Drug reference

Vandetanib

Multikinase inhibitor (VEGFR, EGFR, RET, BRK) · Antineoplastic

START

300 mg PO once daily; ECG/electrolytes at baseline

TYPICAL MAX

300 mg/day (200 mg if CrCl 30–50)

STOP IF

QTc >500 ms, severe ILD, or severe skin/PRES events

WATCH

ECG/QTc, electrolytes (K/Mg/Ca), TSH, BP, skin/photosensitivity

CDSCO approvedSchedule HATC L01EX04

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 2h · absorption
PEAK: 6h · Tmax
t½: 2.7w · t½ ~19 d
DURATION: 1d · once-daily

EXCRETION

~25% renal, ~44% faecal

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Can cause fetal harm — avoid; effective contraception during and 4 months after.

FDA category + note

Top interactionssee all 12 →

AbarelixSevereDatabaseDDInter
AbirateroneSevereDatabaseDDInter
AdenosineSevereDatabaseDDInter
AlfuzosinSevereDatabaseDDInter

Mechanism

Inhibits VEGFR-2, EGFR, RET (including mutant forms), Src and BRK tyrosine kinases, blocking tumour angiogenesis and proliferation signalling — designed for RET-driven medullary thyroid cancer.

Indications

Symptomatic / progressive medullary thyroid cancer (unresectable, locally advanced or metastatic)

Dosing

Adult: 300 mg PO once daily; reduce to 200 mg or 100 mg for toxicity / QT prolongation.
Pediatric: Body-weight–based (specialist).
Renal adjustment: CrCl 30–50: starting dose 200 mg; CrCl <30: not recommended.
Hepatic adjustment: Not recommended in moderate–severe (limited data).
Geriatric: No specific adjustment; monitor QT/electrolytes.
Max dose: 300 mg/day

Pharmacokinetics

Onset

Tumour response over weeks–months

Peak effect

~6 h (Tmax)

Duration

~24 h (once-daily)

Half-life

~19 days (very long)

Bioavailability

Variable (~38%); not food-dependent

Protein binding

~90%

Metabolism

Hepatic CYP3A4 + FMO; renal excretion of unchanged drug

Excretion

~25% renal, ~44% faecal

Contraindications

Congenital long-QT syndrome / baseline QTc >480 ms
Severe hypersensitivity
Caution: cardiac failure, severe hepatic impairment, electrolyte disturbance

Side effects

Common

DiarrhoeaRash / photosensitivityAcneHypertensionNauseaFatigueHeadache

Serious

QT prolongation / torsades / sudden death (boxed)
Severe skin reactions (SJS/TEN, photosensitivity)
Interstitial lung disease
Heart failure
Posterior reversible encephalopathy
Ischaemic cerebrovascular events

Pregnancy & lactation

Pregnancy

Can cause fetal harm — avoid; effective contraception during and 4 months after.

Lactation

Avoid breastfeeding during and 4 months after therapy.