Everolimus (Afinitor)
Everolimus is a type of targeted cancer drug. It is also known as Afinitor.
It is a treatment for a number of different cancer types.
You pronounce everolimus as eh-veh-roh-lih-mus.
How does everolimus work?
Everolimus is a type of targeted drug called an 
. mTOR is a type of protein called a kinase protein. In some types of cancer, mTOR is switched on, which makes the cancer cells grow and produce new blood vessels. mTOR blockers can stop the growth of some types of cancer.
How do you take everolimus?
You take everolimus as a tablet once a day.
When taking everolimus tablets you swallow them whole with a full glass of water. You have the tablets with or without food. You should not crush or chew the tablets. You usually have them at the same time each day.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.
How often do you have everolimus?
You will have treatment for as long as it is working and the side effects aren’t too bad.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
What are the side effects of everolimus?
Side effects can vary from person to person. They also depend on what other treatments you're having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
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you have severe side effects
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your side effects aren’t getting any better
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your side effects are getting worse
Early treatment can help manage side effects better.
Contact your advice line immediately if you have signs of infection, including a temperature above 37.5C or below 36C.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Hepatitis B
Hepatitis B is a viral infection that affects the liver. This drug can make hepatitis B infection active again. So, you should let your doctor know if you have had hepatitis B in the past.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Decreased appetite and weight loss
You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss.
Raised blood sugar levels
You have regular blood and urine tests to check this. If you have diabetes you may need to check your blood sugar levels more often than usual.
Less commonly, you might develop diabetes mellitus.
Raised cholesterol levels
Cholesterol is a fatty substance which helps cells in the body to work normally. When the cholesterol level is too high it could have an effect on your heart. You usually have blood tests to check your cholesterol levels.
Taste changes
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.
Rarely, you may lose your taste.
Headaches
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
Lung problems
You might develop a cough or breathing problems. This could be due to inflammation of the lungs.
Less commonly symptoms are due to scarring (fibrosis) of the lungs.
Rarely you may cough up blood and have a high temperature (fever) or have fluid building up in the lungs causing less oxygen to reach the bloodstream.
Contact your doctor or nurse straight away if you have any of the above symptoms.
Nose bleeds
This might be due to a drop in the number of platelets in your blood. Platelets help the blood to clot. So if you have too few platelets you can bleed more easily.
To try and stop a nose bleed hold your nose tightly just above your nostrils and lean forward slightly. Do this for about 10 to 15 minutes. You can still breathe through your mouth. Contact your advice line if you keep getting nose bleeds or it doesn't stop.
Sore mouth and ulcers
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.
Rarely, you might have pain or a hot, burning sensation in the mouth or you might have a swollen, inflamed tongue.
Diarrhoea
Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.
Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables.
Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
Skin and nail problems
Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.
Less commonly, you might have an acne rash, red or peeling skin or skin bumps. Or you might have nail changes such as your nails breaking.
Tiredness and weakness (fatigue)
Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Swollen hands and feet
Swelling of hands and feet is due to fluid build up. This is called oedema. Let your doctor or nurse know if you have any swelling.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- a drop in the level of platelets which can cause bruising and bleeding gums after brushing your teeth or lots of tiny red spots or bruises on your arms or legs (known as petechiae). Or you might have bleeding from other areas of the body. Let your doctor or nurse know if this happens
- high levels of fats in your blood – you have regular blood tests to check this
- lack of fluid in your body (dehydration)
- difficulty sleeping
- high blood pressure that might cause headaches, confusion, vision problems or chest pain
- a build up of lymph fluid in tissues causing swelling (lymphoedema)
- a dry mouth
- indigestion
- difficulty swallowing
- pain in your tummy (abdomen)
- soreness, redness and peeling on palms and soles of feet
- aching or painful joints
- irregular periods. Rarely, your periods may stop completely
- low levels of substances in the blood such as potassium, calcium or phosphate
- hair thinning
- liver changes – you have regular blood tests to check this
- changes to the way your kidneys work, which could be severe - tell your doctor if you're not passing much urine, have back pain or feel confused. Rarely, you may pass more urine during the day or your kidneys might stop working suddenly. You will have regular blood tests to check this
- swelling of your eyelids
- a high temperature (fever)
Rare side effects
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
- an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening. Alert your nurse or doctor if you notice any of these symptoms
- changes to the heart muscle, causing it to be less able to pump blood around the body
- coughing up blood (haemoptysis)
- chest pain – let your doctor or nurse know if you have this
- wounds taking longer to heal
- hot flushes
- red, itchy or uncomfortable eyes
- blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
Other side effects
You might have inflammation of the skin in an area where you had radiotherapy before. There isn't enough information to work out how often this side effect might happen.
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do you need to know?
Other medicines, foods and drink
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. It is important for women not to become pregnant while you are having treatment and for 8 weeks afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you become pregnant while you're having treatment.
Fertility
It is not known whether this treatment affects in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Breastfeeding
Don’t breastfeed during this treatment and for 2 weeks after your last dose, because the drug may come through into your breast milk.
Treatment for other conditions
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Immunisations
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your recovers from treatment.
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
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