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How to overcome the nausea caused by the Gleevec

hello everyone
I'm pasting a saved piece I put together a while back.
for me, it is an ever evolving, ever expanding and creative process, with freshly new discoveries almost every day.
I'm hoping, that this info will bring some hope to those who have been wrestling with the Gleevec related nausea.
best wishes,jd

here it is:

The following information is based on my personal experience as a CML patient.
It includes my dietary experimentations and research, enabling me to share with you some good news, regarding how you can also reduce the nasty nausea side effect, by close to 100%.

The approach is simple and easy to follow. However it may require some minor adjustments on your behalf, in regards to some of your eating habits and tendencies, which I’m sure you’ll find manageable.

If you follow these suggestions, and find them to be correct, I highly recommend you, to independently contact Novartis, as I’ve done, and share with them your own experience and findings.
I do believe, that if many folks bring this issue up, Novartis will have to consider changing their prescribing information, as unfortunately it is the main culprit.
My intention here is not to criticize anyone, but rather to convey some helpful tips to other patients.

Let’s get started:
It’ll be impossible to get to the Gleevec subject, without first addressing some general food topics, as these issues are inseparably correlated.
Any good nutritional consultant/dietician will tell you, that food and drink don’t always mix.
You don’t have to follow a vegetarian diet like myself, but you may need to try to adopt the following habits, and I believe especially so, because you’re dealing with a serious health challenge.

Consider the following points:
-Apart from your daily beverages, drink plenty of clean water throughout the day on an empty stomach.
-Best is distilled water; next best is purified water that went through a reverse osmosis process among other things.
-Any other type of water contains minerals and potential impurities.
-The clean water is beneficial, in regularly removing many of the bodily toxins, due to the ingestion of drugs, such as Gleevec, as well as from all other sources of environmental and dietary impurities. Drinking plenty of water will also help relieve the constipation associated with the Gleevec.
-Stop drinking anything ½ an hour before a meal, unless you plan on having raw fruits or vegetables for a meal.
-After a heavy meal combination, wait at least 3 hours before drinking anything.
-Do your body a great favor, by not preparing highly salty dishes, or dehydrating foods loaded with onions and heavy spices, which usually prompt an urge to drink.

When taking the Gleevec i.e.“the Gleevec meal”:
Novartis states in their prescribing guidelines that “the prescribed dose should be administered orally, with a meal and a large glass of water”
They use the word meal, which means a lot of different things to a lot of different people, as well as stating, that you need to take the Gleevec with A large glass of water, which in our case is the main nausea-causing agent.

My experience shows that gleevec ‘rides’ on starches and carbohydrates, such as grains, cereal, rice, potatoes, bread etc.; however if your meal is 80% carbohydrates you can add items from some other food groups.
Here’s an example:
A)Eat a small bowl of cereal of your choice.
B)Chew your food slowly (50 or more times a spoonful); break it down to a soupy consistency, as the saliva is an important initial phase in the digestive process.
C)When you’re done with your meal wait 15 minutes.
D) When 15 minutes are up, take the Gleevec with 1-2 ounces of liquid only.
You can try and experiment with other dishes of your own, but always chew your food real slow, and always wait 15 minutes, allowing your digestive juices to kick in, and create a cushion for this highly toxic drug.

And never drink a big glass of water with the Gleevec.

Now this in itself should take care of the nausea.
Pay attention to what your body signals.
If within a ½ hour you feel nausea, take 10-20 cumin seeds or caraway seeds; chew them real well, and then swallow.
If it is a bit bitter for the first time or so, try it with little salt. You’ll feel a relief shortly afterwards, and the nausea gone. Chewing on fresh mint leaves works nicely as well.

Some other option dishes that work quite well:
1)A whole grain sandwich with a slice hard cheese and some greens.
2)Rice and beans.
3)A cereal made of rice, with a sweetener and cinnamon.
4)Grain cereal with dairy milk/rice milk/almond milk etc. (eat the cereal on the thick side, rather than flooding it with the choice liquid)
5)A few pieces of toasted bread with tea of any kind. (And leave 2 ounces of the tea for when you take the Gleevec)

“Conflict foods” when mixed with the Gleevec:
These are the type of foods, with which I’ve experienced some “nausea issues”, if taken primarily alone, or as a major component in a combination meal:
Tomatoes, citrus, yogurt, soft cheeses, nuts, seeds, shakes and smoothies to name a few.

In short, I’ve found that the ‘Gleevec meal’, should be rather a small ‘solid’ meal, and that the 1-2 ounces liquid mentioned, can be anything of your choice, that somehow matches your meal: water, milk, juice, tea, soup etc.

