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Nilotinib and Food

Hi All,

It's been a while since I posted as we've been recovering from the campaigning frenzy of earlier this year (fingers crossed that comes good in the end despite all the delays).

As some of you will know, Jed has now switched from glivec to nilotinib.  Much improvement with side effects, although still waiting for enough time to have passed to get meaningful PCRs.

Anyway, I just wanted to ask if anybody knows how critical the "no food" rule is when taking nilotinib.  We were told that the reason you have to take it on an empty stomach is to do with the absorption rate but are unclear on the degree to which this affects it.  Every now and again Jed accidentally eats something, usually just a couple of bites before remembering that he was supposed to be fasting before taking his meds.  So we reset the clock and the fasting begins again.  Not so much of a problem for his morning dose, but if this happens in the evening it can mean he has to stay up very very late to take his meds, therefore doesn't sleep enough, therefore is exhausted the next day (and the general fatigue he has is bad enough without sleepless nights adding to it).

So I guess what we are wondering is, if he literally has only had a tiny tiny bit of food, is this serious enough to warrant restarting the two hour countdown to drug taking (and bedtime)?  We're going to talk to his consultant in a couple of weeks but any insights in the meantime would be appreciated. 


All the best to you all, Bhiru

Dear Bhiru,  As far as I am aware the reason you need to be quite strict with fasting before taking the drug is that food- particularly with a high fat content- increases the absorption of the drug and therefore increases the plasma levels- this might means that Jed will be more prone to side effects and also will be increasing the dose of the active drug. I am not expert in this but I think you should be quite strict in not combining the drug with any food. So... Jed would need to be quite strict in managing his meal times. This is quite a hard thing to do I imagine! If he does mistime his intake of food and has to start his fast again then this means that his levels of the active drug will drop for a while because he has essentially extended the time between doses.... keeping the level of active drug at a constant level is pretty crucial for all TKI's and for optimal response. This is why 'drug holidays' (if they are taken regularly rather than as an infrequent event) can have an impact on response. Plasma concentration of this class of drug is the key for effective -and optimal- response.

Sandy

Hi Bhiru,  I too am on Nilotinib & have to be very careful about fasting times.  When I swapped from Glivec my consultant made it quite clear that it is strictly 2 hours before and 1 hour regime. Only water can be taken during this time. The dose should be 12 hourly to keep the level of drugs even. As Sandy said it increases the absorption rate of drug in the body if you don't adhere to this. I have found I've got used to the fasting time. I set my alarm to wake at 6 am, take Nilotinib and then try to rest a while before getting up as I get quite tired during the day and then I fast from PM take the tablets at 6 and then dinner is 7.30ish which fits in quite well with my life style. I am afraid Jed will have to try to be a bit more careful!

Its good that Jeds side effects are better on Nilotinib. I found the same. I've been off Nilotinib for two weeks now having had a very severe skin reaction. Its all settling down now so I hope to restart this week. Don't know why that happened as I've been on it for over a year.

Wishing you both the very best.

Ali.