NERLYNX tablet 40 mg

• The antidiarrheal medicine loperamide 4mg should be taken during the treatment with neratinib thrice daily for the first two weeks, followed by twice daily for the next six weeks to avoid diarrhea which is a serious complication of neratinib treatment.‍‍‍‍‍‍​​​‍​​​​​​ The patient should be advised to maintain one to two motions per day with the medications. • Patients should be monitored for the symptoms of diarrhea (dehydration, hypotension) and should be treated with additional anti-diarrheal agents along with the administration of fluid and electrolytes if needed. • Liver enzymes (AST, ALT, Alkaline phosphatase) and bilirubin levels should be monitored before starting the neratinib therapy and at monthly intervals for 3 months and 3 monthly after that during the treatment to detect the risk of liver damage at an early stage. • Men and women of childbearing age should use effective contraceptive measures during the neratinib therapy to prevent pregnancy. Women should continue using the contraception for at least 1 month after the last dose, while male patients should continue using it for at least 3 months after stopping treatment. The treatment should be started in women only after a pregnancy test is confirmed as negative.