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Exercise and TKI timing.

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#1 TeddyB


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Posted 12 May 2013 - 04:04 AM

Hello everyone.

I was wondering if anyone could share your experiences with excersising and the time of day you take your tki?

I just started working out at a gym 2 days a week (on my 2 days off work), and i usually take my Gleevec at around 09:30 after breakfast, then a light lunch at around 12:00, and then go to the gym around 13:00. When i started cycling, i felt dizzy and had to really focus to stay on the exercise bicycle, afterwards i felt like i was about to hit the floor on a few occasions when lifting wheights. I did not exercise hard at all.

Im thinking i maybe should wait until the evening to exercise, but im not sure, thats why i would like to hear your experiences in regards to this.

The best time is probably training before taking the tki, but that is not an option for me at this point, as i like to take my tki with breakfast, at least for now.

PS: The day after my first exercise, i felt better than i had in months, and i had more energy, so this is definately something i will continue doing. The second and third day after, my muscles felt like they had been through hell, but im pretty sure that will get better over time


#2 jjg


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Posted 12 May 2013 - 07:24 AM

Hi Teddy,

Exercise is one of my favorite subjects! I'll try not to ramble on too much....

When I was on gleevec I also took it with breakfast, then I felt really quite average for a few hours and I would often crash later in the day either before dinner or a bit before bed time. I always did my main exercise  before the gleevec ie. before breakfast.  Converting to exercising pre-breakfast takes a little bit of motivation (an GA summer for example) because you have to train your body to use energy stores differently. It's second nature to me now and I can happily run 20k on an empty tummy although I often have a snack before bed. When I was first getting used to it I used to have an icy popsical when I first woke up, lots of my running friends will have a piece of toast and honey 20mins before heading out on a morning run. One thing I would always say to do is lay your gym gear out before you go to bed so that the default position is to get up and get out that door before you are awake enough to think of reasons why not.

I say all that about the exercising before breakfast because I found it just so hard to exercise anytime in the 12 hours after gleevec. Sometimes I would ride to work the long way (90min) have breakfast at work, deal with the side effects and then struggle to ride a v slow 40min home (downhill) later in the day. I'm sure this depends on just how much fatigue you are getting from gleevec. But if you are starting out on an exercise program you want to make it as easy as possible on yourself and by far the easiest time is the longest possible time out from the last gleevec dose. If it takes you some time to get to the gym you might be able to digest something tiny between getting up and starting exercising and maybe subtract that amount of food from your lunch.

I'm on Tasigna now and apart from the fact that I am feeling so much better the side effects are much more even. I don't feel the dose very much and I kinda feel as if the drug levels are not effecting me much more at one time of the day verses another ie. I can exercise any time I like (I still mainly do it pre-breakfast). Although I am doing much better on tasigna overall the 2 hours before the gleevec dose was due would still be the best I have felt on treatment.

Overall I believe that exercise is excellent for fatigue and general well being on treatment but every now and again we'll over do it and it'll bite back. I certainly noticed that if I did a huge ride or run and got quite dehydrated then I would have what we called a "bad G day". Definitely good to get started with your exercise on your days off. Don't expect it to cure the fatigue overnight and listen you your body - tired is ok, pain/injury is not, passing out not so much either :-) Good luck!!!

Dx Dec 2010 @37

2x IVF egg collection

Glivec 600 & 800mg

PCRU March 2012

Unsuccessful pregnancy attempt - relapsed, 3 months interferon (intron A), bad side effects from interferon

Nilotinib 600mg Oct 2012

PCRU April 2013, 2 years MR4.5 mostly PCRU with a few blips

April 2015 stopped again for pregnancy attempt (donor egg), pregnant first transfer, 0.110 at 10wks, 2.1 at 14wks, 4.2 at 16wks, started interferon, slow dose increase to 25MIU per wk, at full dose PCR< 1 for remainder of pregnancy

Healthy baby girl Jan 2016, breastfed one month

Nilotinib 600mg Feb 2016

MMR May 2016

PCRU Feb 2017

#3 cleocans


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Posted 12 May 2013 - 08:32 AM

I take my Sprycel at 9pm and workout in the morning.  I have worked out in the afternoon and evening to.  I have never had any ill effects from any of the times I work out.  I can tell ya though if I don't do some type of workout I am more tired during the day then when I do.

