1. Muscle Spasms
Doctors believe that this happens because hedgehog inhibitors trigger a flow of calcium into muscle cells, leading to uncontrolled muscle contractions. These spasms can usually be managed with supportive care, including medications to relieve the symptoms.
- Drink plenty of water (stay hydrated).
- Get gentle physical activity, like walking.
- Stretch or massage the cramping muscle.
- Apply heat to tight muscles by using a heating pad or taking a warm bath.
- Use a cold compress on sore muscles.
- Try sports drinks to replace electrolytes.
- Splint affected areas while sleeping.
- Change your sleeping or sitting position.
If self-care doesn’t bring relief, ask your doctor whether a prescription pain medication or muscle relaxer might.
“Pain medicine when appropriate may help,” says Hardin. “If cramps are severe or do not go away, the healthcare team may order blood tests to check for muscle injury or electrolyte problems.”
She notes that patients taking sonidegib will require additional monitoring for muscle-related side effects. “In some cases, blood tests may show increased creatine kinase levels, which can be a sign of muscle injury,” says Hardin. “Severe muscle injury may also affect kidney function, making prompt evaluation important when muscle symptoms occur.”
2. Fatigue
Try these tips for more energy:
- Address any underlying factors that are contributing to your fatigue.
- Try to be active every day: Talk to your doctor about an exercise program.
- Do important tasks when you have the most energy.
- Try mind-body activities such as yoga, massage, or tai chi.
- Consider counseling if you’re feeling depressed or mentally fatigued.
3. Hair Loss (Alopecia)
Your hair quality and texture can also be impacted.
“Side effects include hair loss, which can be permanent,” says Hilary Gomolin, MD, a medical oncologist and hematologist at the Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital in Florida. “This differs from chemotherapy-related hair loss, where patients can generally anticipate hair regrowth following treatment.”
- Choose a mild shampoo.
- Not wash your hair every day.
- Limit or avoid using a blow dryer or other heat appliances.
- Limit or avoid chemical hair treatments like straightening or coloring.
- Protect your scalp from the sun with a hat, scarf, or sunscreen.
- Ask your doctor about medications for hair growth, including minoxidil and oral dihydrotestosterone inhibitors.
4. Taste Disturbances (Dysgeusia and Ageusia)
- Try cold or room-temperature foods.
- Boost the flavor of foods by adding lemon, spices, seasonings, or marinades.
- Brush your teeth and tongue before meals.
- Try using a baking soda–salt wash or antibacterial mouthwash.
- Add flavoring to your water.
- Use plastic or wood utensils.
- Try zinc gluconate lozenges.
5. Nausea
Many people experience nausea and other gastrointestinal side effects when they begin taking hedgehog inhibitors for advanced BCC. “Symptoms such as nausea, diarrhea, and vomiting can make it harder for patients to stay hydrated and maintain good nutrition,” says Hardin. “These side effects are usually managed with supportive care, including medications to relieve symptoms, dietary changes, staying well hydrated, and checking for other health issues that may be contributing to the problem.”
There are many medications (antiemetics) that can help with nausea. Ask your healthcare team whether you should take something prior to your BCC medication to try to head off the nausea.
- Ask your doctor if you should take vismodegib with food; sonidegib should be taken on an empty stomach.
- Sip liquids slowly throughout the day. You may find that cold, clear liquids, such as apple juice, broth, or ginger ale, are the easiest on your stomach.
- Try to eat several small meals or snacks throughout the day.
- Stick with bland foods that are easy to digest, such as plain crackers, clear broth, toast, and plain yogurt.
- Sour foods, such as sour candy, pickles, lemons, or lime, might be helpful in controlling nausea.
- If smells bother you, try to eat your meals when they are cool or at room temperature.
- Try to eat small amounts of mild, high-calorie foods that are easy to eat or drink, such as pudding, ice cream, sherbets, yogurt, and milkshakes.
- Limit or avoid fried, spicy, or greasy foods.
- Try relaxation techniques, such as meditation, deep breathing, or listening to soothing music.
6. Decreased Appetite
- Keep food and drinks handy, so they’re available whenever you feel hungry.
- Eat foods that are high in calories and protein, such as dried fruits, nuts, yogurt, eggs, and cheese.
- Eat foods that are cool or at room temperature if food smells bother you.
- Instead of trying to eat three large meals a day, switch to smaller meals or snacks throughout the day.
- Take an anti-nausea medication about 30 minutes before you plan to eat.
7. Weight Loss
“Regular monitoring of weight and nutritional status is especially important for older adults and others who may be at higher risk for malnutrition,” says Hardin.
- Try to eat a high-calorie, well-balanced diet.
- Boost your calorie intake with nutritional supplement beverages.
- Eat smaller meals more frequently to increase your food intake.
- Get help planning meals from a nutritionist or dietitian.
