Have there been reports of bloodshot eyes  with IM?

:KH:  Some patients report bloodshot eyes or noticeable bleeding in the eye.  This should be reported to a doctor, but is not usually considered dangerous.

How about blood in the urine ?

KH: Although this has not been listed by Novartis as an adverse reaction (side effect) to imatinib, some patients have reported small amounts of blood in the urine (hematuria).  Usually this is picked up in lab reports and, in mild cases, is not worrisome.  All cases should be reported to a doctor, especially if one notices blood when urinating.

How about red spots on the skin ?

ER: I have these red flat spots often in areas exposed to the elements (lower limbs). It is said to be a skin reaction to IM. They appear as isolated patches of red, and do not itch, one of those cosmetic flaws we have to live with IM. Some other patients also report having seen these on their forearms, neck and face. They simply resolve and appear again intermittently.

What about itchy rashes ?

KH: Approximately 39% of patients in clinical trials report skin rash while taking IM.  Rashes often present  themselves in the form of red, itchy dry patches.

They may feel and look like a sunburn.  Most rashes reported are mild, but all rashes should be reported to a physician.  Often, rashes may be treated with over-the-counter lotions, such as Aveeno with oatmeal, which help the itchiness.  Occasionally, the rashes require more aggressive treatment with an antihistamine or a topical corticosteroid.

  If the rash is severe and not alleviated with treatment, it may be necessary to reduce or interrupt treatment with IM. 

In some cases, a course of oral steroids (such as prednisone) may be used and IM resumed after the rash has cleared. 

How about liver toxicity or hepatotoxicity ?


KH:  Although liver toxicity (hepatotoxicity) is rare (1.1% to 3.5%) in patients treated with IM,

it is the second most common reason for permanent discontinuation of IM therapy.

  Usually liver toxicity will occur within the first few months of treatment with IM, but may occur much later.  It is critical to have liver function tests (LFTs) performed regularly to monitor counts.

  It has been suggested to obtain LFTs before beginning IM therapy, every other week during the first month of IM therapy, and at least monthly thereafter.  With significant elevation in LFTs, it may be necessary to discontinue IM therapy, either temporarily or permanently.

It is important to avoid alcohol and acetaminophen (brand name Tylenol) while taking IM as both are metabolized through the liver and may increase one's risk for developing liver toxicity.

Any reports of changes in pigmentation ?

KH: Some patients treated with IM have reported depigmentation (the loss of color in the skin).

This is most likely due to the fact that IM inhibits an enzyme called KIT which expresses itself in skin cells.

ER: In some Filipinos, the overall brown skin color lightens up.  While for some darker skinned patietns, these hypopigmentedspots are noticeable on their habds.

KH: Interestingly, there have been other reports of hyperpigmentation (darkening of skin color) and darkening of hair color in some patients.

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