Glivec (Imatinib)

Glivec is indicated for several BCR‑ABL positive malignancies and related cancers. It is commonly prescribed in the following clinical situations:

• Chronic myeloid leukemia (CML)
• Philadelphia chromosome‑positive acute lymphoblastic leukemia (Ph+ ALL)
• Gastrointestinal stromal tumor (GIST)
• Other BCR‑ABL positive hematologic malignancies
• Off‑label use in select solid tumors under specialist supervision

Side effects of Glivec vary in frequency and severity. Patients should be aware of both common and serious reactions.

Common

• Nausea and vomiting
• Diarrhea or constipation
• Fatigue or weakness
• Edema, especially peripheral swelling
• Muscle cramps or joint pain

Serious

• Severe liver enzyme elevation
• Cardiac dysfunction or heart failure
• Severe neutropenia or thrombocytopenia
• Pulmonary arterial hypertension
• Life‑threatening allergic reactions

Glivec requires careful monitoring and specific precautions before and during therapy. Important considerations include:

• Baseline and periodic liver function tests
• Regular complete blood counts to detect cytopenias
• Cardiac evaluation for patients with pre‑existing heart disease
• Pregnancy avoidance; the drug is category D and may cause fetal harm
• Contraception for both male and female patients of reproductive potential
• Monitoring for signs of fluid retention or pulmonary hypertension

Glivec can interact with several drug classes, affecting its efficacy or safety profile.

Avoid

• Strong CYP3A4 inhibitors such as ketoconazole, clarithromycin, or ritonavir
• Certain antacids containing aluminum or magnesium that may reduce absorption

Use with caution

• CYP3A4 inducers like rifampin, phenytoin, or St. John's wort
• Concomitant anticoagulants (e.g., warfarin) due to bleeding risk
• Other myelosuppressive agents that may increase cytopenia risk
• Medications that prolong QT interval