Medical Oncologist
Alectinib (Alecensa)
Taking Alectinib: — Food, Timing and What to Do If You Miss a Dose
Alectinib comes as capsules you take twice a day, always with food. Getting the routine right from the first dose reduces side effects and keeps the medicine working as intended.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Always with food — Taking alectinib without a meal reduces how well it absorbs and increases nausea.
- Swallow capsules whole — Opening or crushing the capsules changes how the medicine enters your body — do not do it.
- Never double up — If you miss a dose, never take two at once. There is a clear rule for what to do instead.
- Grapefruit interferes — Grapefruit and grapefruit juice can change how alectinib is processed in your body.
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Take alectinib twice a day with food, spaced roughly equal hours apart. Swallow the capsules whole. If you miss a dose and your next dose is not yet close, take it as soon as you remember. If your next dose is nearly due, skip the missed one and continue as normal.
How do you take alectinib correctly?
Fix two daily times that fit your routine
Alectinib is taken twice a day. Choose two times spaced roughly equally through the day — for example, with breakfast and with dinner. Keeping to the same times each day helps maintain a steady level of medicine in your body.
Eat a full meal before you take your capsules
Alectinib must be taken with food, not just a snack. A proper meal helps the medicine absorb correctly and reduces the chance of nausea. Do not take it on an empty stomach.
Swallow the capsules whole with water
Do not open, crush or chew the capsules. They are designed to be swallowed whole. If swallowing is difficult, tell your oncology team before trying anything else — do not break them open yourself.
If you vomit shortly after a dose, do not take a replacement
It is not possible to know how much medicine absorbed before you vomited. Taking an extra dose risks too much in your system at once. Take your next scheduled dose at its usual time and let your team know it happened.
If you miss a dose, follow the missed dose rule
Take the missed dose as soon as you remember — unless your next dose is nearly due, in which case skip it and carry on from there. Never take two doses at once to make up for a missed one.
What else should you keep in mind every day?
- Apply a broad-spectrum sunscreen every morning — alectinib increases your skin's sensitivity to the sun, and sunburn can be more severe than usual.
- Avoid grapefruit and grapefruit juice — these can alter how alectinib is processed in your liver and change the effective amount of medicine in your bloodstream.
- Tell your oncology team about every medicine, supplement or herbal remedy you take — including ayurvedic preparations, vitamins and over-the-counter medicines.
- Store capsules at room temperature, away from moisture and direct heat.
- Do not share your capsules or use medicine prescribed for someone else.
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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What should you do in these specific situations?
| Situation | What to do |
|---|---|
| You feel nauseous but do not vomit after a dose | Continue as normal. Tell your team if it is severe or keeps happening. |
| You vomit within an hour of taking a dose | Do not take a replacement dose. Take the next dose at its scheduled time and inform your team. |
| You miss a dose and remember with plenty of time before the next | Take it as soon as you remember. |
| You miss a dose and the next one is nearly due | Skip the missed dose. Continue from the next scheduled dose as normal. |
| You accidentally take two doses at once | Call your oncology team the same day. Do not take your next dose until you have spoken to them. |
Did you know?
Alectinib was designed to reach the brain more effectively than earlier medicines in its class.
NCCN guidelines list it as a preferred first-line treatment for ALK-positive non-small cell lung cancer, including where brain involvement is a concern.
Source: NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer
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Common questions
Frequently asked questions
Do I need a full meal or will a light snack do?
Prescribing guidance for alectinib specifies food, not a snack. A proper meal is what is needed — both to help the medicine absorb correctly and to reduce nausea. If you are struggling to eat full meals because of appetite loss or nausea, tell your oncology team. There are ways to manage both, and they need to know if eating before doses is becoming difficult.
Can I open the capsules if I find them hard to swallow?
No. Alectinib capsules must be swallowed whole. Opening or crushing them is not recommended and may change how the medicine is absorbed. If swallowing is genuinely difficult, tell your oncology nurse or doctor before trying any other approach. They can suggest techniques that help and need to know about the difficulty.
I missed both my doses yesterday. What do I do now?
Take your next scheduled dose as normal and continue from there. Do not try to recover two missed doses by taking extra. Tell your team at your next contact — they will note it and advise if anything else is needed. Consistency going forward matters more than trying to make up for what was missed.
Can I take turmeric, ashwagandha or other herbal supplements alongside alectinib?
Tell your oncology team about anything you are taking alongside alectinib — including herbal preparations, ayurvedic medicines, vitamins and over-the-counter supplements. Some natural products interact with how alectinib is processed in the liver. Your team cannot manage interactions they do not know about, so tell them before starting anything new.
What if nausea makes it too hard to eat before my dose?
Tell your oncology team if nausea is making it difficult to eat before doses. There are effective anti-nausea medicines and practical strategies that can help significantly. Do not simply skip doses because of nausea without speaking to your team — there is likely a better solution, and skipping treatment without guidance is not the answer when the cause can usually be managed.