Xalkori
Xalkori (crizotinib) is a targeted therapy medication used to treat metastatic non-small-cell lung cancer (NSCLC), advanced anaplastic large cell lymphoma (ALCL), and advanced inflammatory myofibroblastic tumor (IMT) that have certain mutations. It’s convenient to take because it’s a medication you take by mouth, typically twice daily. But it can cause some serious side effects like nausea, diarrhea, and vision changes.
What is Xalkori (crizotinib) ?
What is Xalkori (crizotinib) used for?
- Metastatic non-small-cell lung cancer (NSCLC) with an ALK or ROS1 mutation
- Advanced anaplastic large cell lymphoma (ALCL) with an ALK mutation
- Advanced inflammatory myofibroblastic tumor (IMT) with an ALK mutation
How Xalkori (crizotinib) works
Xalkori (crizotinib) works by targeting cells that have genetic changes (mutations) in specific receptors, such as anaplastic lymphoma kinase (ALK) and ROS1. These genetic changes cause cells to become cancer cells. When Xalkori (crizotinib) blocks the activity of these receptors, cancer cells can’t grow and spread as well.
Drug facts
Side effects of Xalkori (crizotinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Vomiting (up to 93%)
- Diarrhea (up to 92%)
- Nausea (up to 86%)
- Higher liver labs, suggesting liver irritation (up to 81%)
- Vision changes (up to 71%)
- Runny nose, sore throat, and other symptoms of an upper respiratory infection (up to 64%)
- Headache (up to 58%)
- Muscle pain (up to 58%)
- Fever (up to 50%)
- Swelling in the legs and feet (up to 49%)
- Lower blood cell counts (up to 48%)
- Mouth sores (up to 46%)
- Tiredness (up to 46%)
- Constipation (up to 43%)
- Lower appetite (up to 42%)
- Itching (up to 35%)
- Stomach pain (up to 26%)
Please note: The side effects you experience can differ depending on factors, such as your age, what type of cancer you’re being treated for, and whether you’re taking any other anticancer medications.
Less Common Side Effects
- Dizziness
- Heartburn
- Numbness in fingers and toes
Xalkori (crizotinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious lung problems: sudden cough, fever, and difficulty breathing.
- Heart rhythm problems: lightheadedness, blurry vision, fainting, seizures, loss of consciousness
- Serious liver problems: nausea, vomiting, tiredness, stomach pain or swelling, pale-colored stool, dark-colored urine, yellowing of the whites of the eyes or skin
The following Xalkori (crizotinib) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Black, tarry stools
bloating or swelling of the face, arms, hands, lower legs, or feet
blurred or loss of vision
body aches or pain
chest pain, discomfort, or tightness
chills
colicky or burning stomach pain
difficult or labored breathing
difficulty in swallowing
disturbed color perception
double vision
ear congestion
halos around lights
headache
hoarseness
increased sensitivity to pain or touch
irregular heartbeat
lightheadedness, dizziness, or fainting
loss of appetite
loss of voice
lower back or side pain
nerve pain
night blindness
overbright appearance of lights
pain in the back of throat or chest when swallowing
pain or burning in the throat
painful or difficult urination
pale skin
rapid weight gain
recurrent fainting
runny or stuffy nose
seeing flashes or sparks of light
slow or irregular heartbeat
sores, ulcers, or white spots on the lips or tongue or inside the mouth
swelling
trouble breathing
tunnel vision
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
vomiting
vomiting blood or material that looks like coffee grounds
weakness in the arms, hands, legs, or feet
Less common
blue lips, fingernails, or skin
clay-colored stools
confusion
dark urine
fast heartbeat
flushed, dry skin
fruit-like breath odor
increased hunger
increased thirst
increased urination
irregular, fast or slow, or shallow breathing
itching, skin rash
loss of consciousness
stomach pain or tenderness
sweating
swelling of the feet or lower legs
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
back pain
belching
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in taste
increased weight
indigestion
loss of taste
muscle spasm or weakness
pain in the arms or legs
stomach discomfort or upset
trouble in walking
unsteadiness or awkwardness
weakness in the arms, hands, legs, or feet
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Xalkori (crizotinib)
Pros
- Taken by mouth, so good for people who don’t like needles
- Works in a more specific, targeted way than traditional chemotherapy
- Can be taken with or without food
- Recommended treatment option for patients with NSCLC, ALCL, IMT who have certain mutations
Cons
- Taken twice a day
- Can interact with many medications, such as diltiazem (Cardizem), amiodarone (Pacerone), and several medications that treat infections and seizures.
