Indications:

Treatment of advanced renal cell carcinoma (RCC, kidney cancer) after failure of prior systemic therapy.

Dosage & Administration

Standard Dose:

               ● Starting dose: 5 mg orally twice daily (~12 hours apart)

               ● Take with or without food, but avoid high-fat meals (may increase absorption).

               ● Swallow whole with water—do not crush, split, or chew.

Dose Adjustments:

               ● Based on tolerability & blood pressure (BP) monitoring:

                                                ■ If well-tolerated, may increase to 7 mg, then 10 mg twice daily.

                                                ■ If evere side effects occur, reduce to 3 mg or 2 mg twice daily.

Missed Dose:

                          ■ If a dose is missed, skip it and take the next dose at the regular time.

                                               ■ Do not double the dose.

Precautions

⒈ Hypertension (High Blood Pressure)

            ● Common & serious—monitor BP weekly for first 2 months, then regularly.

            ● May require antihypertensive medication (e.g., amlodipine, lisinopril).

⒉ Blood Clotting & Bleeding Risk

            ● Increased risk of arterial/venous thrombosis (e.g., DVT, stroke).

            ● Watch for unusual bleeding, swelling, or chest pain.

⒊ Liver & Kidney Function

            ● Monitor LFTs (liver enzymes) and kidney function tests (creatinine).

            ● Dose reduction needed in moderate liver impairment.

⒋ Drug Interactions

            ● Avoid strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin)—may increase toxicity.

            ● Avoid strong CYP3A4 inducers (e.g., rifampin, carbamazepine)—may reduce effectiveness.

Common Side Effects

            ● Hypertension (↑BP)

            ● Diarrhea, nausea, fatigue

            ● Hand-foot syndrome (redness/pain on palms & soles)

            ● Decreased appetite, weight loss

            ● Voice changes (hoarseness)

Storage

Store at room temperature (20–25°C), away from moisture.

Note: Regular blood tests (BP, liver/kidney function, thyroid tests) are required during treatment.