Although this information is incomplete, I do believe it conveys some suggestions, which may be applicable to other drugs as well.
I sincerely hope that you’ll find it useful and helpful, and perhaps get some encouragement to further experiment beyond the scope of this text.

susan dickerson
Hi everyone, I'm glad that I'm not the only one still having problems with the gleevic meal so to speak after being on gleevic for five years I still struggle with this. I can't eat any kind of fish or certain cheeses,I have to make sure everything is grilled, roasted or baked and nothing must be fried my stomach is constantly or easily upset either feeling sick, indegestion or actually throwing up straight after eating my meal with which I take the gleevic. I do find that the bio yog drinks help a little if I tAke one first thing in the morning and by the way I am often left with a really bad throbbing headache acompanied with feeling dizzy which passes after about 1 hour. does anyone else suffer these symtoms. I usually take a glasses of water with the tablet and meal but it makes no difference Sue d

Hi, thanks for in the info. Becky is STILL feeling sick every night. She will not drink plain water ;0( but I try to make her drink quite dilute squash. One drink we found to aggrivate the sickness was anything with grapefruit in it. She had some pink grapefruit squash for a few days and threw up every time she took her Glivec. I will ask her to try the above to help her. Dawn xxx :0)

Dawn,
It is quite well known (or should be) that grapefruit should not be eaten / drunk whilst on glivec.
I understand that the nausea is due to acid imbalance in the stomach, has the doctor given Becky anti-nausea medication or a pill to line the stomach?
Poor old Becky, give her my love and hopefully it will get sorted.

Susan

jd: Thank you for this comprehensive info. I have been battling nausea myself a lot lately (4x100mg glevec), and will certainly try some of your advice. Here is what i will try first:

 

  • Chew my food more.
  • Drink less water with my pill. (Today i drink 2,5 dl, thats 8,3 ounces if i calculated correct).
  • Take the pills 15 minutes after food instead of taking them right after (I even some times eat one slice of bread, take 2 pills, then eat one slice more and take 2 more pills.

 

I always take it with breakfast as its an easy meal to control. (I eat the same each morning, 2 slices of bread with some butter, goats cheese and strawberry jam)

Although JD's original post was made some years ago, it is very pertinent still. Thanks for reposting this, I am sure it will help a lot of people.

Sandy

I take Nexium (or any anti-acid) tablet before sleep.  No more nausea after that.  Depending on your situation, start with full dosage 40mg,then reduce to 20mg,  20mg every second day eventually.  Avoid dairy product, do not eat too much.  When you feel nausea, lie down and have some cold apple juice. Hope it will help.

William

My understanding is that antacid products are contraindicated with Gleevec.

Contra-indications of antacids with TKIs.

This is my understanding too. I think you need to make sure that if you do take antacids, you take them at least 2 hours apart from when you take your TKI therapy. This is because antacids interfere with how TKIs are absorbed in the digestive tract, so they will reduce the amount of drug that gets into your blood and therefore its effectiveness in blocking the abnormal protein that signals the Ph+cell to continue to divide. 

Sandy

 

Actually antacids (or at least, proton pump inhibitors like Nexium) are fine with imatinib.  Before going on DESTINY, I was on 10mg omperazole (predecessor to Nexium) for reflux/indigestion and that is fine (with blessings of consultants) with imatinib. I believe it is nilotinib and dasatinib that are problemmatic with antacids.

I found that imatinib nausea was best dealt with for me by taking it a little while after my evening meal - certainly not at the same time.  And starchy foods like potato, rice, pasta helped. Dairy - cream, butter, milk - were a problem.  

Quite different to the advice I was given by my Consultant. 

I discussed with no fewer than 4, including 3 at the Hammersmith and indeed one of them suggested omeprazole to deal with the acid reflux that imatinib caused me.   All said it is fine.  Imatinib has a different profile to the others and PPIs are OK with it.  On imatinib for over 5years pre destiny with excellent results (undetectable after 6 months) and very good imatinib plasma levels.  It is my understanding that other TKIs may require a more acidic environment than imatinib and that does result in different advice.  Obviously it is something that should always be discussed with your own doctor.  

Hi, Sandy and Darley,

Thanks for reminding me the drug interaction.  I checked with my specialist, he said its Ok to take Nexium with Imatinib but not with Dasatinib.  But I think you are right that we need to be careful with that.  All I can suggest is not to take Nexium as a long term solution, and separate 2 drugs for at least 2 hours.     

Thanks,

Wiliam