Tivozanib (Fotivda®)

Tivozanib comes as capsules you take at home. 

During treatment, you usually see a:

• cancer doctor
• cancer nurse or specialist nurse
• specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Your doctor, nurse or pharmacist will discuss your treatment plan with you. They will give you the capsules to take home. 

While you are taking tivozanib, you will have regular blood samples taken to check different things. For example, the level of your blood cells and how well your liver, kidneys and thyroid gland are working.

You may also have a urine (pee) test before, and possibly during, treatment to check your kidneys.

You take tivozanib once a day, every day, for 21 days. You then have a break of 7 days when you do not take it. These 28 days are called a cycle of treatment. 

You usually take tivozanib for as long as:

• it is working for you
• and the side effects can be managed.

Do not stop taking tivozanib without talking to your doctor first.

The nurse or pharmacist will give you the capsules to take home. 

Your doctor, nurse or pharmacist will explain your treatment plan. Always take the capsules exactly as explained. This is to make sure they work as well as possible for you. 

Take the capsule whole with a glass of water.  Do not chew, dissolve, open or crush the capsule. Tivozanib can be taken with or without food.

If you forget to take your capsules or are sick after taking them, take your next dose at the usual time. Do not take a double dose.

Other things to remember:

• keep the capsules in the original package and at room temperature
• ay from moisture, heat and direct sunlight
• keep the capsules safe and out of the sight and reach of children
• get a new prescription before you run out of capsules
• if you go on holiday, make sure you have plenty of capsules 
• if you stop treatment, return any unused capsules to the pharmacist.

Tivozanib can cause high blood pressure. You may need to take drugs to control this during your treatment. Tell your doctor or nurse if you have ever had high blood pressure or taken drugs for this.

Your doctor or nurse will check your blood pressure regularly. They may also show you how to check your blood pressure at home. Tell them if you have any headaches as this can be a symptom of high blood pressure. 

High blood pressure may increase the risk of a mini stroke or stroke. Call 999 to get help straight away if you or other people notice:

• you are confused
• you have difficulty speaking
• your face is drooping 
• you have numbness or weakness on one side of your body.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

• try to drink at least 2 litres (3½ pints) of fluids each day
• avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
• contact the hospital for advice

You may be given anti-diarrhoea tablets to take at home.

If you feel sick, your doctor can give you anti-sickness drugs to control this. Take the drugs exactly as your nurse or pharmacist tells you.

If you continue to feel sick or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They can give you advice. Your doctor or nurse can change the anti-sickness drug to one that works better for you.

Tivozanib can cause pain or discomfort in your tummy (abdomen). It can also cause heartburn (indigestion). Your doctor can give you drugs to help with these side effects. 

Rarely tummy pain can be a sign of a more serious problem. Always tell your doctor if the pain does not improve or gets worse.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• a sore mouth or throat affects how much you can drink or eat 
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

Your voice may become hoarse or sound different to usual. This usually gets better after treatment ends. Tell your doctor or nurse if you have a sore throat.

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

• be sore
• be painful, tingle, or swell
• peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

• keeping your hands and feet cool by washing in cool water
• gently moisturising your hands and feet regularly
• wearing gloves to protect your hands and nails when working in the house or garden
• wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Tivozanib can affect the skin. You may develop a rash and your skin may feel dry and itchy. It may peel. Tell your doctor or specialist nurse if you notice any skin changes. They can advise you about creams or lotions to help with dryness. They can also prescribe medicines to help with itching.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

You may get pain in your back, muscles or joints. You may get pain in the area where the cancer is. Tell your doctor if this happens, so they can give you painkillers. Tell them if the pain does not get better. 

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Tivozanib capsules contain a food colouring called tartrazine. If you are allergic to tartrazine, talk to your doctor before taking this treatment.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.