Afatinib

Uses

Precaution

Side Effects

Handling

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Uses

What is Afatinib for?

Afatinib is used to treat Epidermal Growth Factor Receptor (EGFR) positive non-small cell lung cancer.

How should I take or use Afatinib?

Take Afatinib once a day on an empty stomach (one hour before food or three hours after food), at the same time each day
Swallow the tablet/capsule whole.
- Do not break, chew or crush the tablet.
- Inform your doctor or pharmacist if you have difficulty swallowing.

What should I do if I forget to take or use Afatinib?

If you forget to take a dose, take it as soon as you can if it is within 8 hours of the missed dose. If more than 8 hours have passed since the missed dose, skip the missed dose and take it at the next scheduled time. Do not take two doses to make up for the missed dose.
If you vomit out a dose of Afatinib, do not take another dose to make up for it. Take your next dose at the usual time.

Precaution

What precautions should I take when taking or using Afatinib?

Inform your healthcare professional if:
- You are allergic to this medication or any of the other ingredients of this medication.
- You are taking any other medications, including supplements, traditional medications and herbal remedies.
- You have any other medical conditions.
- You are going to receive any vaccination or surgery, including dental surgery.
- You have any plans to start a family in the future.
Afatinib may have an anti-fertility effect, which could be irreversible. You should discuss fertility preservation options with your doctor before starting treatment.
- You should not breastfeed during treatment and for at least 2 weeks after stopping Afatinib.
- You should not become pregnant during treatment. You should use an effective birth control method during treatment and for at least 2 weeks after stopping Afatinib.
- If you have a partner who could become pregnant, you should use an effective birth control method during treatment and for at least 2 weeks after stopping Afatinib

Side Effects

What are some common side effects of Afatinib?

The table below will list some of the common side effects as well as the rare but serious side effects.

Side Effect	Management
Acne-like rashes (pimples) may appear on the face, upper chest and back. It usually develops within the first 2 weeks of treatment and will get better after stopping treatment. Your skin may also become flaky and scaly.	Avoid direct sunlight during and 2 months after treatment. Apply sunscreen with an SPF (Sun Protection Factor) of at least 30. Also, you may wear a hat, long sleeves, and long pants outside on sunny days. Apply moisturisers to dry areas. You may be prescribed antibiotic cream or oral antibiotics to treat the rashes. Inform your doctor if the acne-like rash becomes widespread and is bothering you.
Diarrhoea (loose and frequent stools)	Drink plenty of clear fluids (at least 2 litres or 8 cups every day). Eat food that is gentler on the stomach such as porridge or soup. Avoid milk, dairy products, high-fibre food and oily or spicy food. Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed. Proceed to the A&E Department immediately if you have very bad diarrhoea (for example increase in bowel movement of more than 4 times per day) that does not improve even after taking anti-diarrhoeal medications.
Nausea or vomiting	Take small and frequent meals. Avoid foods / smells that may make you feel nauseous, such as oily, fried or strong-smelling food. Avoid tight-fitting clothes around the waist. Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.
Nail changes that may affect both fingernails and toenails. Your nails may Become more brittle and break easily Turn darker in colour Develop ridges (lines) on the surface, which may give an uneven appearance Rarely, nails may come off.	Try to keep your nails short, clean and dry. Avoid contact with harsh chemicals e.g. detergent or dish-washing liquids. Wearing gloves when washing dishes or using detergents can help protect your nails during treatment. If you experience pain, redness or swelling around your nails, inform your doctor.
Mouth ulcers or sores. This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.	Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce chances of infection. Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush. Rinse and brush your dentures after eating and soak them in denture solution overnight. Avoid spicy food and take soft foods e.g. porridge. Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed. Inform your doctor if you are eating or drinking a lot lesser because of mouth pain.
Liver problems	Proceed to the A&E department immediately if you experience any: Dark or tea-coloured urine Pale or light-coloured stools Yellowing of skin or eyes Nausea, vomiting with loss of appetite Severe abdominal pain
Eye dryness causing discomfort, redness and increased tearing.	Your doctor may prescribe eye drops or gels to help moisturize and lubricate the eyes to relieve discomfort. Inform your doctor if you experience eye pain, changes in vision and/or sensitivity to light or other changes.
Symptoms of drug allergy including one or more of the following: Swollen face/eyes/lips/tongue Difficulty in breathing Itchy skin rashes over your whole body	Inform your doctor if you experience eye pain, swelling, redness, blurred vision, and/or sensitivity to light or other changes.

It is normal to experience some side effects from Afatinib. As discussed with your doctor, taking Afatinib will be beneficial for your condition. Do not stop taking Afatinib without checking with your doctor.

Handling

How should I store Afatinib?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How do I throw away Afatinib safely?

For general waste: Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.

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What else should I know about Afatinib?

Tips to help manage your condition while you are on Afatinib

Exercise	Light exercise is recommended as it helps to improve mobility, balance, and even emotional well-being. Avoid strenuous exercise, and rest when you are feeling tired.
Adequate hydration	Have plenty of hydration with 2 to 3 litres of fluids per day unless you have been informed by your doctor to limit how much fluids you can drink. This will decrease your chances of getting constipation and prevent dehydration.
Medical and dental treatment	If you need to go into hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment. Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.
Seek support if you feel overwhelmed	It is normal to feel fearful or worried about your condition. Do not be afraid to share your concerns with your healthcare team or loved ones. There may be resources and support available to help you.

Disclaimers

Please take note that the above is not a complete list of all possible side-effects. If you have any concerns about your medication or if you have other side-effects that you think are caused by this medication, please consult your doctor or pharmacist. If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (NHG Health, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.