- Might need to have regular eye check-ups, which means more appointment visits
- Not recommended during pregnancy or breastfeeding
Pharmacist tips for Xalkori (crizotinib)
- Xalkori (crizotinib) can cause nausea. Your provider might recommend you to take a medication to prevent nausea before each dose of Xalkori (crizotinib) . Sometimes, your provider might ask you to take it in between Xalkori (crizotinib) doses as well. There are many types of medications to manage nausea, so if one doesn’t work, ask your provider about other options.
- You might experience some diarrhea at the beginning of Xalkori (crizotinib) treatment, but it should go away over time. Your provider might suggest an over-the-counter medication, like loperamide (Imodium A-D), to help manage diarrhea. If you experience diarrhea it’s important to drink a lot of fluids, but try to avoid sugary sports drinks because they can make diarrhea worse.
- Sometimes, taking Xalkori (crizotinib) can cause your liver to become irritated. Most of the time, you won't feel any noticeable symptoms. But your provider can see signs of this through blood tests. Make sure you continue to get regular blood tests while you're taking Xalkori (crizotinib) so your provider can check your liver health and make sure it's still safe for you to keep taking this medication. If you have stomach pain, yellowish skin, or yellow around the whites of your eyes, call your provider right away.
- Xalkori (crizotinib) can cause a slow heart rate (bradycardia). Because of this, some medications that also cause slow heart rate shouldn’t be taken with Xalkori (crizotinib) . You can monitor your own heart rate at home with a blood pressure monitor, smart watch, or by counting your pulse for one minute. If your heart rate is below 60 beats per minute and this isn’t normal for you, contact your provider.
- Even though it’s rare, Xalkori (crizotinib) can cause severe and complete vision loss. Because of this, it’s important to see an ophthalmologist before you start Xalkori (crizotinib) and regularly as long as you’re taking it.
- Ask your provider about the best way to handle and throw away Xalkori (crizotinib) safely. Anticancer medications can be harmful to people who handle or come in contact with them. If you’re a parent of a child taking Xalkori (crizotinib) for ALCL or IMT and will be handling the medication, you should wear gloves. Store Xalkori (crizotinib) in a safe place away from children and pets.
Common questions about Xalkori (crizotinib)
You should take Xalkori (crizotinib) as instructed by your provider. How long you take Xalkori (crizotinib) depends on several factors, such as how well the medication is working to treat your cancer and how well you tolerate the side effects. Your doctor will tell how well the drug is working based on your symptoms, lab results, and scan results. Don’t stop taking Xalkori (crizotinib) without first discussing it with your provider.
If you have a history of heart problems, talk to your provider before starting Xalkori (crizotinib) . People born with heart rhythm problems (e.g., long QT syndrome) shouldn’t take Xalkori (crizotinib) because Xalkori (crizotinib) might worsen their condition. If you have other heart conditions, like heart failure or slow heart rate, your provider might still prescribe Xalkori (crizotinib) for you but will ask you to monitor your heart rate and blood pressure regularly. If your heart rate is dropping too low on your heart rate monitor or if you’re experiencing symptoms of heart problems, such as dizziness, lightheadedness, or chest pain, let your provider know.
Some people who take Xalkori (crizotinib) experienced changes in their vision including blurred vision, double vision, and loss of eyesight. The reason this happens isn’t clear, but it might be because the receptor Xalkori (crizotinib) blocks in your tumor is also found in some eye tissue. If you’re an adult taking Xalkori (crizotinib) , you should see an ophthalmologist before you start Xalkori (crizotinib) and once a month while you’re still taking it. And young adults and children should see an ophthalmologist before starting Xalkori (crizotinib) , one month after starting, and then every three months after that.
Yes, there are certain medications that you shouldn't take if you’re taking Xalkori (crizotinib) . Your provider will review all the medications you’re taking, both prescription and over-the-counter, before you start Xalkori (crizotinib) . Some medications, like phenytoin (Dilantin) or carbamazepine (Tegretol), can cause Xalkori (crizotinib) to not work as well. Others, like clarithromycin (Biaxin) or diltiazem (Cardizem) can raise the levels of Xalkori (crizotinib) in your body and might make side effects worse. Because Xalkori (crizotinib) can change your heart rhythm (long QT) and cause slow heart rate, your provider might ask you to avoid taking other medications that can do the same, such as amiodarone (Pacerone) or metoprolol (Lopressor). Once you start taking Xalkori (crizotinib) , talk with your provider before starting any new medications.
Talk with your provider if you’re pregnant or thinking about becoming pregnant. Xalkori (crizotinib) hasn’t been well-studied in human pregnancies, but animal studies suggest that Xalkori (crizotinib) might cause harm to an unborn baby. If you’re a female able to have babies, you should use birth control while taking Xalkori (crizotinib) and for at least 45 days after the last dose. Let your provider know right away if you become pregnant while taking Xalkori (crizotinib) .
