9 Tagrisso Side Effects and How to Manage Them

Genetic mutations are the culprit behind many cases of non-small cell lung cancer (NSCLC). They encourage cancer cells to grow and spread, but modern technology is making them less threatening. Cancer specialists can run DNA tests to determine which mutations are causing cancer cells to grow. And countless mutation-targeting medications are now available.

Tagrisso (osimertinib) is one popular option. It’s a targeted therapy medication that treats NSCLC that’s epidermal growth factor receptor (EGFR) mutation-positive. By targeting and blocking EGFR, Tagrisso helps slow lung cancer cell growth.

There are some downsides, though. Even though it's not a traditional chemotherapy medication, this oral tablet can cause some significant side effects. Many side effects are manageable and get better with time. However, serious side effects may require medical attention.

Tagrisso side effects at a glance

Like all medications, Tagrisso can cause side effects.

Common Tagrisso side effects include:

• Changes in blood cell counts

• Diarrhea

• Joint pain

• Muscle pain

• Dry skin

• Fatigue

• Nail changes

• Mouth sores

• Skin rashes

Rare but serious Tagrisso side effects include:

• Lung inflammation

• Heart rhythm problems

• Heart failure

• Serious skin reactions

Here’s how to manage nine noteworthy Tagrisso side effects.

1. Changes in blood cell counts

Tagrisso may lead to a drop in your white blood cells, platelets, and red blood cells. The impact of this varies depending on which blood cells are affected — and how low they go.

When your white blood cells are lower than normal, your immune system becomes weaker. This leads to a higher risk of catching an infection. When your platelets or red blood cells are lower than normal, there’s a higher risk of bleeding and bruising.

Let your healthcare provider know if you develop any new symptoms of an infection, such as fever, chills, or cough, while you’re receiving Tagrisso. Also, let them know if you experience unusual bruising or bleeding that doesn’t stop or go away. This could include blood in your urine or stool, bleeding gums, or reddish-purple dots on your skin.

Risks like these highlight the importance of routine lab work. Your provider should check your blood work before starting treatment with Tagrisso. They’ll likely do this regularly throughout your treatment, too. If your blood cell counts become too low, your provider may suggest lowering your dose of Tagrisso or stopping it altogether.

2. Diarrhea

Diarrhea is another common Tagrisso side effect. Nearly half of people who took Tagrisso in clinical studies reported experiencing it. Diarrhea is generally more common in the first month of taking Tagrisso, but it should improve over time.

If you develop diarrhea, it’s important to stay hydrated. Drinking 8 to 10 glasses of non-sugary liquids a day is a good starting point. It also helps to avoid spicy and greasy foods that may make diarrhea worse. When needed, you can consider an over-the-counter (OTC) antidiarrheal medication, such as loperamide (Imodium A-D), with your healthcare provider’s OK.

3. Joint or muscle pain

Another common side effect of Tagrisso is muscle and joint pain. About one-third of people who took Tagrisso in clinical trials reported one or both issues.

To combat muscle and joint pain, try keeping up with regular exercise. This helps promote muscle and bone strength. Even light exercise, as your body can tolerate it, can make a difference. Some people find relief with alternative therapies, like massages, too. OTC pain relievers, such as acetaminophen (Tylenol) or naproxen (Aleve), can help relieve pain when needed.

4. Dry skin

Tagrisso can sometimes cause your skin to become dry and itchy. Dry skin tends to show up after taking Tagrisso for 5 weeks or longer.

If your skin dries out while taking Tagrisso, sticking to a skincare routine can help. You can apply moisturizing creams or lotions that are fragrance-free and non-irritating to your skin a couple of times per day. Products containing urea or colloidal oatmeal are especially helpful.

If your dry skin feels intense, loop in your healthcare provider. They may recommend a prescription corticosteroid cream, such as triamcinolone. They may also want you to pause treatment with Tagrisso and restart it at a lower dose once your dry skin has improved.

5. Nail changes

Tagrisso may cause changes to your fingernails or toenails. This includes nail tenderness, brittleness, or separation from the nailbed. If they happen, they tend to appear after taking the medication for 6 to 8 weeks.

Some ways to help prevent and manage nail changes include:

• Cutting your nails short and keeping them clean

• Applying nail polish to protect your nails

• Avoiding wearing tight shoes

• Wearing gloves while working, gardening, or cleaning

• Taking a biotin supplement to help strengthen nails over time

If nail changes become severe, reach out to your healthcare provider. They may recommend removing the affected nails so they can regrow.

6. Mouth sores

Tagrisso can cause mouth inflammation, potentially leading to mouth sores. Symptoms range from mouth tingling and cracks in the side of the mouth to painful ulcers. They often make eating and drinking more difficult, too.

Prevention is key when it comes to mouth sores. Minimizing their impact can make a meaningful difference in your quality of life. These are some tips to manage mouth sores:

• Brush your teeth with a soft toothbrush.

• Avoid alcohol or mouthwashes that contain alcohol.

• Rinse your mouth several times a day with salt water and baking soda.

• Suck (don’t chew) on ice chips.

• Avoid eating crunchy or hard foods that may cut the inside of the mouth.

If mouth sores become unmanageable, contact your healthcare provider. They may be able to recommend other medications for mouth pain and inflammation, such as magic mouthwash or viscous lidocaine.

7. Skin rashes

Tagrisso can cause an acne-like rash on the face, scalp, and/or torso. Rashes tend to appear within the first 2 weeks of taking Tagrisso, but they generally get better over time.

To manage rashes from Tagrisso, you should loop in your healthcare provider once you first notice any rashes. Prescription medications, such as minocycline (Minocin) pills or hydrocortisone (Locoid) cream, can help keep it under wraps. If the rash is severe, they may recommend pausing your Tagrisso regimen or lowering your Tagrisso dose.

Although rare, serious skin reactions have also been reported — including cases of Stevens-Johnson syndrome. Go to the nearest emergency room if you develop a fast-spreading rash, skin peeling, or fluid-filled blisters.

Good to know: Some skin rashes from Tagrisso may look like acne. However, they’re not acne. Acne products shouldn’t be used to treat skin changes from Tagrisso.

8. Lung inflammation

Very rarely, Tagrisso can cause a serious lung problem called interstitial lung disease (ILD). This can be dangerous if left untreated. ILD can cause lung scarring and make it hard to breathe.

Let your healthcare provider know right away if you suddenly experience a fever, cough, or shortness of breath. If your symptoms feel especially severe, go to the nearest emergency room.

9. Heart rhythm problems

Tagrisso can contribute to a heart rhythm problem known as QT prolongation. This is when the heart takes a while to reset between beats. Possible symptoms include chest fluttering (palpitations), lightheadedness, and feeling faint. Your risk for this is higher if you have a history of heart rhythm problems or take other medications that also cause QT prolongation.

It’s important to get ahead of QT prolongation before it happens. If you have a history of heart problems, your healthcare provider may periodically monitor your heart rhythm with a test called an electrocardiogram.

When should I contact a healthcare provider about Tagrisso side effects?

Many of Tagrisso’s side effects are mild and should improve on their own. But some situations are more serious. If you experience side effects that feel bothersome or get worse at any point, contact your cancer specialist. They can help you address the situation with personalized management tips.

It’s better to seek emergency care if you think you're having a serious side effect of Tagrisso. Watch out for symptoms like:

• Peeling or blistering of the skin

• Sudden chest pain

• Trouble breathing

• Sudden or worsening cough

• Abnormal or fast heartbeat

• Fever

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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