Nilotinib Eg (Nilotinib)

Nilotinib is a targeted therapy that acts on the BCR‑ABL tyrosine‑kinase pathway in myeloid malignancies.

• Chronic myeloid leukemia (CML): reduces disease progression and improves long‑term survival.
• Philadelphia chromosome‑positive acute lymphoblastic leukemia (Ph+ ALL): provides an alternative targeted option.
• Imatinib‑resistant CML: offers a second‑line treatment for patients who have failed first‑line therapy.

• Nilotinib selectively binds to the ATP‑binding site of the BCR‑ABL fusion protein, inhibiting its tyrosine‑kinase activity. This blockade prevents downstream signaling that drives uncontrolled proliferation of leukemic cells, leading to cell cycle arrest and apoptosis of the malignant clone.

Adverse reactions may occur with any medication. The following list reflects the most frequently reported events and those that require prompt medical attention.

Common Side Effects

• Nausea: mild to moderate upset stomach.
• Diarrhea: loose stools that may be watery.
• Rash: skin redness or itching.
• Fatigue: feeling unusually tired.

Serious or Rare Side Effects

• QT interval prolongation: may cause abnormal heart rhythms.
• Pancreatitis: severe abdominal pain with elevated enzymes.
• Hepatic injury: jaundice or abnormal liver tests.
• Severe neutropenia: markedly low white blood cell count increasing infection risk.

Nilotinib requires careful monitoring and patient education to minimise risks.

• Cardiac monitoring: assess ECG and electrolytes before and during therapy.
• Hematologic monitoring: regular complete blood counts to detect neutropenia or thrombocytopenia.
• Avoid QT‑prolonging drugs: co‑administration can increase arrhythmia risk.
• Hepatic impairment: dose adjustment may be needed in patients with liver dysfunction.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Nilotinib may interact with several drug classes; awareness helps prevent adverse outcomes.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): can raise nilotinib plasma levels.
• QT‑prolonging agents (e.g., amiodarone, sotalol): increase risk of cardiac arrhythmias.
• Antacids containing aluminum or magnesium: reduce nilotinib absorption.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inducers (e.g., rifampin, carbamazepine): may lower drug exposure.
• Other tyrosine‑kinase inhibitors: overlapping toxicities require dose adjustments.
• Warfarin: may enhance anticoagulant effect, necessitating INR monitoring.