From the Guidelines
Nilotinib can cause several cardiac side effects that require monitoring, including QT interval prolongation, which can lead to potentially fatal arrhythmias like torsades de pointes, and ischemic events such as coronary artery disease, peripheral arterial disease, and cerebrovascular events, as reported in the most recent study 1. The most concerning cardiac side effects of nilotinib include:
- QT interval prolongation, which can lead to potentially fatal arrhythmias like torsades de pointes
- Ischemic events such as coronary artery disease, peripheral arterial disease, and cerebrovascular events
- Pericardial effusion, heart failure, and hypertension Before starting nilotinib, patients should undergo:
- Baseline ECG and electrolyte assessment
- Regular monitoring throughout treatment Nilotinib should be used cautiously in patients with:
- Pre-existing cardiovascular disease
- QT prolongation risk factors
- Electrolyte abnormalities The drug should be avoided with other QT-prolonging medications when possible. The mechanism behind these cardiac effects involves direct inhibition of cardiac ion channels and vascular endothelial growth factor receptors, which can impair cardiac function and promote atherosclerosis, as described in 1. Patients on nilotinib should be educated about cardiac symptoms requiring immediate medical attention, including:
- Chest pain
- Shortness of breath
- Palpitations
- Dizziness
- Fainting It is essential to monitor patients regularly for these cardiac side effects and to adjust treatment accordingly, as recommended in 1 and 1.
From the FDA Drug Label
QT Prolongation Advise patients that nilotinib can cause possibly life-threatening, abnormal heartbeat. Advise patients to seek immediate medical attention if symptoms of abnormal heartbeat occur, such as feeling light-headed, faint or experiencing an irregular heartbeat [see Warnings and Precautions (5. 3)]. Cardiac and Arterial Vascular Occlusive Events Advise patients that cardiovascular events (including ischemic heart disease, peripheral arterial occlusive disease, and ischemic cerebrovascular events) have been reported Advise patients to seek immediate medical attention if any symptoms suggestive of a cardiovascular event occur, such as chest or leg pain, numbness or weakness, or problems walking or speaking occur suddenly [see Warnings and Precautions (5. 5)].
The cardiac side effects of Nilotinib (nilotinib) include:
- QT Prolongation: possibly life-threatening, abnormal heartbeat
- Cardiac and Arterial Vascular Occlusive Events: cardiovascular events, including ischemic heart disease, peripheral arterial occlusive disease, and ischemic cerebrovascular events 2
From the Research
Cardiac Side Effects of Nilotinib
The cardiac side effects of Nilotinib (nilotinib) have been studied in various research papers. Some of the key findings include:
- Nilotinib has been associated with a risk of prolongation of the QT interval, which can increase the risk of cardiac arrhythmias and other cardiac adverse events 3, 4, 5, 6.
- Cardiac adverse events, including cardiac failure, ischemic heart disease, cardiac arrhythmias, and torsade de pointes/QT prolongation, have been reported in patients taking nilotinib 4, 5, 6.
- The risk of cardiac adverse events associated with nilotinib may be higher in patients with pre-existing cardiovascular risk factors or those who have received prior imatinib therapy 3, 5.
- Electrocardiogram QT prolongation is one of the most frequently reported cardiac adverse events associated with nilotinib, with a reported incidence of 30.9% in one study 6.
- Other cardiac adverse events associated with nilotinib include cardiac failure, atrial fibrillation, acute myocardial infarction, pericardial effusion, myocardial infarction, cardiac arrest, pericarditis, and cardiac tamponade, with some cases resulting in fatal outcomes 6.
Specific Cardiac Side Effects
Some specific cardiac side effects associated with nilotinib include:
- QT prolongation: Nilotinib has been shown to prolong the QT interval, which can increase the risk of cardiac arrhythmias and other cardiac adverse events 3, 4, 5, 6.
- Cardiac failure: Cardiac failure has been reported in patients taking nilotinib, with a reported incidence of 9% in one study 3.
- Ischemic heart disease: Ischemic heart disease has been reported in patients taking nilotinib, with a reported incidence of 11 clinical cardiac adverse events requiring treatment in one study 3.
- Cardiac arrhythmias: Cardiac arrhythmias, including atrial fibrillation and ventricular arrhythmias, have been reported in patients taking nilotinib 4, 5, 6.
- Torsade de pointes: Torsade de pointes, a potentially life-threatening cardiac arrhythmia, has been reported in patients taking nilotinib 5, 6.