APHON Pediatric Chemotherapy-Biotherapy Renewal

Table 1. Administration Guidelines for Oral Small Molecule Inhibitors

Extemporaneous liquid preparations permissible (see Lexicomp or prescribing information for drug-specific instructions)

Do not crush, break, or chew

Alternative dose form available

Dabrafenib Erlotinib Olaparib Palbociclib Pazopanib Ponatinib Sorafenib Sunitinib Vemurafenib

Everolimus (dispersible tab commercially available) Larotrectinib (oral solution commercially available) Trametinib powder for oral solution(investigational) Sirolimus (oral solution commercially available) Veliparib oral solution (investigational)

Crizotinib Dasatinib Imatinib Isotretinoin Lenvatinib Nilotinib Ruxolitinib Vandetanib

Information from Lexicomp and drug monographs

For patients enrolled on clinical trials, there may be protocol-specific instructions regarding whether the small molecule inhibitor can be made into an extemporaneous solution. When extemporaneous oral solutions are permissible, the prepared liquid medication should be given as soon as possible after preparation to avoid oxidation that could compromise the potency of the medication. Additional considerations for oral administration pertain to foods or medications taken concurrently with the drugs. Some tablets (e.g., afatinib, sunitinib, venetoclax) should be taken on an empty stomach. High-fat meals can affect absorption for some (for example, nilotinib has increased bioavailability if it is taken after a high-fat meal). Some small molecule inhibitors should not be administered together with medications that affect gastric pH, such as proton pump inhibitors or H2 blockers. Increased gastric pH may reduce the bioavailability of dasatinib. Antacids may be used in place of H2 blockers, but dasatinib should be given 2 hours before or after the antacid (Lexicomp). Many small molecule inhibitors are metabolized by the CYP3A4 group of liver enzymes, which can be adversely influenced by certain medications and foods (see Table 2 ). Nurses should be aware that taking small molecule inhibitors with macrolide antibiotics, “-azole” antifungals, aprepitant, or grapefruit juice can result in increased drug levels of the small molecule inhibitor, which can result in increased toxicities. When small molecule inhibitors are taken with dexamethasone, barbiturates, carbamazepine, phenytoin, or topiramate, decreased efficacy of the drug may result. Careful review of all concurrent medications and foods is strongly