Best time to take Tarceva

[Greybird]

A recent biopsy of a lymph node in my neck confirmed that the cancer continued to grow in spite of the radiation and chemo treatments I'd received, so my doctor put me on Tarceva (150 mg) about a week ago. I have a couple of questions and I am hoping those of you with more experience can help me.

First, what is the best time to take Tarceva? I know it should be taken on a empty stomach but is it wise to take it just before bedtime and then not eat until the morning? Or, is it better to take it between two meals that are spaced apart enough to meet the "empty stomach" requirement? I guess my real question is are the side effects any more or less severe depending on the time of day and length of time between meals?

And, what kind of lotion is good for the rash? I've heard that Eucerin is good but it contains "cetyl alcohol" and I thought products with alcohol were bad?????

Also, regarding the rash, is it ok to cover it up with make-up? I need to cover for my boss for the next few weeks while he takes a much needed vacation. Although I generally try to maintain a low profile when I'm at work, I will be required to be more "visible" while he is gone. I've started developing a pretty good rash on my face and I don't really want to deal with the staring and the questions that will arise when people see me.

Sorry for the long post - I'm just trying to make these side effects manageable so that I can tolerate this medicine for a very long time.

Thanks! You guys are the best!!

Sharon

[recce101]

Hi, Sharon. Check these 3 links for lots of information on managing Tarceva side effects:

http://cancergrace.org/lung/2008/10/22/wird-egfr-rash/

http://cancergrace.org/forums/index.php ... 04#msg2904

http://cancergrace.org/forums/index.php ... 70#msg3170

I don't think it matters when you take the Tarceva, as long as it's at least 2 hours since you ate and at least 1 hour before you're going to eat again. Some people seem to experience a few hours of fatigue shortly after taking the tablet, so they prefer to take it at bedtime for that reason. I haven't noticed that specific effect myself — just a general lack of energy which could be from age and all the other stuff I'm taking as much as from the Tarceva — so I take it between 10 and 11 AM. I do get sluggish for a couple of hours after lunch, but that's been a lifelong pattern.

I haven't used Eucerin. What I have found very helpful is maintaining a good routine of skin care and lubrication, something that was never on my priority list before I started Tarceva. This includes use of a non-drying soap or body wash for bathing/showering (I currently use Dove Body Wash Sensitive Skin), then liberal daily use of a fragrance-free hypoallergenic moisturizing lotion (such as Cetaphil or Vaseline Intensive Rescue). I do this before bedtime, then the next morning put a dab of Clindamycin gel on any red bumps/pustules that are visible. There were quite a number of these around weeks 2 thru 8, then the rash calmed down considerably. With the daily lube (also oral doxycycline) I don't get any of the itching that drove me up the wall initially. I don't think makeup would be a problem, but maybe Jamie (Jyoung20) or another of the ladies can give you first-hand tips on that.

Best wishes and Aloha,

Ned

[Janet B]

Hi Sharon

I don't think it matters when you take the Tarceva either. Because I wake up starving and am an all day snacker - I choose to take my Tarceva at bedtime - I usually eat desert at 9 - take the Tarceva at 11.

As for lotions - my oncologist has me using all Dove products - skin and hair and it seems to be working well. I was having a terrible time controlling the rash on my scalp and it is all cleared up now. Like Ned - I use Clindamycin on the rash.

As for make -up, I use it very sparingly. Especially eye make up, because of Tarceva side effects. First my eyelashes tend to get oozy, almost like conjunctivitis, which makes mascara a problem. Also, because my skin has become so dry, my eyelids get irritated and raw. When I do wear makeup -I use Oil of Olay cleansing wipes which are very gentle and do a good job. As far as "covering up" the rash - I think you could try it as long as you cleanse it well at the end of the day.

Hope that helps a little

Peace

Janet

[SandraL]

Hi Greybird. I take my Tarceva in the morning. It is followed very shortly by coffee which I hope is ok.

I have found eucurin to be a very helpful cream in dealing with dry skin. I do wear makeup during the day but I give myself a full "facial" every night. An Oil of Olay cleanser and lots of eucurin. I started wearing foundation when I went bald. Decided I would do what I could with what I had. I have continued using it throughout, including on top of the rash. It is a fairly expensive one mind you with a good moisturizer and sun screen. It only really felt icky with my first really bad outbreak of Tarceva. Since then I have had no problem continuing to use it.

Best wishes to you. I work as well and do feel the need to look as presentable as possible as I interact with many people.

Sandra

[Wendy]

I have been on Tarceva close to 3 years now. I found that I couldn't take it at night before I went to bed because it aggrevated my acid reflux in the middle of the night. I found the best time for me was right between lunch and dinner.

I have worn foundation with the rash. I have several I use depending on how dry or irritated my skin is. Sometimes I use a tinted moisturizer instead of foundation if my skin is really really dry. I wear a dry skin formula foundation from clinique too.

I hope that you find a combo that works good for you.

Wendy

[Greybird]

Thanks everyone for the information!

I've started reading the posts from the links that Ned sent. Wow - it is so nice that someone took the time to compile all of those posts in one spot.

I already use the Olay cleansing cloths on my face but it sounds like I'll need to give the Dove products a try. I am bothered more by the rash around my nose right now (can you say Rudolph?) and never really thought about the Tarceva affecting my eyes. I'll definately keep Janet's advice in mind and go easy on the eye shadow. And mascara won't be a problem for now anyway as I still do not have any eyelashes.

