The management of side effects of lenatinib is crucial to ensure the smooth progress of treatment. Adopting proactive prevention and layered treatment strategies for diarrhea, nausea, and fatigue can significantly improve patients' quality of life.

1、 Prevention and graded management of diarrhea

1. Loperamide Mandatory Prevention Program

Simultaneously initiate loperamide prophylaxis during the first dose administration, without waiting for diarrhea to occur.

The initial dose is 4mg (2 pills), followed by an additional 2mg (1 pill) every 2 hours or every time loose stools appear.

Medication can be taken every 4 hours at night to maintain coverage, and the daily dose generally does not exceed 16mg.

2. Dose adjustment strategy

If the number of diarrhea episodes exceeds 6 within 24 hours with the support of the maximum dose of loperamide, lenatinib should be suspended.

After the diarrhea subsides to ≤ grade 1, the dose of lenatinib should be reduced when re administered (following a decreasing regimen).

2、 Disgusting hierarchical management

1. Basic preventive measures

It is recommended to take medication with meals or within 30 minutes after meals to reduce stomach irritation.

Avoid high-fat, spicy, or overly sweet foods and switch to a light, easily digestible small and frequent meal pattern.

2. Timing of antiemetic medication addition

When basic measures cannot alleviate nausea, antiemetic drugs (such as metoclopramide or ondansetron) can be used according to medical advice.

If nausea leads to inability to eat or weight loss, it is necessary to contact a doctor in a timely manner and should not be forcibly endured.

3、 Energy conservation strategies for fatigue

1. Balance between activities and rest

Split daily activities into multiple short time periods to avoid excessive one-time consumption.

Arrange a short nap (20-30 minutes), but avoid staying in bed for long periods of time during the day to avoid affecting nighttime sleep.

2. Nutrition and mild exercise support

Prioritize consuming high protein foods during periods of good appetite to maintain physical reserves.

Taking a light walk or stretching can help alleviate fatigue, but vigorous exercise should be avoided.

4、 Danger signals requiring urgent medical attention

Diarrhea accompanied by severe abdominal pain, bloody stools, or fever suggests the possibility of concurrent infection or intestinal mucosal damage and requires immediate medical attention.

If nausea and vomiting persist for more than 24 hours without water intake, or if dehydration symptoms such as blurred consciousness and palpitations occur, seek medical attention promptly.