Diarrhoea is the commonest adverse effect of abemaciclib and usually starts in the first weeks. Patients should have loperamide at home before the first dose, start it at the first loose stool, increase fluids, and contact the team if diarrhoea persists beyond about 24 hours or is severe. Persistent grade 2 or worse diarrhoea usually warrants a dose hold and reduction per the label.
- Prescribe loperamide with the first abemaciclib supply.
- Tell patients to start it at the first loose stool, not to wait.
- Persistent or severe diarrhoea needs review and a dose interruption.
- Check for dehydration and electrolyte disturbance in older patients.
Why it matters
Early management keeps most patients on treatment at an effective dose.
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