Lyrfigtu (lirafugratinib) is a targeted pill used to treat certain adults with previously treated cholangiocarcinoma (bile duct cancer) whose tumors carry a fusion or other rearrangement in a gene called FGFR2 (fibroblast growth factor receptor 2).
Like all medicines, Lyrfigtu can cause side effects and may interact with other medicines or supplements.
This article covers both the common and the serious side effects of Lyrfigtu, tips for managing them, and medicines that may interact with Lyrfigtu.
This article doesn't include every possible side effect or interaction. Tell your health care provider about any symptoms that concern you or don't improve.
Lyrfigtu Side Effects
Common side effects
The most commonly reported side effects of Lyrfigtu include:
- Nail changes, such as brittleness, ridging, or infections around the nail
- Hand-foot skin reactions (redness, swelling, or peeling on the palms and soles)
- Mouth sores
- Hair loss
- Dry eyes and dry mouth
- Fatigue
- Changes in taste
- Dry skin
- Constipation
- Belly pain and diarrhea
- Nausea
Serious side effects
Less commonly, Lyrfigtu can cause more serious side effects such as:
- Vision changes, including a buildup of fluid under part of the retina
- A sudden rise in blood phosphate levels, which can lead to calcium or mineral deposits in soft tissue
- Serious infections
- Serious bleeding
- A serious allergic reaction
If you have symptoms that feel serious or life-threatening, seek medical care right away.
How to Manage Lyrfigtu Side Effects
While not a complete guide, the following tips can help you prevent or manage some of the more common Lyrfigtu side effects.
1. Nail changes
Nail toxicity is one of the most common side effects of Lyrfigtu, affecting most people (89%) who take it.
Symptoms may include brittle, cracked, or ridged nails, nail separating from the nail bed, and redness, swelling, and tenderness around the nail (sometimes with infection).
To help manage nail changes:
- Keep nails trimmed short and filed smooth to help prevent snagging or cracking.
- Wear gloves for household chores, gardening, or dishwashing to protect your nails and the skin around them.
- Moisturize your hands, feet, and nails regularly.
- Avoid harsh nail products, artificial nails, and cutting cuticles.
- Wear comfortable, well-fitting shoes to reduce pressure on your toenails.
Tell your health care provider if a nail becomes painful or swollen or shows signs of infection (such as pus or spreading redness). They may recommend treatment. In more severe cases, they may pause or lower your Lyrfigtu dose until the condition improves.
2. Hand-foot skin reactions
Hand-foot skin reactions (also called palmar-plantar erythrodysesthesia) are very common with Lyrfigtu. For some people, they're severe enough to require a dose change.
Symptoms may include:
- Redness, swelling, or tenderness on the palms of your hands or soles of your feet
- Tingling, burning, or numbness
- Peeling, blistering, or thickened skin, especially in areas of friction or pressure
To help manage symptoms:
- Moisturize your hands and feet several times a day with a thick, fragrance-free cream.
- Avoid very hot water, friction, and tight-fitting shoes or gloves.
- Use padding or cushioned insoles in shoes to reduce pressure on your feet.
- Avoid activities that put prolonged pressure on your hands or feet, such as running or using tools that require gripping.
- Apply cool compresses to help ease discomfort.
Tell your health care provider if symptoms are painful, interfere with daily activities, or keep getting worse. They may recommend a prescription cream or pause or lower your Lyrfigtu dose until your skin heals. A large share of people in clinical studies needed a temporary dose reduction or break because of this side effect, so don't hesitate to bring it up early.
3. Mouth sores
Mouth sores (stomatitis) are a common side effect of Lyrfigtu. Symptoms may include red or swollen gums, mouth or lip sores, and pain while eating or swallowing.
These tips may help prevent or reduce the symptoms:
- Brush your teeth and gums gently, three or four times a day, with a soft-bristle toothbrush and mild toothpaste.
- Rinse your mouth several times a day with salt water or a mix of salt water and baking soda.
- Eat soft, cool foods such as yogurt, smoothies, or ice pops. Use a straw for liquids to keep them away from sores.
- Avoid hot, spicy, or citrus-based foods and drinks.
Tell your health care provider if mouth sores make it hard to eat, drink, or take your medicine. They may recommend a mouth rinse or other treatment or lower your Lyrfigtu dose until your sores heal.
4. Eye changes
Lyrfigtu can affect your eyes. This can include a buildup of fluid under part of the retina (called retinal pigment epithelial detachment, or RPED), dry eyes, blurred vision, and irritation of the clear outer layer of the eye (the cornea).
As covered in the Lyrfigtu primary article, this is why you'll have regular eye exams, including imaging of the retina, before and during treatment.
Possible symptoms include blurry or wavy vision, new floaters or flashes of light, sensitivity to light, and eyes that feel gritty, dry, or irritated. To help manage dry eyes or mild irritation, use artificial tears or lubricating eye gels as needed, and avoid rubbing your eyes.
Call your health care provider right away, even between scheduled visits, if you notice any new or worsening vision changes. Depending on how severe the change is, they may order an urgent eye exam and pause or lower your Lyrfigtu dose until your vision improves.
