sunitinib malate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
sunitinib malate: clinical details
Prescribing considerations
- Initiation and supervision should be by a clinician experienced in systemic anticancer therapy.
- Review cardiovascular disease, hypertension, thromboembolic history, QT-risk factors, bleeding risk, liver disease, renal impairment and proteinuria.
- Assess planned surgery, wounds, dental disease and intravenous bisphosphonate exposure.
- Assess aneurysm or artery-dissection risk factors and address modifiable factors such as hypertension and smoking.
- Review pregnancy intentions, contraception and fertility implications.
Contraindications and cautions
- Hypersensitivity to sunitinib or any product excipient.
- Use additional caution in significant cardiovascular disease, QT prolongation, uncontrolled hypertension, severe hepatic impairment, active bleeding or impaired wound healing.
Monitoring
- Blood pressure, full blood count, and assessment for bleeding or infection.
- Liver and thyroid function.
- Urinalysis for proteinuria and assessment of renal function.
- Clinical monitoring for heart failure; consider left-ventricular ejection fraction assessment according to cardiac risk.
- ECG and electrolytes where QT-prolongation risk is relevant.
- Blood glucose in people with diabetes or symptoms of hypoglycaemia.
- Skin, oral health, wound healing, and symptoms of thromboembolism, neurological toxicity or tumour lysis syndrome.
Clinical pharmacology
Sunitinib inhibits multiple receptor tyrosine kinases involved in tumour proliferation, angiogenesis and metastatic progression. It is metabolised mainly by CYP3A4 to an active metabolite; elimination is predominantly faecal.
Formulation and product differences
- The selected product is a hard gelatin capsule containing sunitinib as sunitinib malate.
- Capsule appearance, excipients, packaging and storage conditions can differ between manufacturers; verify the supplied pack and current product information.
- Capsules are not interchangeable by appearance alone.
sunitinib malate preparations and strengths
Capsule
Route: Oral
Strengths: 12.5 mg, 25 mg, 37.5 mg, 50 mg
sunitinib malate interactions
The specialist team should check all prescribed, non-prescribed and herbal products before treatment and whenever medicines change.
Strong CYP3A4 inhibitors, including itraconazole, clarithromycin and ritonavir
May increase sunitinib exposure and toxicity; an alternative is generally preferred.
Grapefruit or grapefruit juice
May increase sunitinib exposure and should be avoided.
Strong CYP3A4 inducers, including rifampicin, carbamazepine, phenytoin and phenobarbital
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.