When educating patients on imatinib (Glivec) nurses must include advice on:

1. HOW THE DRUG WORKS AND WHEN TO TAKE IT
Imatinib is a selective oral biological therapy. Show this clip to patients: https://www.youtube.com/watch?v=7ZMVQ1Vbb7Y

Imatinib produces high response rates and an 89% 5 year survival rate, but needs to be taken as prescribed. Patients are advised to take their prescribed dose (400–800 mg) daily continuously.
Imatinib should be swallowed whole with a glass of water after food.

2. SIDE EFFECTS AND THE IMPORTANCE OF REPORTING SIDE EFFECTS ASSOCIATED WITH THE DRUG
Side effects of imatinib are manageable and even preventable. Patients are advised not to stop the drug themselves and if experiencing side effects to contact their specialist nurse of doctor. Nurses must stress to patients the importance of reporting symptoms in order to continue the drug and gain is benefits. Common side effects include:

• Increased risk of infection due to low WBC count. Severe infections can be life-threatening.
• Patients should have regular blood tests and report immediately temperature of 39°C or above.
• Bruising can develop due to low platelets. Gum and nose bleeds are common. In addition, patients can develop petechiae (tiny red spots/bruises on the skin).
• Fluid retention resulting in weight gain and fluid around the lungs which may cause breathlessness. Rarely fluid can develop in the abdomen or around the eyes.
• Fatigue may be present at diagnosis. This usually improves/resolves within 6–12 months.
• Nausea is usually well controlled with an antiemetic. It is important to ensure patients have one prescribed and the nurse assesses its effectiveness.
• Headache. Provide advice on maintaining good hydration to avoid this.
• Diarrhoea
• Muscle cramps
• Joint pain and swelling
• Loss of appetite
• Skin rash

3. DRUG INTERACTIONS
Patients are advised that some medications can increase or decrease the effects of imatinib and they are therefore advised to consult with their doctor when commencing any new medications, including herbal remedies

4. CONTRACEPTION, PREGNANCY AND BREASTFEEDING
Nurses must educate patients on the importance of not having/fathering a child whilst taking imatinib. Education on effective forms of contraception must be provided. Patients should consult their haematologist if they are planning a pregnancy. Women are advised not to breastfeed when taking imatinib due to the risk of the drug being present in breast milk.

5. IMMUNISATIONS
Patients are advised to consult with their doctor before receiving vaccinations.

6. DRUG ADHERENCE:
Imatinib is taken once daily for CML until the disease has progressed or becomes resistant. Missed doses or ‘drug holidays’ are not permitted. Because patients live with CML long-term, a challenge for them is to continue to take their mediation when they feel ill. Nurses must educate patients on the risks if they do not take their medication and the potential for loss of response. Ensuring patients’ symptoms are controlled is central to patients taking their medication. Patient education on the availability and use of drug reminder apps and use of mobile devices reminders should be encouraged to increase adherence.