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Risks and warnings for Xalkori (crizotinib)
Xalkori (crizotinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious lung problems
Though rare, some people taking Xalkori (crizotinib) have experienced a serious lung problem called interstitial lung disease (ILD). Talk to your provider right away if you experience sudden or worsening cough, trouble breathing , and fever. You might have to pause or stop Xalkori (crizotinib) while your provider figures out the cause.
Serious liver problems
Risk factor: History of liver problems
Some people taking Xalkori (crizotinib) have shown high levels of liver enzymes on their blood tests, which can suggest liver problems. Your doctor will monitor your liver health on a regular basis, usually every month, and if something changes, you might need to pause or stop the Xalkori (crizotinib) while your doctor looks into it. Most people don’t feel any noticeable symptoms when this happens, so it’s important to keep up with your lab work regularly. If you have stomach pain, yellowish skin, or yellow around the whites of your eyes, call your provider right away.
Abnormal heart rhythm
Risk factors: Heart failure | History of abnormal heart rhythms | Taking other medications that can affect heart rhythm
Rarely, some people taking Xalkori (crizotinib) have changes in their heart rhythm, also called QT prolongation. Don’t take Xalkori (crizotinib) if you’re born with long QT syndrome. If you’re at risk for QT prolongation for another reason, such as because of another medication you take, your doctor might monitor you more closely with a test called an electrocardiogram (EKG). If you have sudden chest pain, feel very dizzy or pass out, seek medical help right away. Your provider will review all the other medications you take to check if you’re at a higher risk.
Slow heart rate (bradycardia)
Risk factors: History of bradycardia | Taking other medications that can slow heart rate, such as metoprolol (Lopressor)
People who take Xalkori (crizotinib) might experience a slow heart rate, which can cause tiredness, weakness, and feeling light-headed. A slow heart rate isn’t always serious, but if it causes fainting, then your provider might ask you to pause or stop taking Xalkori (crizotinib) . You can check your own heart rate at home between clinic visits and call your provider if you notice a change. You can check it at home with a blood pressure cuff, smart watch, or by counting your pulse for one minute. If you’re taking other medications that can also slow heart rate, your provider might ask you to monitor your heart rate more often.
Serious eye problems
Xalkori (crizotinib) can cause vision changes such as blurred vision and not seeing as well. In rare cases, people have experienced near total vision loss. If you’re an adult, you should see an ophthalmologist before you start crizotinib and once a month while you’re still taking it. Young adults and children should see an ophthalmologist before starting crizotinib, one month after starting, and then every three months. If you do experience changes in your vision, your provider might ask you to stop crizotinib treatment, depending on how serious the changes are.
Nausea and diarrhea
Children and young adults taking Xalkori (crizotinib) for ALCL or IMT might experience nausea, vomiting, and diarrhea. Your prescriber will give you medication to prevent nausea that should be taken before each dose of Xalkori (crizotinib) and in between doses if needed. They can also recommend medications to treat diarrhea, as well as give you lifestyle tips such as eating bland, low-fat foods and drinking plenty of non-sugary fluids. If you have nausea or diarrhea that won’t stop even after three days of using medication, call your provider.
Harm to unborn baby
Based on animal studies, Xalkori (crizotinib) might harm an unborn baby or raise the risk for miscarriage (pregnancy loss). Because of these risks, if you’re a female who can get pregnant, you should use birth control while taking Xalkori (crizotinib) and for 45 days after the last dose. Let your provider know right away if you become pregnant while taking Xalkori (crizotinib) . If you’re a male who is sexually active with a partner who is able to get pregnant, use condoms during treatment and for at least three months after the last dose.
Xalkori (crizotinib) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| oral pellets of 20mg | 60 capsules | $2,288.46 | $38.14 |
| oral pellets of 50mg | 120 capsules | $10,771.40 | $89.76 |
| oral pellets of 150mg | 30 capsules | $8,080.14 | $269.34 |
Typical dosage for Xalkori (crizotinib)
NSCLC
- Adults: The usual dose is 250 mg by mouth twice a day
ALCL
- Children and young adults: Your provider will determine your dose based on body surface area (BSA), which is a measurement of body size that takes into account weight and height. The usual dose ranges from 200 mg to 500 mg twice a day, depending on body size.
IMT
- Adults: The usual dose is 250 mg by mouth twice a day
- Children: Your child's provider will determine your child's dose based on their body size, taking into account their weight and height. The usual dose ranges from 200 mg to 500 mg twice a day, depending on body size.
