Table 7.

Pocket guidelines for the management of adverse events with vandetanib

Adverse event	Patient education before starting treatment	At the time adverse event emerges
Skin toxicity	Prophylactic use of hydrating creams all over the body, especially areas of sun-exposed skin and hands and feet	Early use of fatty ointments and urea creams. If no improvement, the addition of topical steroids, with or without antibiotics, could be helpful. The oral administration of cloxacillin and anti-histamines also may help
Diarrhea	Patient education with dietary measures	As soon as diarrhea is apparent, oral hydration and anti-diarrhea medications such as loperamide 2 mg, taken after every fecal deposit up to a maximum of 16 mg per day, is required. Special care should be taken with elderly patients who have a higher risk of dehydration
Nausea and vomiting	Patient education with dietary measures	Common antiemetics such as metoclopramide or ondansetron are not recommended to prevent or relieve vomiting and nausea. There is a need to ensure correct hydration
Fatigue and asthenia	Treat underlying factors according to standard medical practice that may induce or promote fatigue	Monitor for possible comorbidities that could contribute to fatigue
	Advise patients to maintain a healthy diet and to take moderate exercise
Mucositis and/or stomatitis	Recommend patients to switch to a mild toothpaste and a soft toothbrush	Rinse mouth with water and use alcohol-free mouthwash
		Use lip creams or balms
		Avoid alcohol, acidic food and drink, and excessively hot (temperature) food
Hypertension	Blood pressure should be checked and controlled appropriately	Prescribe anti-hypertensive medication such as ACE inhibitors
	Educate patients to measure blood pressure and to recognize the most common symptoms of hypertension

ACE angiotensin-converting-enzyme