5. High phosphate levels
Lyrfigtu can raise the amount of phosphate in your blood. Over time, high phosphate levels can lead to calcium or mineral deposits building up in soft tissue, including in and around blood vessels.
This often doesn't cause noticeable symptoms early on, which is why your health care provider will check your blood phosphate levels regularly during treatment. Tell your health care provider right away if you notice muscle cramps, numbness, or tingling around your mouth, as these can be signs of a sudden change in phosphate levels.
Depending on your results, your health care provider may prescribe a phosphate binder medicine, adjust your diet, or lower your Lyrfigtu dose.
6. Fatigue
Fatigue, including feelings of tiredness or weakness, is a common side effect of Lyrfigtu. These symptoms may improve over time as your body adjusts to treatment.
To help support your energy:
- Get plenty of sleep, and keep a regular sleep schedule.
- Include nutrient-rich foods in your meals.
- Stay as physically active as you comfortably can. Light activity, such as walking, can actually help with fatigue more than resting too much.
- Minimize stress where you can, with support from counseling sessions or relaxation techniques.
- Plan your more demanding activities for times of day when your energy tends to be highest.
Tell your health care provider if fatigue doesn't improve or interferes with your daily life. They can check for other possible causes, and they may suggest changes to your treatment plan if needed.
Tell your health care provider about any side effect, even if it isn't listed here, especially if it feels severe or doesn't go away.
Lyrfigtu Interactions
Lyrfigtu can interact with other medicines.
An interaction happens when a substance changes how a medicine works or affects the body.
Lyrfigtu is broken down in the body mainly by a liver enzyme called CYP3A4. Medicines that change how active this enzyme is can raise or lower the amount of Lyrfigtu in your body. Lyrfigtu can also affect certain transport systems the body uses to move other medicines in and out of cells, which can change how much of those other medicines stay in your body.
This is not a full list of interactions, but the following are important to know about while taking Lyrfigtu.
Medicines that can make Lyrfigtu less effective
Some medicines speed up how quickly your body breaks down Lyrfigtu. This can lower the amount of Lyrfigtu in your bloodstream and make it less effective at treating your cancer.
Examples include:
- Efavirenz, an HIV medicine
- Rifampin, an antibiotic
You should avoid these medicines while you're taking Lyrfigtu. Tell your health care provider about all the medicines you take so they can check for this kind of interaction before you start Lyrfigtu.
Medicines that can raise the amount of Lyrfigtu in your body
Other medicines slow down how your body breaks down Lyrfigtu. This can raise Lyrfigtu levels in your blood and the risk of side effects.
Examples include:
- Erythromycin, an antibiotic
- Itraconazole, an antifungal medicine
These medicines are typically avoided while you're taking Lyrfigtu. If you and your health care provider decide you need to take one of these medicines anyway, they may lower your Lyrfigtu dose while you take them together and then adjust it again after you stop. Don't change your Lyrfigtu dose on your own. Any dose adjustment should be made by your health care provider.
Medicines that Lyrfigtu may affect
Lyrfigtu can slow down how your body clears certain other medicines, which may raise their levels in your blood and increase their side effects.
Examples of medicines that may be affected this way include:
- Digoxin, a heart rhythm medicine
- Rosuvastatin, a cholesterol medicine
If you take one of these medicines or a similar one, your health care provider may want to monitor you more closely for side effects, such as checking blood levels of the other medicine or watching for symptoms specific to it. Don't stop or change the dose of any of your other medicines without talking to your health care provider first.
FAQs: Lyrfigtu Interactions
Does Lyrfigtu interact with alcohol?
It isn't known for certain whether alcohol affects Lyrfigtu directly. Lyrfigtu can affect your liver (liver enzyme changes in blood tests were common in studies), and alcohol can also stress the liver. So, it's a good idea to ask your health care provider how much alcohol, if any, is safe for you while taking Lyrfigtu.
Does Lyrfigtu interact with food or supplements?
Possibly. Lyrfigtu is broken down by the same liver enzyme (CYP3A4) that's affected by grapefruit and grapefruit juice, as well as the herbal supplement St. John's wort (sometimes used for mood or sleep). Grapefruit may raise Lyrfigtu levels and increase your risk for side effects, while St. John's wort may lower them and make Lyrfigtu less effective.
Tell your health care provider about any supplements, herbs, or vitamins you take, and ask them before adding anything new while on Lyrfigtu.
Reducing Your Risk of Side Effects and Interactions
You can help lower your risk of side effects and interactions by taking Lyrfigtu exactly as prescribed and following your health care provider's instructions closely.
Helpful tips include:
- Tell your pharmacist and other health care providers about everything you take, including prescription drugs, over-the-counter medicines, vitamins, herbs, and other supplements.
- Ask your health care provider before starting or stopping any medicine, vitamin, or supplement.
- Keep all recommended lab test and eye exam appointments.
- Report any new or worsening symptoms to your health care provider, even if they seem minor.
Your health care provider can review your treatment plan and adjust it if needed. Don't change or stop Lyrfigtu on your own, even if you're having side effects.
