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. 2017 Jan 27;61(1):81–89. doi: 10.1590/2359-3997000000245

Table 3. Common adverse events of MKIs.

  MKI most frequently involved (frequency of any grade of AE) Management
Fatigue and loss of weight All (26-59%) Increase or at least maintain physical activity; take pills in the evening Monitor other causes (e.g., anemia, depression, electrolyte disturbance, hypothyroidism)
Diarrhea All (30-68%) Loperamide and/or codeine Dietary changes (eat low-fiber foods; avoid high-fat or spicy foods, alcohol, and caffeinated or carbonated drinks)
HTA All (30-67%) Monitor blood pressure at least once a week Diuretics, ACEIs, ARBs, BBs, or CCBs alone or in combination Avoid diltiazem, verapamile, and nifedipine
Rash All (20-50%) Use perfume-free soaps and wear loose, natural-fabric clothing; avoid hot or cold water Topical corticosteroids or antihistamines
TSH increase All (30-60%) Monitor TSH levels monthly and adjust thyroid-replacement medication dose
Hand-foot syndrome Sorafenib (76%) Prevention: local care of feet and hands, urea cream 10% on hands and feet, use cotton socks Treatment: Thick urea-based cream (30%), topical lidocaine Use comfortable shoes and avoid hot/cold water NSAIDs, codeine, or pregabalin
Alopecia Sorafenib (67%) Inform the patient that it is temporary, usually recovering after the treatment, and does not require any treatment
Proteinuria Lenvatinib (31%) If ≥ 2 g/24 hours: withhold treatment Resume at reduced dose when proteinuria is < 2 g/24 hours Discontinue if nephrotic syndrome
Mucositis All (30%) Mouthwash with lidocaine + sucralfate, salt and sodium bicarbonate, or chlorhexidine
Hypocalcemia Sorafenib (18%) Monitor blood calcium levels at least monthly and replace calcium + vitamin D as necessary
QTc prolongation Vandetanib (23%, G > 3 in 14%) Serially monitor ECG and electrolytes and correct any abnormality Avoid drugs known to prolong QTc Discontinue MKIs if QTc ≥ 500 msec

AEs: adverse events; ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blockers; BB: beta-blockers; CCB: calcium channel blockers; NSAID: non steroidal anti-inflammatory drugs.