(For veterinary information only)
WARNING
The size of the tablet/medication is NOT an indication of a proper dose. Never administer any drug without your veterinarian's input. Serious side effects or death can occur if you use drugs on your pet without your veterinarian's advice.
It is our policy not to give dosing information over the Internet.
Brand Name: Palladia
Available in 10 mg, 15 mg, and 50 mg tablets
Background
Toceranib phosphate is a chemotherapy agent developed to target a particular type of tumor in dogs: the mast cell tumor. Mast cell tumors are highly inflammatory and invasive with varying tendency to spread and the development of this medication has been a welcome addition to the list of treatment options. Toceranib phosphate is what is called a “tyrosine kinase inhibitor.” It has two actions against tumors: first, it kills the tumor cells directly, and second, it interferes with the tumor’s blood supply.
Since its release and success against the mast cell tumor, much research has been conducted using toceranib phosphate against other tumors, particularly those not generally amenable to other types of chemotherapy agents. Tumors that have been found to show a notable response to this medication include:
Research is continuing to determine new uses for this relatively unique medical approach to cancer.
How this Medication is Used
Toceranib phosphate is a tablet usually given every other day to dogs with mast cell tumors. Periodic monitoring blood tests are recommended.
The pill may be given with or without food.
Keep away from light and store at room temperature. Do not refrigerate.
If you miss a dose, do not double up on the next dose. Simply give the medication when you remember or pick up with the next dose, allowing at least the proper interval between doses according to the label instructions.
Side Effects
The most common side effects of toceranib phosphate include:
- Diarrhea
- Appetite loss
- Lameness
- Weight loss
- Bloody stool (either black and tarry or with fresh blood)
Notify your veterinarian if any of the above occurs. In fact, the drug should be temporarily discontinued in the event of more than two episodes of vomiting or diarrhea in a 24-hour period; appetite loss; more than two days of fresh blood in stool; or unexplained bruising you might find during grooming or petting. Report any such episode to your veterinarian and expect a dose reduction after your pet returns to normal.
Blood test monitoring may reveal anemia (deficiency of red blood cells), a drop in neutrophil (a type of white blood cell) count, an increase in renal toxin buildup (azotemia), elevated blood phosphate, or a drop in blood albumin level. Any of these changes warrant temporary discontinuation of the medication.
Some dogs have depigmentation of their nose or fur during treatment with toceranib phosphate.
Interactions with Other Drugs
Use of toceranib phosphate with non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of intestinal bleeding. That said, it is not unusual to combine toceranib phosphate with piroxicam, an NSAID that has anti-tumor properties. In this situation, medications are given on alternating days, and the combination seems to be well tolerated.
Use of toceranib phosphate with non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of intestinal bleeding.
Concurrent use with calcitriol, the active form of vitamin D, appears to enhance the activity of toceranib phosphate. Exploiting this enhancement is currently being studied.
Concurrent use with antifungal medications such as ketoconazole, itraconazole, or fluconazole may increase toceranib phosphate concentrations in the body. It is a theoretical issue at this point, but worth consideration.
There is some feeling that four to seven days of antacids, carafate, and anti-inflammatory medication before starting toceranib phosphate can minimize the potential for side effects.
Concerns and Cautions
- Toceranib phosphate should not be considered a substitute for surgery.
- Toceranib phosphate is typically given every other day. The dose is frequently altered based on the response.
- Wash your hands after handling this medication. Do not break the tablets, as they have a special coating.
- If the dog spits out the tablet or the tablet gets wet in any way, use gloves to handle the tablet.
- Wear protective gloves when handling the stool, vomit, or urine of a dog using toceranib phosphate. Seal the waste in double plastic bags before placing it in the trash to minimize exposure of other people to the trash. Any laundry items contaminated with stool, vomit or urine of a dog on toceranib phosphate should be washed separately.
- Feline use is still in the early stages of the investigation but appears promising.
- There are some concerns of abnormal blood clotting. If surgery is planned, it is best to wait at least three days from the last dose of toceranib phosphate before surgery to minimize complications.
- Expect blood pressure to be monitored regularly during toceranib phosphate use.
- Safety of toceranib phosphate has not been evaluated in dogs under age 2 years nor in dogs under 11 lbs.
The manufacturer of toceranib phosphate has created this client information sheet/product insert and recommends that it accompany each prescription.