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Everolimus is used to treat the following:

-Hormone receptor-positive (HR+), human epidermal growth factor receptor-2 (HER-2)-negative breast cancer, in combination with the medication exemestane.

-Pancreatic cancer (i.e., pancreatic neuroendocrine tumour [PNET]).

-Neuroendocrine tumour (NET) of the stomach, intestine (gastrointestinal), or lung.

-Kidney cancer, called renal cell carcinoma or angiomyolipoma, and tuberous sclerosis complex.

-Brain tumour, called subependymal giant cell astrocytoma (SEGA).

Dose and Schedule

Taking Everolimus as instructed is important to ensure that your treatment is as effective as possible. Here are some key points to remember:

  • Your dose may vary, but the usual dose of Everolimus is:
    • 10 milligrams taken by mouth at a scheduled time once a day for 4 weeks.
  • Everolimus can be taken with or without food. Choose one (with or without food) and take it at the same time each day.
  • Take Everolimus with a full glass of water.
  • Everolimus should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow Everolimus, speak to your doctor about possible alternatives.
  • If you miss a dose of Everolimus:
    • Only take the missed dose if it has been less than 6 hours since you were supposed to take it. Then take the next dose at the regularly scheduled time.
    • If it has been more than 6 hours since you should have taken it, do not take the missed dose.
    • Do not take an extra dose or two doses at once. Simply take the next dose at the regularly scheduled time.
    • Write down if you miss a dose and inform your doctor about any missed doses.
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Drug and Food Interactions

  • Everolimus has many drug interactions. Inform your doctor about all prescription medications, over-the-counter medications, vitamins, and herbal products you are taking.
  • Grapefruit or grapefruit juice may interact with Everolimus; avoid eating or drinking these during treatment with Everolimus.
  • Talk with your doctor or pharmacist before taking new medications or supplements or receiving any vaccines.
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Storage and Handling

  • Handle Everolimus with care. Just like chemotherapy administered into the vein, this drug can be toxic, and exposure to others should be limited.
  • Store Everolimus at room temperature (below 25°C) in a dry location away from light.
  • Keep Everolimus out of the reach of children and pets.
  • Leave Everolimus in the provided packaging until it is ready to be taken.
  • Whenever possible, administer Everolimus to yourself.
  • If a family member, friend, or caregiver needs to administer Everolimus, they should wear gloves when handling the tablets.
  • Administer the medicine immediately by mouth with water.
  • If you have any unused Everolimus, do not throw it in the trash or flush it down the sink or toilet. Return all unused medication to your practice for proper disposal.
  • When travelling, place Everolimus packaging in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed.
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Side Effects of Everolimus

The following side effects are common and have been known to occur in 30% of patients taking Everolimus. Please note that you may not experience these side effects.

Decreased white blood cells (WBCs) and increased risk of infectionA blood test will be done before starting a new cycle of Everolimus to monitor your white blood cells, haemoglobin, platelet count, liver and kidney function. Take precautions to protect yourself from infection: • Wash your hands often, especially before eating and after using the bathroom. • Avoid crowds and people with fevers, flu, or other infections. • Bathe regularly to maintain good personal hygiene. Contact our unit if you experience any signs or symptoms of infection such as fever (over 38°C), chills, sore throat, or burning during urination.
Decreased haemoglobin (iron and oxygen-carrying part of red blood cells)When your haemoglobin is low, you may feel more tired or fatigued. • Try to get 7–8 hours of sleep per night. • Balance work and rest. • Stay active, but rest as needed. • You may also notice that you look more pale than usual. Let us know if you experience shortness of breath, chest discomfort, dizziness, or palpitations.
Decreased platelet count and increased risk of bleeding• Use caution to avoid bruises, cuts, or burns. • Blow your nose gently and avoid picking your nose. • Brush your teeth gently with a soft toothbrush. • Use an electric razor instead of razor blades when shaving. Contact us if you experience bleeding that won’t stop, such as: • A bloody nose that bleeds for more than 5 minutes. • A cut that continues to ooze despite pressure. • Excessive gum bleeding when flossing or brushing. • Red or brown urine.
Changes in liver functionContact us if you notice yellowing of your skin or the whites of your eyes, or dark brown urine.
Changes in kidney functionSigns of decreased kidney function may include decreased urination or unusual swelling of your legs and feet.
Changes in electrolytes and other laboratory valuesA blood test will be done regularly to monitor these changes, including glucose, prothrombin time, cholesterol, triglycerides, calcium, phosphate, and albumin levels.
FatigueYou may feel more tired than usual. • Stay active, but take rest as needed. • Plan activities for times when you feel more energetic.
DiarrhoeaStay hydrated by drinking 8–10 glasses of water unless your doctor has instructed otherwise. • Eat small, frequent meals. • Eat bland, low-fibre foods. • Avoid high-fibre foods, gas-producing foods, and lactose-containing products. If diarrhoea increases, use over-the-counter medication like Loperamide (Imodium) or Smecta.
Mouth irritation or soresMaintain good oral hygiene and rinse your mouth frequently. • Use a soft toothbrush and avoid spicy, acidic, or hard foods. • Apply lip balm to keep lips soft.
Decreased appetite or weight lossTalk to your doctor if you notice significant weight loss. • Eat small, frequent meals and keep snacks nearby. • Drink liquid nutritional supplements.
Rash or itchy skinKeep your skin moisturised, wear loose-fitting clothing, and avoid sun exposure. • Apply sunscreen with at least SPF 30, wear hats, and protective clothing.
Fluid retention or swellingAvoid standing for long periods. • Keep your legs elevated when sitting or lying down. • Weigh yourself daily and avoid salty foods. Contact your doctor if you notice swelling in your hands, feet, or legs, shortness of breath, or a weight gain of 2kg or more in a week.
HeadacheContact your doctor if your headache is severe, persistent, or accompanied by symptoms like vomiting, visual disturbance, or confusion.
Muscle or joint pain or weaknessStay as active as possible but take rest when needed. • Keep a diary of your pain and discuss with your doctor if it interferes with your daily activities.
Cough or shortness of breathNotify your doctor immediately if you experience a dry cough or shortness of breath.
Abdominal painReport any serious or persistent abdominal pain to your doctor.
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Handling Body Fluids and Waste

Because Everolimus remains in your body for several days after it is taken, some of the drug may be present in your urine, stool, sweat, or vomit. It is important to follow the instructions below for the duration of your treatment to keep yourself, loved ones, and the environment safe:

  • Pregnant women should avoid touching anything that may be soiled with body fluids from the patient.
  • Toilet use: Close the lid and flush twice to ensure all waste has been discarded. Clean any soiled surfaces before others use the toilet.
  • Wash hands with soap and water after using the toilet.
  • If using a bedpan, ensure your caregiver wears gloves and cleans the bedpan daily with soap and water.
  • Use disposable pads, diapers, or sheets if you are unable to control bladder or bowel movements.
  • Wash any skin exposed to body fluids or Everolimus with soap and water.
  • Laundry: Wash soiled linens or clothing separately from other items, and wash hands after handling them.
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Pregnancy, Sexual Activity, and Contraception

  • Women should not become pregnant, and men should not father a child while taking Everolimus. Both men and women of childbearing age should use effective contraception during therapy and for at least 8 weeks after the last dose of Everolimus.
  • Do not breastfeed while taking Everolimus and for 2 weeks after the last dose.
  • Inform your doctor immediately if you become pregnant.
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Compiled by : Karin Mouton

Registered Oncology Nurse

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