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Vomiting with Gleevec increased dose


New to CML support.  My husband has had CML since 2014.  First on Sprycel that had to be discontinued because of plural effusions, has been on Gleevec since 2017.  His numbers went up (BCR/ABL) so end of December they upped his dose from 400 to 600.  Since January he has been vomiting yellow fluid (no food) almost every day.  All the tests, blood, CAT, EGD, ultrasound and HIDA) were normal.  He visited the ER 3 times.  Yesterday he saw a GI doctor who strongly believes the Gleevec is causing this. I see a lot of you have had nausea but has anyone vomited only the yellow fluid?  He is so afraid to have to switch meds again since there is only so many you can use, and his latest test shows he is in remission.


That sounds awful for your husband.

I know imatinib can make people feel very nauseous. Has your husband tried shifting the time of day he takes it, and with / without food?

600mg is quite a lot and is considered "high dose". Do you know what his numbers were leading up to this change? He should not be too fearful of trying another TKI ... if it doesn't agree with him, he can always switch back.


He should absolutely change meds - and consider Bosutinib. It is an src based inhibitor and will not have the gastric upset gleevec is known for and will likely help him achieve a terrific response.

When you write your husband is in remission - what do you mean? PCR < 0.01%? You indicated his bcr-abl went up while taking gleevec 400mg. That alone should have led to a drug switch. Bosutinib is a perfect candidate.

(returning to sprycel is also 'possible', but only at a very low 20 mg dose to avoid pleural effusion. He likely was started at 100 mg which is no longer considered proper protocol - dose is too high and leads to adverse events such as pleural effusions).

(additional note: my first doctor wanted to increase my gleevec dose from 400 mg to 600 mg when it wasn't working "properly". I changed doctors and changed drugs - to 20 mg sprycel. If sprycel caused pleural effusion I would next try bosutinib.)

Though bosutinib is well renowned for rather 'explosive' GI issues for the first couple of weeks! It seems to settle pretty quickly for most people.

I don't have the data to hand, but I believe bosutinib has the best tolerated side effect profile of all TKIs. I'm sure I saw a presentation on this at a conference a year or two back but can't seem to find the slides.


Yes,  if bosutinib had been available to me back in the day, I would have chosen it as my TKI of choice.

I was on 600 mg Glivec for two years as I lost my molecular remission and now with a number of undetectable PCRs,have since December 2018 been  back to 400mg thank goodness. I found 600 mg quite tough and I have been through the vomiting and the dreadful headaches but only on an occasional basis.For me high dose Glivec worked so possibly you might rethink when you take the drug and how you take it?

I was concerned that I was vomiting up all or part of the dose;there is a brown coating on the capsule and it is white inside so any brown coloured vomit worried me  as one should ideally not miss more than 3 doses per month.

I found that the key to the issue was the type of food that I ate just before taking the pills and the necessity to swallow with 2 glasses of water.My routine was to take it with a late lunch of foods like pasta or foods heavy in carbs or stodgy food and then take 2 glasses of water whilst swallowing the pills or soon after.Often if I took  say soup with some bread and then the pills I would soon throw up everything.There are threads on here from patients who have experimented with different foods in respect of taking 400mg Glivec which you might be able locate.

My experience was that if I took the high dose with little or the wrong food or with no food at all it would certainly lead to vomiting and severe nausea.

I am not sure if I would rush to go on to Bosutinib because it has its own side effect profile and if you are intolerant of that there is only the quite toxic Ponatinib left as a choice.

I wish you well


I was recently moved up from 400mg to 600mg too. I had one ”blip” upwards (0.18 at 9 months, 0.47 at 12 months).

They talked about some ”GUS sensitivity” which ”was down more now” hence they increased dose. I’ve asked them but have not yet got an answer to what exactly this sensitivity is and how it’s measured. Maybe sometimes it makes sense to increase dose?

For me there wasn’t much difference in side effects to increase dose. I could become a little nauseous the first weeks of both 400 and 600, but it’s right after I take it and it disappears after 10 min and I’ve never had to vomit. I always take it after dinner and with a big glass of water. If I feel nauseous I take another glass of water.