Has your doctor prescribed you a combination of two drugs called Ribociclib and Letrozole for breast cancer? Seeing a prescription like this can be a bit scary and can raise a lot of questions. But don't worry. This is normal. Let's talk simply and clearly about these drugs, how they affect the body, how to use them correctly, and what to be careful of.
What is Ribociclib and Letrozole?
Simply put, these are two types of drugs that are given to control the growth of breast cancer cells. When these are given together, we call them co-packs.
- Ribociclib: This drug works by targeting certain proteins inside cancer cells that help them divide and grow, and stopping them from working. It slows down the growth of cancer cells.
- Letrozole: This medication works by blocking the body's production of a hormone called estrogen. Some types of breast cancer use estrogen as fuel to grow. So Letrozole cuts off that fuel supply.
These two drugs work together to attack cancer cells from two sides and help control their growth.
Things you need to tell your doctor before starting medication
Before starting this treatment, it is extremely important to inform your doctor about your complete health history. Be sure to tell him/her if you have any of the following conditions:
| Health status | Description |
|---|---|
| Heart disease | If you have a history of any type of heart disease or irregular heartbeat. |
| Liver diseases | Any previous or current liver disease. |
| Decreased blood components | If you have previously been diagnosed with a low white blood cell count, red blood cell count, or platelet count. |
| Mineral imbalances | If you have low levels of calcium, magnesium, potassium, or phosphorus in your blood. |
| Infections | Any current infection, especially viral infections such as chickenpox or herpes. |
| Lung diseases | Lung or respiratory diseases such as asthma. |
| Other points | Also tell about weak bones, allergies to other medications, foods, or substances. |
| Pregnancy/breastfeeding | If you are pregnant, trying to get pregnant, or breastfeeding, it is **absolutely** a must. |
How exactly do I use this medicine?
To get the most out of your medication, it is very important to use it correctly.
- Swallow these tablets with a glass of water. Do not crush or chew the tablets.
- Take your medicine exactly as prescribed by your doctor, at the time prescribed. Don't skip doses.
- This medicine can be taken before or after meals. However, if you experience stomach upset, it is best to take it with food.
- Important: Avoid grapefruit, pomegranate, or their juices while taking this medication. These can affect the effectiveness of the medication.
- Do not stop taking the medication without your doctor's advice.
If you think you have taken too much medicine, go to a hospital's Emergency Treatment Unit (ETU) immediately. Or call the National Poisons Information Centre at the Colombo National Hospital for advice.
What to do if you miss a dose or vomit?
If you miss a dose, or if you vomit after taking the medicine, do not take another pill that day . Skip the missed dose altogether and take your medicine at your regular time the next day. Do not take two doses at once.
Other medicines that should not be used with this medicine
This medicine may interact with some other medicines. Therefore, it is important to tell your doctor about all the medicines you are taking (including vitamins and herbal remedies) . In particular, you should avoid taking the following medicines with this medicine. This list may not be complete, so tell your doctor about all the medicines you are taking.
- Some medications taken for heart disease, cholesterol, fungal infections, and HIV/Hepatitis.
- Some medications used for seizures (such as carbamazepine, phenytoin).
- Herbal products such as `St. John's Wort`.
- Antibiotics such as `ketoconazole` and `clarithromycin`.
- Other medications that affect the electrical activity of the heart (QT interval prolongation).
What are the things to consider when taking the medicine?
Very important: Avoid getting pregnant while taking this medicine and for 3 weeks after stopping the medicine. It can cause serious harm to the unborn baby. Also, avoid breastfeeding during this time. For men, this medicine can also affect sperm count, so talk to your doctor if you are thinking about having a child.
- Protect yourself from infections: This medicine may lower your body's immunity a little. So stay away from people who are sick. If you experience symptoms like fever, cold, or sore throat, do not self-medicate and tell your doctor immediately.
- Bleeding and bruising: There may be an increased risk of minor bruising and bleeding. Be careful when brushing your teeth and performing dental hygiene. Tell your doctor if you notice any unusual bleeding or bruising.
- Painkillers: Do not take painkillers such as aspirin and ibuprofen without your doctor's advice. These can suppress symptoms such as fever.
- Blood tests: Your doctor will perform regular blood tests to monitor your blood counts and liver function during treatment. Don't skip them.
Be aware of side effects
Like any medicine, this can cause side effects. Not everyone gets them. But it's important to be aware of them.
| Symptoms that should be reported to your doctor immediately | |
|---|---|
| Characteristic | Description |
| Allergies | Skin rash, itching, swelling of the face, lips or tongue. |
| Symptoms of liver damage | Dark yellow/brown urine, yellowing of the eyes or skin, pain in the upper right part of the stomach, nausea. |
| Signs of infection | Fever, chills, sore throat, cough, urinary tract infection. |
| Changes in heart rate | Chest pain, dizziness, feeling like your heart is beating fast or irregularly, difficulty breathing. |
| Symptoms of blood clots | Sudden shortness of breath, chest pain, swelling and pain in a leg, difficulty speaking. |
| Symptoms of anemia | Unusual tiredness, paleness, easy bruising, red spots on the skin, blood in the urine. |
| Symptoms to report to the doctor if they persist | |
| Digestive system | Constipation, diarrhea, nausea/vomiting, stomach pain, mouth sores, loss of appetite. |
| General characteristics | Headaches, hair loss, weakness, night sweats, insomnia, swelling of the limbs. |
How do you protect your medicine?
- Keep away from children.
- Store the medicine in the original packaging at room temperature between 20-25 degrees Celsius.
- Throw away expired medicine.
This information sheet is only a summary. If you have any further questions about this medicine, please feel free to talk to your doctor.
Take-Home Message
- Take your medicine exactly as prescribed by your doctor, at the right time. Don't skip doses.
- Avoid pregnancy completely during this treatment and for 3 weeks after stopping it.
- Be alert for signs of infection, such as fever and sore throat. If you notice anything like this, inform your doctor immediately.
- Tell your doctor about all other medications, vitamins, and supplements you take.
- Avoid drinking grapefruit and pomegranate or their juice.
👩🏽⚕️ Additional questions (FAQs)
💬 What is Ribociclib and Letrozole / Kisqali Femara Co-Pack used for?
This is a combination of 2 highly successful targeted therapy drugs that completely control 'Advanced/Metastatic Breast Cancer' in women! Specifically, this is designed to eliminate the roots of cancers that use the female hormone 'estrogen' (ER-positive / HER2-negative) to grow.
💬 How do these two drugs (Ribociclib + Letrozole) kill breast cancer?
This attacks cancer from both sides! First, 'Letrozole' blocks the production of the 'estrogen hormone' that feeds/grows cancer 100%, starving the cancer. Then, 'Ribociclib' completely destroys two enzyme machines (CDK4 and CDK6) that help cancer cells divide rapidly and grow. Then, the growth of the cancer is stopped right there.
💬 What are the main side effects of taking these powerful cancer drugs?
When killing cancer cells, the body's 'white blood cells/neutrophils (Neutropenia)' and red blood cells (more than ever) are also destroyed. Therefore, even a small cold is strong enough to cause pneumonia and death! Also, because these pills have a high chance of damaging the 'Liver' (Hepatotoxicity), doctors always do blood tests (LFT). It can also change the heart rate (QT prolongation).
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