain in the tummy area (abdominal pain) when taking everolimus. Tell your doctor if this affects you. They can give you medicines to help.

If you have had a liver infection called hepatitis B, everolimus can make it active again. Let your doctor or nurse know if you have had hepatitis in the past or are worried about this.

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.

Do not take the herbal remedy St John’s Wort while you are having everolimus. This is because it can make everolimus less effective. 

Some other medicines can affect how this treatment works and may be harmful to take when you are having everolimus. 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.

Everolimus tablets contain lactose. If you are intolerant to lactose, let your doctor know.

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, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

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 a period, these may become irregular or stop while you are having this treatment. This may be temporary, but it can sometimes be permanent. Your menopause may start sooner than it would have done. Your doctor or nurse can give you more information.

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.