Neratinib Brand Name– Nerlynx
What is Neratinib
Neratinib is a kinase inhibitor that irreversibly inhibits EGFR, HER2, and HER4.
It is indicated for the extended adjuvant treatment of adult patients with early-stage HER2-overexpressed/amplified breast cancer, to follow adjuvant trastuzumab-based therapy.
It is also indicated for the treatment of metastatic HER2-positive breast cancer in patients who have received at least 2 prior anti-HER2 based regimens, in combination with capecitabine.
Most patients (95%) treated with neratinib develop diarrhea, which may be severe and was the most frequent reason for discontinuation of treatment.
Prophylaxis with loperamide is recommended for the first 2 months of treatment, and should be used as needed thereafter.
Liver function tests should also be monitored, as neratinib has been associated with hepatotoxicity
Indications
- breast cancer
For the treatment of breast cancer
For the extended adjuvant treatment of early-stage HER2-positive breast cancer, after completion of adjuvant trastuzumab-based therapy, as monotherapy
Side Effects
- abdominal pain
- abdominal pain
- acneiform rash
- anorexia
- anorexia
- arthralgia
- asthenia
- back pain
- cheilitis
- constipation
- dehydration
- dehydration
- diarrhea
- diarrhea
- dizziness
- dyspepsia
- dyspepsia
- dysuria
- elevated hepatic enzymes
- elevated hepatic enzymes
- eosinophilia
- epistaxis
- fatigue
- fatigue
- fever
- glossitis
- hepatotoxicity
- hyperbilirubinemia
- hypotension
- infection
- infection
- influenza
- maculopapular rash
- malaise
- muscle cramps
- muscle cramps
- nail discoloration
- nausea
- nausea
- oral ulceration
- rash
- rash
- renal failure (unspecified)
- stomatitis
- stomatitis
- vomiting
- vomiting
- weight loss
- weight loss
- xerosis
- xerostomia
Monitoring Parameters
- LFTs
- pregnancy testing
Contraindications
- breast-feeding
- contraception requirements
- diarrhea
- geriatric
- hepatic disease
- hepatotoxicity
- infertility
- pregnancy
- pregnancy testing
- reproductive risk
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Afatinib
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amiodarone
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Antacids
- Apalutamide
- Aprepitant, Fosaprepitant
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Omeprazole
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Betrixaban
- Bexarotene
- Boceprevir
- Bosentan
- Butabarbital
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Carbamazepine
- Cenobamate
- Ceritinib
- Chloramphenicol
- Cimetidine
- Ciprofloxacin
- Clarithromycin
- Cobicistat
- Colchicine
- Colchicine; Probenecid
- Conivaptan
- Crizotinib
- Cyclosporine
- Dabigatran
- Dabrafenib
- Danazol
- Dapagliflozin; Saxagliptin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deferasirox
- Delavirdine
- Dexamethasone
- Dexlansoprazole
- Digoxin
- Diltiazem
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Doxorubicin
- Dronedarone
- Duvelisib
- Edoxaban
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix
- Elagolix; Estradiol; Norethindrone acetate
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir disoproxil fumarate
- Enzalutamide
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Esomeprazole
- Esomeprazole; Naproxen
- Etravirine
- Famotidine
- Famotidine; Ibuprofen
- Fedratinib
- Fexofenadine
- Fexofenadine; Pseudoephedrine
- Fluconazole
- Fluvoxamine
- Fosamprenavir
- Fosphenytoin
- Glecaprevir; Pibrentasvir
- grapefruit juice
- H2-blockers
- Idelalisib
- Imatinib
- Indinavir
- Irinotecan
- Irinotecan Liposomal
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ketoconazole
- Lamivudine; Tenofovir Disoproxil Fumarate
- Lansoprazole
- Lansoprazole; Naproxen
- Lapatinib
- Lefamulin
- Letermovir
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lorlatinib
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Magnesium Hydroxide
- Maraviroc
- Mephobarbital
- Metformin; Saxagliptin
- Methohexital
- Mifepristone
- Mitotane
- Modafinil
- Morphine
- Morphine; Naltrexone
- Nafcillin
- Nefazodone
- Nelfinavir
- Netupitant, Fosnetupitant; Palonosetron
- Nevirapine
- Nicardipine
- Nilotinib
- Nizatidine
- Octreotide
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole
- Omeprazole; Amoxicillin; Rifabutin
- Omeprazole; Sodium Bicarbonate
- Pantoprazole
- Pazopanib
- Pentobarbital
- Phenobarbital
- Phenytoin
- Posaconazole
- Primidone
- Proton pump inhibitors
- Quinine
- Rabeprazole
- Ranitidine
- Ranolazine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Rifaximin
- Rimegepant
- Ritonavir
- Romidepsin
- Saquinavir
- Saxagliptin
- Secobarbital
- Simeprevir
- Sirolimus
- Sodium Bicarbonate
- St. John’s Wort, Hypericum perforatum
- Talazoparib
- Telithromycin
- Telotristat Ethyl
- Temsirolimus
- Tenofovir, PMPA
- Thiopental
- Tipranavir
- Tolvaptan
- Topotecan
- Trandolapril; Verapamil
- Tucatinib
- Ubrogepant
- Venetoclax
- Verapamil
- Vincristine
- Vincristine Liposomal
- Voriconazole