GIST Support Wiki

 

FATIGUE is a common problem GIST patients deal with. It is also one of the common Gleevec Side Effects. This page is a place to share ideas on coping with fatigue.

One of the main reasons people feel fatigued when taking Gleevec is because of the way Gleevec interacts with the immune system. Since Gleevec binds to the membrane of red blood cells the immune system identifies these Gleevec bound cells as foreign to the body (antigenic). Antibodies form against these red blood cells, attach to them, and then cause their premature destruction. This is called drug-induced immune hemolytic anemia. You can see this in your blood counts, especially Hb.

Red blood cells perform the most important blood duty. A single drop of blood contains millions of red blood cells which are constantly traveling through your body delivering oxygen and removing waste. If they weren't, your body would slowly die.

Red blood cells are red only because they contain a protein chemical called hemoglobin which is bright red in color. Hemoglobin contains the element Iron, making it an excellent vehicle for transporting oxygen and carbon dioxide. As blood passes through the lungs, oxygen molecules attach to the hemoglobin. As the blood passes through the body's tissue, the hemoglobin releases the oxygen to the cells. The empty hemoglobin molecules then bond with the tissue's carbon dioxide or other waste gases, transporting it away.

Over time, the red blood cells get worn out and eventually die. The average life cycle of a red blood cell is 120 days. Your bones are continually producing new blood cells, replenishing your supply. The blood itself, however, is re-circulated throughout your body, not being remade all of the time.

Here a few tests which are part of the larger picture concerning the health of your blood:

  • Iron and Ferritin are needed by the bone marrow for the production of red blood cells.
  • RBC shows the red blood cell concentration.
  • Hematocrit shows the percentage red blood cells in whole blood.
  • Hb measures the total amount of hemoglobin in the blood. Hemoglobin is the main component of red blood cells. Hemoglobin is a protein that carries oxygen from the lungs to the body's tissues, and carbon dioxide from the tissues to the lungs to be exhaled.
  • Reticulocyte count measures the percentage of reticulocytes (slightly immature red blood cells) in the blood. This can help determine if red blood cells are being created in the bone marrow at an appropriate rate.
  • MCH reflects the size and hemoglobin content of individual red blood cells.
  • Albumin Serum is the clear fluid portion of blood and is very important for osmosis.

Here are a few ways to help alleviate this fatigue:

Contents

Taking Iron Supplements

In order for our bone marrow to produce red blood cells it needs iron. If you have iron deficiency then iron supplements make sense. If you have had bleeding episodes from your tumor you may have iron deficiency. Your doctor can tell you if you need more iron. Not all iron supplements are as easily absorbed. Ferrous iron (ferrous fumarate, ferrous sulfate, and ferrous gluconate) are better absorbed than ferric iron. Furthermore, iron is absorbed better when taken with Vitamin C.

Note that Novartis cautions against taking iron supplements with Gleevec because the coating of Gleevec tablets contains iron. Novartis recommends against taking 800 mg/day of Gleevec in the 100-mg pill form (as 8 100-mg pills) to avoid extra iron.

You can read more about iron at the National Institute of Health (NIH): http://ods.od.nih.gov/factsheets/iron.asp

Counseling

This is a summary in Medscape, which is free-access after a free registration. Exercise and Counseling May Help Reduce Fatigue in Patients With Cancer: http://www.medscape.com/viewarticle/565276?src=mpnews

Exercise

Some people experience less fatigue if they get plenty of exercise (without over doing it). This may seem counterproductive but it's not. The body responds to exercise by building itself up - better blood supply, better muscle tone, better VO2 uptake.

This is a summary in Medscape, which is free-access after a free registration. Exercise and Counseling May Help Reduce Fatigue in Patients With Cancer: http://www.medscape.com/viewarticle/565276?src=mpnews

Take Gleevec at Night

Some people find the can sleep during the worst fatigue if they take at least half their daily [Gleevec] dose near bedtime. However, if you take it immediately before lying down you may develop stomach irritation. Therefore, it is advisable to take Gleevec at least half an hour before lying down.

See Also

  • Putting Evidence Into Practice: Evidence-Based Interventions for Fatigue During and Following Cancer and Its Treatment by Sandra A. Mitchell et al. - PDF File, HTML Version (scroll down table of contents until you see it)

Personal Stories

I started taking PROVIGIL. It is a drug that is used for narcolepsy or shift workers (people who work over night--7p-7a) and it is also off label for fatigue d/t treatments. I am taking it for the fatigue that I have had since taking Gleevec.


Caution must be excercized when taking Provigil. I used to take it for fatigue, but quit when my Oncologist found that Provigil is a powerful CPY3A4 inducer. Gleevec is metabolized by CPY3A4.

Please follow this link and and click on 'Full Prescribing Information' - when that pdf opens read Pharmacokinetics and Drug Interaction sections. http://www.provigil.com/

Ask your doctor about this, as I believe it can lead to reduced blood serum levels of Gleevec.


I tried to get a script for Provigil and my insurance (Blue Shield) absolutely refused to approve it because of the fact it would be used to combat the side effects of another drug (Gleevec and now Sutent.)

However I was able to get a script for Adderall XR. It is similar to Provigil and gives me no side effects. I take it once in the morning so I can have a sort of normal day. Currently I take 10 mg. once a day in the morning. It sure is a blessing.

It is interesting in that the most common use of Adderall is to combat ADD in children. It calms them down. However in adults it has the opposite effect. If you decide to go the route of any one of the anti-fatigue drugs you may have to "play" with the dosage in order to find out which one works for you without getting you all jacked up. Perhaps I should have said your doctor may have to play with the dosage rather than you.