EGFR tyrosine kinase inhibitor (specialist)

Erlotinib

Brand names: Tarceva

Adult dose

Dose: 150mg PO OD on empty stomach (NSCLC); 100mg OD (pancreatic, with gemcitabine)

Route: Oral

Frequency: OD

Clinical pearls

NICE TA258/TA374: EGFR-TK mutation-positive NSCLC; largely superseded by osimertinib (1st-line)
ESMO NSCLC guidelines
Take on empty stomach (≥1h before / 2h after food); avoid gastric acid suppressants
Smoking cessation reduces clearance

Contraindications

Severe hepatic impairment
Pregnancy
Severe renal impairment (precaution)
Hypersensitivity

Side effects

Acneiform rash (very common)
Diarrhoea
Interstitial lung disease
Hepatotoxicity
Renal failure
Corneal ulceration
Bullous/exfoliative skin reactions

Interactions

Strong CYP3A4 inhibitors/inducers
PPIs/H2 blockers (reduced absorption — avoid)
Smoking (CYP1A2 induction reduces levels)
Warfarin (INR fluctuation)

Monitoring

LFTs
Renal function
Skin
Pulmonary symptoms
ILD signs

Reference: BNF; NICE TA258/TA374; ESMO NSCLC; SmPC; https://bnf.nice.org.uk/drugs/erlotinib-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways