Kisqali: What to Expect, Side Effects, and More
If you were diagnosed with certain types of hormone receptor-positive, HER2-negative breast cancer, your doctor may prescribe Kisqali (chemical name: ribociclib) in combination with a hormonal therapy medicine.
Kisqali is a CDK4/6 inhibitor, a targeted therapy that disrupts the ability of cancer cells to divide and grow.
For advanced-stage or metastatic breast cancer, Kisqali is prescribed in combination with an aromatase inhibitor (which reduces the body’s ability to produce estrogen) or Faslodex (which blocks the effects of estrogen on hormone receptor-positive breast cancer cells) as a first hormonal therapy treatment. If the cancer grew during initial hormonal therapy treatment, Kisqali may be used in combination with Faslodex as a next treatment.
For stage II or stage III breast cancer with a high risk of recurrence, Kisqali is prescribed with an aromatase inhibitor after breast cancer surgery to reduce the risk of recurrence.
See Kisqali prescribing information.
How Kisqali works
Cancer cells grow in an uncontrolled fashion. Like Ibrance (chemical name: palbociclib) and Verzenio (chemical name: abemaciclib), Kisqali is a cyclin-dependent kinase (CDK) 4/6 inhibitor. A kinase is a type of protein in the body that helps control cell division. CDK4/6 inhibitors work by interfering with the kinase and stopping cancer cells from dividing and growing.
What to expect during Kisqali treatment
Kisqali is prescribed with either Faslodex or an aromatase inhibitor, such as Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole). Kisqali and the aromatase inhibitors are pills taken by mouth. Faslodex is a liquid that is given once a month as an injection into a muscle, usually at your doctor’s office.
If you’ve not yet gone through menopause and have been prescribed Kisqali and an aromatase inhibitor, your doctor will also prescribe a medication that shuts down your ovaries, such as Zoladex. Zoladex is given as an injection, usually in your doctor’s office, once a month for several months or every few months. Faslodex is typically prescribed to women who have gone through menopause.
You take Kisqali and the aromatase inhibitor on a 28-day cycle:
for 21 days, you take the Kisqali and aromatase inhibitor pills at the same time each day, with or without food
for the last seven days, you take only the aromatase inhibitor
If you’re being treated with Kisqali and Faslodex, you also take Kisqali on a 28-day cycle:
for 21 days you take Kisqali at the same time each day, with or without food
for seven days, you don’t take Kisqali
on days 1, 15, and 29 of the 28-day cycle, you receive an injection of Faslodex; after that, you receive an injection of Faslodex once per month
There are certain medicines, supplements, and foods you should not take or eat if you are taking Kisqali:
You should not take a type of medicine called a CYP3A inhibitor because it increases the effects of Kisqali. This class of medicines includes antifungal medicines such as Onmel (chemical name: itraconazole) and Biaxin (chemical name: clarithromycin), as well as antiretroviral drugs used to treat HIV such as Kaletra (chemical name: lopinavir and ritonavir).
You should not take a type of medicine called a CYP3A inducer because it decreases the effects of Kisqali. This class of medicines includes Rifamate (chemical name: rifampin), an antibiotic used to treat tuberculosis, and Carbatrol (chemical name: carbamazepine), which is used to control certain types of seizures in people with epilepsy.
You should not take Kisqali with medicines used to treat improper beating of the heart, whether too fast or too slow. These medicines include Cordarone (chemical name: amiodarone), Norpace (chemical name: disopyramide), procainamide, Quinaglute (chemical name: quinidine), and Betapace (chemical name: sotalol).
You should not eat grapefruit or pomegranate — or drink grapefruit juice or pomegranate juice — because they can increase the effects of Kisqali.
People who are pregnant or planning to get pregnant should not take Kisqali. Kisqali can harm the developing fetus. If there is any chance you can become pregnant, you must use birth control while you’re taking Kisqali and for at least three weeks after your last dose.
Also, women who are breastfeeding or plan to breastfeed shouldn’t take Kisqali. Together, you and your doctor will decide if you should take Kisqali or breastfeed.
Kisqali side effects
Like almost all breast cancer medicines, Kisqali can cause side effects, some of them severe.
The most common side effects of Kisqali are:
Less commonly, Kisqali may cause serious side effects, including:
Heart problems known as QT prolongation: This condition can cause an abnormal heartbeat and can be fatal. Tell your doctor right away if you have a change in heartbeat, including a fast or irregular heartbeat, or if you feel dizzy or like you might faint. Your doctor will always perform an electrocardiogram, both before and at least twice after you start taking Kisqali, to monitor for this side effect.
Liver problems: Tell your doctor right away if you have any of the following signs of liver problems:
yellowing of the skin or the whites of the eyes
dark or brown urine
feeling very tired
loss of appetite
pain on the upper right side of the abdomen
bleeding or bruising more easily than normal
Severe neutropenia (very low white blood cell count): Low white blood cell counts are a common side effect of Kisqali. Still, some women’s white blood cell counts may drop so low that they have to decrease the dose of Kisqali or stop treatment. Your doctor will check your white blood cell count before and during treatment with Kisqali.
Severe lung inflammation: In some women, Kisqali may lead to severe pneumonia or interstitial lung disease. Interstitial lung disease describes a large group of conditions that cause scarring of the lungs. The scarring makes the lungs stiff, which makes it difficult to breathe. Tell your doctor right away if you have difficulty breathing, discomfort when you breathe, or shortness of breath when you’re resting or doing an activity that requires little exertion.
You may also experience side effects from the medications you take with Kisqali. Common side effects of aromatase inhibitors are joint stiffness and bone/joint pain. Common side effects of Faslodex are hot flashes, nausea, and vomiting. Common side effects of Zoladex are hot flashes, mood swings, and loss of libido.
Real patient reviews
Members of our community discuss their experiences with Kisqali in the community forum. Here are some of their comments. Remember, it's very important to talk to your doctor about any side effects you're having and ask about ways to manage them.
“I have been on Kisqali for five months now. I do have some hair thinning, but no big chunks. Just noticing more hair in the shower drain than before.” —twyse
“I've had a few different side effects, they have been minor and they come and go (except for the hair). For me, thankfully the Arimidex/Kisqali treatment has been easy and effective so far.” —DorothyFromKansas
“I am on week 3 of the first cycle of Kisqali. I have had the dosage lowered to 400 due to gastrointestinal side effects. The stomach cramps are terrible.” —meme5
Read more in our Kisqali discussion forum.
Paying for Kisqali
The cost of Kisqali may vary. The price you’ll pay depends on the drug manufacturer, your health insurance provider and plan, where you live, and the pharmacy you use.
Note: Your insurance company may require you to get prior authorization before covering Kisqali.
If your doctor prescribes Kisqali and you have problems getting it covered by insurance or you don’t have insurance, the Novartis Patient Assistance NOW program may be able to help you. To talk to a patient support representative, call 1-800-282-7630 or check out the Kisqali® (ribociclib) Care Patient Support Program.
Learn more about financial assistance and medicine cost-lowering tips.
— Last updated on January 22, 2025 at 6:05 PM
