Sunitinib

• To reduce risk of infection:
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
  • Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection such as fever of 38ºC and above, chills, bad sore throat, pain when you pass urine or have mouth sores or wounds that do not heal.
  • Avoid taking Paracetamol to relieve fever as this may mask your fever and delay treatment of the infection

• To reduce risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have:
  • Bruising without a cause or bruises that get larger in size
  • Black, sticky stools
  • Blood in the urine
  • Coughing out blood or vomit that looks like coffee grounds
  • Bleeding which does not stop
     

• Drink plenty of clear fluids (at least 2 litres or 8 cups every day).
• Eat food that is gentler on the stomach such as porridge or soup.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.
• Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed.
• Proceed to the A&E Department immediately if you have very bad diarrhoea (for example increase in bowel movement of more than 4 times per day) that does not improve even after taking anti-diarrhoeal medications.

• Take small and frequent meals.
• Avoid foods / smells that may make you feel nauseous, such as oily, fried or strong-smelling food.
• Avoid tight-fitting clothes around the waist.
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.

Mouth ulcers or sores. 

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.
   

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce the chances of infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot lesser because of mouth pain.

Mouth ulcers or sores. 

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.
   

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce chances of infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot lesser because of mouth pain.

Hand-foot syndrome. This may occur during treatment.

• Palms of the hand and soles of the feet may become numb, sore, swollen, red or painful
• Nail beds may darken.
• Skin may become dry or itchy.

• Moisturize these areas daily. Wear thick cotton gloves and socks or soft bedroom slippers at home to avoid slipping.
• Avoid tight-fitting shoes. Wear shoes with padded insoles.
• Apply sunscreen with an SPF (Sun Protection Factor) of at least 30.
• Avoid exposure to hot water which may worsen pain.
• Inform your doctor if blisters, severe pain or ulcers affect your normal daily activities.

• Avoid hot showers. Use cool or lukewarm water to bathe.
• Apply a moisturizer to areas with dry skin.
• Avoid staying out under the sun. Use sunscreen with Sun Protection Factor (SPF) of at least 30 and covered clothing when you are out in the sun.
• Please see a doctor immediately if the rashes are painful, blistering, or affect a large area of the body.

Slow wound healing

• Wounds may take longer to heal while you are being treated with (drug). 

• If you have any surgery or dental procedures planned, inform your doctor. You may need to stop Sunitinib for a period of time before surgery and resume only when the wound is fully healed.

Symptoms of a heart attack include:

• A discomfort in the middle of your chest that lasts for a few minutes or goes away and comes back;
• Shortness of breath with or without chest discomfort;
• Chest pain or chest discomfort that feels like an uncomfortable heavy pressure;
  sensation of squeezing or fullness in the chest area, or
• pain at the chest area.

• If you experience any of these symptoms, call 995 for an ambulance and proceed to the A&E department immediately. 

Increase in blood pressure 

• If your blood pressure is very high, you may have headache, dizziness or blurry eyesight.

• Inform your doctor if you have such symptoms of increase in blood pressure frequently. 

If you are  prescribed with high blood pressure medications, continue to take your medications regularly as instructed.

• Your doctor may adjust your blood pressure medications if needed.
• If you have a blood pressure monitoring machine at home, measure your blood pressure at the same time(s) every day and record it in a book. Bring it for your future appointments.

Symptoms of a stroke, such as:

• Sudden onset of severe headache
• Eyesight changes
• Trouble talking or moving properly
• Drooping of the face, weakness or numbness in an arm or leg.

• If you experience any of these symptoms, call 995 for an ambulance and proceed to the A&E department immediately.
• Learn how to recognise symptoms of a stroke using the FAST acronym: https://www.healthhub.sg/a-z/diseases-and-conditions/stroke-emergency

Abnormal blood clot

• This may occur in the one of the legs or arms (deep vein thrombosis) or lungs (pulmonary embolism)
• Symptoms may include:
  • Warmth, pain of redness with swelling on the arm of leg
  • Sudden onset of cough, chest pain or shortness of breath

Proceed to the A&E department immediately if you experience any:

• Dark or tea-coloured urine
• Pale or light-coloured stools
• Yellowing of skin or eyes
• Nausea, vomiting with loss of appetite
• Severe abdominal pain
   

Thyroid function may be less effective

• Symptoms of an underactive thyroid gland include tiredness, weight gain, constipation, aches, feeling cold, dry skin and dry hair.
   

• Inform your doctor if you have any new symptoms as you may need a blood test to check your thyroid levels.

Symptoms of drug allergy including one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body
   

• Inform your doctor if you experience eye pain, swelling, redness, blurred vision, and/or sensitivity to light or other changes.