Vandetanib

CAPRELSA

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Pronunciation: van-DET-a-nib (kap-REL-sa)

Vandetanib ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Vandetanib ballicule

Vandetanib CAPRELSA mascot mnemonic cartoon — Visual mnemonic: Vandetanib mascot
**“Cop-wrestlin’ Van-detained nibbler”**

What it isOral multikinase inhibitor of RET, VEGFR, and EGFR for symptomatic or progressive unresectable locally advanced or metastatic medullary thyroid cancer.

Why this oneTargets RET-driven signaling and can produce durable disease control with once-daily oral dosing.

What limits itA roughly 19-day half-life makes QT toxicity slow to emerge and slow to resolve; correct electrolytes, avoid QT-prolonging drugs, and perform serial ECGs.

Vandetanib molecular structure (skeletal formula) — Molecular structure: Vandetanib

FDA-approved for

medullary thyroid cancer (2011)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING QT prolongation, torsades de pointes, and sudden death. Do not use in hypocalcemia, hypokalemia, hypomagnesemia, or long QT syndrome; correct electrolytes and monitor.

FDA dosing	Population	Start	Target	Max
Medullary thyroid cancer (unresectable, locally advanced or metastatic)	Adults	300 mg QD until progression or unacceptable toxicity	300 mg QD	300 mg QD

Renal Moderate impairment (CrCl ≥30 to <50 mL/min): start 200 mg QD; monitor QT.

Hepatic Not recommended in moderate or severe hepatic impairment.

Do not take a missed dose within 12 hours of the next dose.

Instructions

With or without food
Do not take a missed dose within 12 hours of the next dose
Do not crush; tablets may be dispersed in water (stir ~10 min) and given by NG/gastrostomy tube

Available strengths

tab 100, 300 mg

Contraindications

Congenital long QT syndrome

Cautions

QT prolongation/torsades/sudden death (monitor ECG, K/Ca/Mg, TSH)
Severe skin reactions (SJS/TEN)
Interstitial lung disease
Ischemic cerebrovascular events, hemorrhage, heart failure
Diarrhea, hypertension
Reversible posterior leukoencephalopathy syndrome
Impaired wound healing
Embryo-fetal toxicity
Osteonecrosis (including jaw)

Adverse reactions

Diarrhea/colitis
Rash
Acneiform dermatitis
Hypertension
Nausea
Headache
Upper respiratory tract infection
Decreased appetite
Abdominal pain

Pregnancy Can cause fetal harm (embryotoxic, fetotoxic, teratogenic in animals).

Lactation Do not breastfeed during treatment and for 4 months after the last dose.

Cost

Vandetanib (CAPRELSA)

Strength		#/mo	generic $/mo	CostPlus
100 mg	tab	30 qd		not offered
300 mg	tab	30 qd		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Vandetanib is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2028 est.

⚠ BOXED WARNING

QT prolongation can cause torsades and sudden death; avoid long-QT states, correct calcium/potassium/magnesium, avoid QT-prolonging drugs, and monitor ECGs and electrolytes

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades4 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilityMyelosuppression and agent-specific hepatic, cardiac, pulmonary, neurologic or reproductive toxicity require oncology monitoring.

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Memory aids: interaction avatars

OCT2/MATE1 inhibitor

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