And, I must confess that one of my biggest concerns was how I was going to get all of my daily snacks in if I have to take this medicine on an empty stomach! For now, I've settled on taking the Tarceva mid afternoon and it seems to be working out well.

Wendy - Do you take any medicine for the acid reflux? I've been on prilosec for over two years and, when I read that you shouldn't take prilosec when taking Tarceva I called my doctor to see if I should stop. He told me to just be sure to take them at least 2 hours apart. I'm not sure I'm comfortable with that advice and I plan on talking to him tomorrow at my next appointment.

Sorry..I'm rambling again.

Thanks again!!

P.S. SandraL - How was your vacation?

[recce101]

I've been on prilosec for over two years and, when I read that you shouldn't take prilosec when taking Tarceva I called my doctor to see if I should stop. He told me to just be sure to take them at least 2 hours apart. I'm not sure I'm comfortable with that advice and I plan on talking to him tomorrow at my next appointment.

Sharon, I believe the idea that proton pump inhibitors (such as Prilosec) may interfere with the effectiveness of Tarceva is still somewhat controversial and probably not discussed in the standard reference materials used by physicians and pharmacists, so I wouldn't expect a doctor other than an oncologist (and not even all of them) to be familiar with the issue. In case your cancergrace.org reading hasn't taken you down to the Tarceva vs. acid reflux discussions, here's one of my contributions:

http://cancergrace.org/forums/index.php ... 420#msg420

By eliminating raw tomatoes and greatly reducing tomato-based sauces and soups, I now have predictable control over acid reflux. If we're planning to have a family favorite like eggplant parmigiana or lasagna for dinner, I'll take it easy on the previous meals and avoid the leftovers the following day. With those precautions, I find I don't need any antacid medications at all except a $3 jug of Wal-Mart liquid antacid that I take a little swig from on occasion. I'm really happy with how this has worked out.

Aloha,

Ned

[cat127]

"recce101"]

Sharon, I believe the idea that proton pump inhibitors (such as Prilosec) may interfere with the effectiveness of Tarceva is still somewhat controversial and probably not discussed in the standard reference materials used by physicians and pharmacists

I wouldn't use the word controversial, but the issue is that although we KNOW it interferes with the absorption of Tarceva, we don't know if it interferes with the efficacy of Tarceva. And we will never know that, as those studies won't be done. So we recommend not taking them together. The dr's advice to space them a couple hours apart is WRONG, as something like prilosec actually alters the gastric pH for a very very long time, so it is not possible to space them apart to overcome the decreased absorption.

And this information is in the current label of Tarceva, but you are correct Ned in that it wasn't in there prior to the latest label (from a couple months ago). So any dr that isn't looking at the most recent label, would not know this information if they hadn't really been out there looking for it. I know Kelly's Dr. learned it from me.

Here is the comment in the newest PI for Tarceva, and FYI omeprazole=prilosec

Co-administration of TARCEVA with omeprazole, a proton pump inhibitor, decreased the erlotinib AUC by 46%. Increasing the dose of TARCEVA when co-administered with such agents is not likely to compensate for the loss of exposure. Since proton pump inhibitors affect pH of the upper GI tract for an extended period, separation of doses may not eliminate the interaction. The concomitant use of proton pump inhibitors with TARCEVA should be avoided if possible. The use of antacids may be considered in place of histamine 2 receptor blockers (H2 blockers) or proton pump inhibitors in patients receiving TARCEVA. However, no clinical study has been conducted to evaluate the effect of antacids on erlotinib pharmacokinetics. If an antacid is necessary, the antacid dose and the TARCEVA dose should be separated by several hours

[recce101]

Thanks for the excellent clarification, cat. I've bookmarked your post for reference whenever the subject comes up again. Aloha,

Ned

[CAL]

Thanks for this discussion. I've been taking Tarceva (150) for just over two weeks now and was experiencing lack of appetite, mild nausea and fatigue. I was taking Tarceva first thing in the morning and it seems that for around 4 hours afterwards I felt sick and very tired.

Since reading this thread I have decided to take Tarceva before sleep (starting tonight). So far today my feelings of fatigue have gone so I am keeping my fingers crossed that this was a side effect of Tarceva.

I'd be interested to know if people who originally had a lack of appetite found that it came back?

[cat127]

Glad to help Ned. PI's for drugs are always evolving as new information is obtained and reviewed by the FDA. But people may not always be working from the latest version. So folks can definitely go to www.fda.gov and find on their website a new version of the insert (though even that may not be the most up-to-date, but only by a month or so). If folks have a dr that isn't aware of the issue with gastric pH and Tarceva bioavailability, then it may be worthwhile printing a copy of the latest PI and taking it with you to the appt.

[Wendy]

Greybird,

I have taken protonix in the am daily and nexium at night for the 3 years I have been on tarceva.

I had a paralyzed vocal cord when my lung was removed 4 years ago. Because of the vocal cord surgery I had to fix it, my throat is super sensitive. I needed the double doseage of ppi so it didn't interfere with my speech further. For me, it is essential to take the ppi's in order to communicate above a whisper.

With the new warning labels, I will be discussing it with my oncologist.

I hope Tarceva is your magic bullet too.

Wendy