Drug General Information (ID: DDI471V38Y)
Drug Name			Cabozantinib		Drug Info		Desirudin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Vegf/Vegfr Inhibitors				Anticoagulants
Structure

Mechanism of Cabozantinib-Desirudin Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Cabozantinib				Desirudin
Mechanism		Risk of bleeding Antiplatelet/anticoagulant effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Cabozantinib and Desirudin

Recommended Action
Management		Concomitant use of other medications that interfere with platelet function or coagulation should be considered cautiously in patients treated with cabozantinib. Close clinical and laboratory observation for bleeding complications is recommended during therapy. The INR should be monitored more frequently during coadministration of warfarin. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Product Information. Cometriq (cabozantinib). Exelixis Inc, S San Francisco, CA.