Interactions between Xalkori (crizotinib) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Atazanavir
- Bepridil
- Cisapride
- Cobicistat
- Dronedarone
- Eliglustat
- Fluconazole
- Ketoconazole
- Lopinavir
- Mesoridazine
- Nelfinavir
- Pimozide
- Piperaquine
- Posaconazole
- Ritonavir
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Acalabrutinib
- Acebutolol
- Alfentanil
- Alfuzosin
- Alprazolam
- Amiodarone
- Amisulpride
- Amitriptyline
- Amprenavir
- Anagrelide
- Apalutamide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Astemizole
- Atenolol
- Avapritinib
- Azithromycin
- Bedaquiline
- Benzhydrocodone
- Betaxolol
- Bisoprolol
- Boceprevir
- Bosutinib
- Brigatinib
- Buprenorphine
- Buserelin
- Carbamazepine
- Carteolol
- Carvedilol
- Celiprolol
- Ceritinib
- Chloroquine
- Chlorpromazine
- Cilostazol
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clonidine
- Clozapine
- Codeine
- Colchicine
- Conivaptan
- Cyclobenzaprine
- Cyclosporine
- Dabrafenib
- Dasatinib
- Deflazacort
- Degarelix
- Delamanid
- Delavirdine
- Desipramine
- Deslorelin
- Deutetrabenazine
- Digoxin
- Dihydrocodeine
- Dihydroergotamine
- Diltiazem
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droperidol
- Ebastine
- Efavirenz
- Eletriptan
- Elexacaftor
- Encorafenib
- Entrectinib
- Enzalutamide
- Ergotamine
- Eribulin
- Erythromycin
- Escitalopram
- Esmolol
- Famotidine
- Felbamate
- Fentanyl
- Fingolimod
- Flecainide
- Flibanserin
- Fluoxetine
- Formoterol
- Fosamprenavir
- Foscarnet
- Fosnetupitant
- Fosphenytoin
- Fostemsavir
- Galantamine
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Histrelin
- Hydrocodone
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibrutinib
- Ibutilide
- Idelalisib
- Ifosfamide
- Iloperidone
- Imipramine
- Indinavir
- Inotuzumab Ozogamicin
- Itraconazole
- Ivabradine
- Ivacaftor
- Ivosidenib
- Labetalol
- Lapatinib
- Lefamulin
- Lemborexant
- Lenvatinib
- Levobunolol
- Levofloxacin
- Lofexidine
- Lumacaftor
- Lumateperone
- Lumefantrine
- Lurasidone
- Lurbinectedin
- Macimorelin
- Mefloquine
- Meperidine
- Methadone
- Methotrimeprazine
- Metipranolol
- Metoprolol
- Metronidazole
- Mifepristone
- Mirtazapine
- Mitotane
- Mizolastine
- Moricizine
- Moxifloxacin
- Nadolol
- Nafarelin
- Naloxegol
- Nebivolol
- Nefazodone
- Netupitant
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Olaparib
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxprenolol
- Oxycodone
- Ozanimod
- Paclitaxel
- Paliperidone
- Panobinostat
- Papaverine
- Paroxetine
- Pasireotide
- Pazopanib
- Pemigatinib
- Penbutolol
- Pentamidine
- Pentazocine
- Perhexiline
- Perphenazine
- Pexidartinib
- Phenytoin
- Pimavanserin
- Pindolol
- Pipamperone
- Pitolisant
- Ponesimod
- Practolol
- Probucol
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Propranolol
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Ranolazine
- Ribociclib
- Rifabutin
- Rifampin
- Rilpivirine
- Rimegepant
- Risperidone
- Selpercatinib
- Selumetinib
- Sertindole
- Sertraline
- Sevoflurane
- Simeprevir
- Siponimod
- Sirolimus
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sonidegib
- Sorafenib
- Sotalol
- St John's Wort
- Sufentanil
- Sulpiride
- Sultopride
- Sunitinib
- Tacrolimus
- Tamoxifen
- Tazemetostat
- Telaprevir
- Telavancin
- Telithromycin
- Temsirolimus
- Terodiline
- Tetrabenazine
- Tezacaftor
- Timolol
- Tolterodine
- Tolvaptan
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Troleandomycin
- Vandetanib
- Vardenafil
- Vemurafenib
- Venetoclax
- Venlafaxine
- Vilanterol
- Vinflunine
- Voclosporin
- Voriconazole
- Vorinostat
- Zanubrutinib
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Midazolam
- Suvorexant
How much does Xalkori (crizotinib) cost?
$2,288.46
What are alternatives to Xalkori (crizotinib) ?
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