Toceranib Phosphate

By Rania Gollakner, BS, DVM, MPH

What is toceranib phosphate?

Toceranib phosphate (brand name: Palladia®) is an antineoplastic/anticancer medication used to treat mast cell tumors in dogs. It may also be useful in treating sarcomas, carcinomas, melanomas, and multiple myeloma, as well as treating cancers in cats.

While its use in dogs is on label, its use in cats to treat various cancers is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their direction may be significantly different from those on the label.

How is toceranib phosphate given?

Toceranib phosphate is given by mouth in the form of a tablet. It may be given with or without food, but if vomiting occurs when dosed on an empty stomach, give future doses with food. Do not split or crush the tablets unless directed by your veterinarian. Make sure your pet receives the entire dose.

Wear gloves when administering this medication. Use gloves when handling bodily waste (urine, feces, blood, vomit) for a few days after each dose, and seal the waste in a plastic bag before discarding. Avoid contact with bare skin, eyes, or mouth. Do not let your pet lick your skin; if this occurs, wash the area thoroughly with soap and water.

Pregnant women should not handle this medication or any bodily waste while your pet is on this medication.

This medication can take a few weeks before full effects are noted, but side effects can occur immediately. Gradual improvements are usually noticeable after a few days.

What if I miss giving my pet the medication?

If you miss a dose, contact your veterinarian for further instructions, as this medication must be dosed very carefully.

Are there any potential side effects?

Common side effects may include diarrhea, decreased or lack of appetite, lameness or weight loss. Less common side effects include muscle pain, low white blood cell counts, low blood protein levels, blood clots (may appear as leg swelling or difficulty breathing), pancreatitis, loss of nose color, skin coat changes, nose bleeds, seizures, high blood pressure, and itchiness.

Serious side effects include prolonged lack of appetite, severe diarrhea or bloody stools, bruising or bleeding. In cats, gastrointestinal effects, low blood cell counts, liver and kidney problems, and hair loss have been reported.

This moderate-acting medication should stop working in a few days, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Toceranib phosphate should not be used in pets that are allergic to it or in pets that are breeding, pregnant, or lactating. Do not use in dogs less than 24 months of age or that weigh less than 11 lbs (5 kg ). It should not be used 3 days prior to or 2 weeks after surgery, as it can prolong healing time and can increase risks of swelling and blood clots. Toceranib phosphate should be used cautiously in pets with bulky or systemic mast cell tumors, liver or kidney problems, or pets with existing gastrointestinal problems, bone marrow problems, or infection. Do not vaccinate your pet with live or modified live vaccines while your pet is on this medication.

Pregnant women should not handle this medication or any bodily waste while your pet is on this medication.

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with toceranib phosphate: calcitriol, nonsteroidal anti-inflammatories (NSAIDs), CYP3A4 inhibitors, or other cytotoxic anticancer agents.

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this medication?

Your veterinarian will monitor complete blood cell counts, percent red blood cells, blood proteins, kidney values, and phosphate levels weekly for the first 6 weeks, and then every 6 weeks thereafter. Blood pressure, urinalysis, chemistry profiles, and urine protein:creatinine ratios may be monitored every 6-8 weeks.

Your veterinarian may monitor your pet to be sure that the medication is working and monitor tumor size. Monitor your pet for serious side effects; if diarrhea persists after a few days or if there is blood in stools occur for more than 2 days, contact your veterinarian.

How do I store toceranib phosphate?

Store this medication at room temperature between 68°F and 77°F (20°C and 25°C), protected from light.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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