Major TKI side effects
| TKI side effects . | Recommended intervention . |
|---|---|
| Hematologic toxicity: neutropenia, anemia, or thrombocytopenia | Hold TKI until count recovery for up to 2 wks; G-CSF may be administered to treat neutropenia; restart at full dose if cytopenia persists < 2 wks; reduce dose by 20% if longer than 2 wks |
| Rash | Observation; consider topical steroids |
| Elevated liver function tests | Observation |
| Muscle cramps | Supportive care, consider electrolyte repletion |
| Nausea, vomiting | Supportive care, consider ondansetron |
| Headache | Supportive care |
| Edema | Restrict salt intake, consider diuretics |
| Cardiac toxicity | Consider ECG, echocardiogram, electrolytes if there is clinical concern |
| Imatinib: possible, not proven | |
| Dasatinib: possible, not proven | |
| Nilotinib: QT prolongation and sudden death have been reported | Do not use nilotinib with history of cardiac or electrolyte problems |
| Effusions | Hold TKI; if multiple sites of edema, give diuretics; and if severe, thoracentesis and brief course of steroids |
| Dasatinib: pleural effusions | |
| Decreased height/growth retardation | Closely monitor height |
| Poor bone health | Closely monitor calcium and phosphorus; replete as necessary |
| Teratogen | Avoid TKIs during pregnancy |
| TKI side effects . | Recommended intervention . |
|---|---|
| Hematologic toxicity: neutropenia, anemia, or thrombocytopenia | Hold TKI until count recovery for up to 2 wks; G-CSF may be administered to treat neutropenia; restart at full dose if cytopenia persists < 2 wks; reduce dose by 20% if longer than 2 wks |
| Rash | Observation; consider topical steroids |
| Elevated liver function tests | Observation |
| Muscle cramps | Supportive care, consider electrolyte repletion |
| Nausea, vomiting | Supportive care, consider ondansetron |
| Headache | Supportive care |
| Edema | Restrict salt intake, consider diuretics |
| Cardiac toxicity | Consider ECG, echocardiogram, electrolytes if there is clinical concern |
| Imatinib: possible, not proven | |
| Dasatinib: possible, not proven | |
| Nilotinib: QT prolongation and sudden death have been reported | Do not use nilotinib with history of cardiac or electrolyte problems |
| Effusions | Hold TKI; if multiple sites of edema, give diuretics; and if severe, thoracentesis and brief course of steroids |
| Dasatinib: pleural effusions | |
| Decreased height/growth retardation | Closely monitor height |
| Poor bone health | Closely monitor calcium and phosphorus; replete as necessary |
| Teratogen | Avoid TKIs during pregnancy |