Your muscles will adjust to the exercise and not "feel like hell" as much!


#4 mdszj


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Posted 12 May 2013 - 08:33 AM

I exercise pretty much every day, except when it rains.  I take 100 mg sprycel.  On weekdays I workout around 5 pm, right after I get home from work.  Then we eat dinner about 7 pm after my wife gets home from her workout at the YMCA.  I always take my S with dinner.  On Sat and Sun morning I do my workout in the 730 to 830 am timeframe so I can get it over with for the day.  So far, from what I can tell, it does not seem to matter when I exercise compared to when I take my pill. 

Starting next month I will be shifting my work schedule earlier by about half an hour so I will be able to workout on weekdays starting around 4:30 pm.  Hopefully this wont have any bad impact on anything.  But if it does I will do a follow up post.

dx cml 7/2012; 100 mg sprycel; splenectomy 9/2012; reached prcu 10/2013; dx smoldering myeloma 1/2015; 80 mg sprycel 12/2015; 50 mg sprycel 7/13/16; discontinued sprycel 11/15/16

#5 Trey


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Posted 12 May 2013 - 09:02 AM

Uptake of these drugs is very rapid, and for Gleevec 70% of the drug is absorbed within the first 2 hours after taking it.  So the most significant impacts from the drug will occur within roughly the first 3 hours, including side effects such as light-headedness and maximum level muscle cramps.  So exercising within 3 hours of taking the drug could have some of these (and possibly other) side effects.  If this causes an issue of safety, then it would be better to avoid the 3 hour window after taking Gleevec for intense exercise, but otherwise it is not an issue.

#6 LivingWellWithCML


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Posted 12 May 2013 - 02:18 PM

Not sure why this works for me, but I take Gleevec 400mg with breakfast and if schedule permits, I specifically try to get a bike ride in within 3 hours of the dose.  I don't get any of the dizzy side effects mentioned, so I'm pretty fortunate in that regard.  Yesterday morning, I took G 400mg with a Vitamin C supplement and a little bit of food at 5:40am, then went on a fast & furious 22 mile bike ride with a friend at 6:30am while G was reaching maximum levels in my bloodstream.  My feeble mind likes to think that the cardio + the dose can work together to mask the fatigue entirely and make some greater impact on the CML at the same time.  There's no science behind it at all, but it's something that motivates me.  Regardless, if you're getting some uncomfortable side effects from the dose, then do your workouts before your dose if you can squeeze it in.  Early morning workouts are a great way to start the day!

re: Sore muscles ... that's totally normal and I don't think it's related to Gleevec at all.  You just have to get your body used to working out.

Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg

#7 TeddyB


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Posted 13 May 2013 - 12:43 PM

Thank you for all your replies!!

jjg: Thank you for all your insight, ive been thinking of exercising pre-tki, but as you say, it requiers some self disiplin and motivation. Maybe i could as you say eat a small "snack" before training at around 9:00, then exercise and maybe eat my breakfast at around 11:00. I will think about it

cleocans: I went to the gym yesterday, so lets hope my muscles have adjusted a bit more now than last time!

mdszj: Let us know how it goes with your new schedule

Trey: Thanks for the info, will adjust workout schedule so that i either work out before the G, or at least 3-4 hours after. Yesterday i worked out around 4.5 hours after taking my meds, and i didnt feel so dizzy.

Dan: Seems you can work out any time no matter when you take your drugs, you are probably a lot fitter than me, maybe i will be able to work out when ever i want regardless of when i take my Gleevec, some time in the future

Yeah, sore muscles are always an issue when i start exercising, im sure it will get better.

I might try to get a workout before the tki on the days that i have off, and see how it goes. I dont think i can squeeze in a workout before delivering the kids to kindergarten the days i go to work, at least not yet on account of my energy levels. After 4-5 hours of work im usually totally beat, and need to have a small rest before picking up the kids again.

I really hope the fatigue gets better over time, but its been over a year now, and it doesnt seem to be getting any better, so im hoping the new work out regime will help with that. At least the fatigue is not getting any worse. (Knock on wood)


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