Before starting Imatigliv, tell your doctor about all of your medical conditions and all the medicines you take, including if you:

• Have heart problems, or risk factors for heart disease;
• Have liver problems;
• Have ever had hepatitis B, or are a carrier of the hepatitis B virus — Imatigliv can cause it to become active again;
• Have kidney problems;
• Have thyroid problems, or have had your thyroid gland removed;
• Have diabetes;
• Have ever had a severe skin reaction to a medicine;
• Take any other prescription or over-the-counter medicines, vitamins, or herbal supplements — some can interact with Imatigliv or make it less effective, and grapefruit or grapefruit juice can raise the amount of Imatigliv in your body. Always check with your doctor before starting anything new while on treatment;
• Are pregnant, could become pregnant— Imatigliv can harm an unborn baby. Women who can become pregnant should have a pregnancy test before starting and use effective contraception during treatment and for at least 15 days after the last dose;
• Are breastfeeding — do not breastfeed during treatment with Imatigliv and for at least 15 days after the last dose.

Also tell your doctor about:

• Any planned hospital, dental, or medical care — always tell the treating team that you are on cancer treatment;
• Any recent or upcoming vaccinations — live vaccines (such as MMR, BCG, yellow fever, or shingles) are not safe during treatment or for at least 6 months afterwards, although the flu vaccine is fine. Also mention if you have been in close contact with anyone recently given a live oral vaccine (such as oral polio, cholera, or typhoid).

Imatigliv may also affect fertility. If having children in the future is important to you, discuss this with your doctor before starting treatment.

• Take Imatigliv exactly as your doctor tells you — the right dose, not more or less. Never stop taking it without talking to your specialist first.
• Swallow the tablets whole with a glass of water, with food, to reduce stomach irritation. If you cannot swallow the tablets, you may disperse them in a glass of plain water or apple juice — stir until the tablets have broken up completely, then drink the whole glassful.
• Imatigliv is usually taken once or twice a day, depending on your dose. It is usually continued for as long as it works and the side effects are manageable. For Philadelphia chromosome-positive ALL, it may be given on its own or together with chemotherapy.
• Do not eat grapefruit or drink grapefruit juice while taking Imatigliv, as this can increase the amount of medicine in your body.
• If you miss a dose, take it as soon as you remember, unless it is nearly time for your next dose. Do not take a double dose to make up for a missed one.
• Your doctor will regularly check your blood counts, your liver and kidney function, and your weight (to watch for fluid build-up), and may adjust or pause your dose if needed.

Serious side effects

Tell your doctor or specialist nurse right away — or get emergency medical help — if you have any of the following:

• Low blood cell counts and serious infections. Imatigliv can lower your white blood cells (raising the risk of infection), red blood cells (causing tiredness, breathlessness, or pale skin), and platelets (causing bruising or bleeding, such as nosebleeds, bleeding gums, or tiny red spots on the skin). Infections can be life-threatening. Your blood counts will be checked regularly. Tell your doctor about fever, chills, a cough, a sore throat, or pain when passing urine.
• Fluid build-up (edema). This can become serious, especially around the lungs, heart, or abdomen. Tell your doctor about rapid weight gain, swelling of your legs, ankles, feet, or around your eyes, or shortness of breath.
• Heart problems (heart failure). Tell your doctor about shortness of breath (especially when lying down), swelling of your ankles or feet, rapid weight gain, or unusual tiredness or weakness.
• Liver problems. Serious liver damage can occur. Your doctor will check your liver with blood tests. Tell your doctor about yellowing of your skin or the white part of your eyes (jaundice), dark urine, pale stools, pain on the right side of your stomach area, or unusual tiredness.
• Serious bleeding. Get medical help for vomiting blood or material that looks like coffee grounds, black or tarry or bloody stools, blood in your urine, or any bleeding that will not stop.
• Severe skin reactions. Get medical help right away for a widespread rash, blistering or peeling skin, or sores in your mouth, eyes, or genital area.
• Serious allergic reactions. Get medical help for swelling of your face, lips, tongue, or throat, hives, or trouble breathing.
• Kidney problems. Tell your doctor about a change in how much you urinate, or swelling.
• Hepatitis B reactivation. If you have ever had hepatitis B, it can become active again during treatment and can, rarely, be serious or life-threatening. Your doctor may test you for hepatitis B before you start and monitor you. Tell your doctor about yellowing of your skin or eyes, dark urine, unusual tiredness, or loss of appetite.
• Thyroid problems. If you have had your thyroid gland removed and take thyroid hormone (such as levothyroxine), Imatigliv can lower your thyroid levels. Your doctor may check your thyroid during treatment.
• A tear in the stomach or intestine (perforation). Get emergency help for severe stomach (abdomen) pain.
• Tumor lysis syndrome. This is a fast breakdown of cancer cells, usually early in treatment. Drinking enough fluids is important, and your doctor will monitor you.
• Effects on growth in children. Imatigliv may slow growth in children. Your child's doctor will check their growth regularly.
• Harm to an unborn baby. Imatigliv can harm an unborn baby.

Common side effects

These may include:

• Tiredness (fatigue)
• Mild fluid retention, such as puffiness around the eyes or ankles
• Nausea (usually managed well with anti-sickness medicine)
• Diarrhea
• Headache
• Indigestion
• Loss of appetite
• Skin rash, or dry or itchy skin
• Weakness
• Fever and night sweats
• Muscle cramps, or muscle and joint pain
• Constipation
• Sore mouth or mouth ulcers
• Taste changes
• Weight loss
• Dizziness
• Difficulty sleeping
• Eye irritation (conjunctivitis), watering eyes, or blurred vision
• Abdominal pain or swelling
• Wind (flatulence)
• Hair thinning
• Numbness or tingling in the hands or feet

This is not a complete list of side effects. Tell your doctor about any side effect that bothers you or does not go away.

For further information

This page answers common questions about Imatigliv. It is a general summary and does not replace the advice of your doctor or the full prescribing information. For complete details, including all warnings, precautions, and side effects, please read the Imatigliv prescribing information. Always follow your doctor's instructions.