Neratinib

Side Effect

Management

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 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-diarrheal medications.

Nausea or vomiting

This is usually mild.

• Take small and frequent meals, rather than 3 large meals.
• Avoid foods / smells that may make you feel nauseous, such as oily, fried food 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.

Abdominal pain

• You may experience mild discomfort or pain in the stomach area.
• Inform your doctor immediately if you experience severe abdominal pain or if there are other symptoms e.g. fever.

Feeling tired or lack of energy

• Eat well and get enough sleep.
• Prioritize tasks to ensure you make the best use of your energy.
• Do not drive or operate machinery if you are feeling tired.
• Inform your doctor if your energy level does not improve or gets worse.
• Simple exercise such as walking can help to boost your energy.
• Avoid alcohol as this may cause you to feel more tired and drowsy.

Mouth ulcers or sores.

This may 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 cleansing 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.

Dry skin and rash

• You can use moisturiser to prevent dry skin.
• Inform your doctor if the symptoms become worse.

Poor appetite

• Try different flavours of food and small frequent meals.

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 stomach pain
• Keep your doctor informed about any supplements or over-the-counter medications that you take.

Drug Allergy

Symptoms may include:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

• If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

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

Maintain adequate hydration with 2 to 3 litres of fluids per day unless you have been informed by your doctor to restrict fluids. This will decrease your chances of getting constipation and prevent dehydration.

Medical and dental treatment

If you need to go to the 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 talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.