The usual metastatic starting dose is ribociclib 600 mg once daily on Days 1–21 followed by Days 22–28 off. Continue the prescribed AI daily or fulvestrant on its own injection schedule; add ovarian suppression when indicated. Continue while beneficial and tolerated.
Ribociclib with an aromatase inhibitor or fulvestrant aims to control advanced HR-positive/HER2-negative breast cancer. The exact endocrine partner depends on previous treatment and menopausal status.
Open your complete treatment referenceRibociclib blocks CDK4 and CDK6, proteins that help cells move through the cycle of division. Endocrine therapy reduces the hormone signal that can drive HR-positive breast cancer.
Keep blood and ECG appointments. Fever, jaundice, fainting, palpitations, severe rash or new breathlessness need prompt advice.
An aromatase inhibitor (AI) lowers oestrogen production; fulvestrant blocks and reduces oestrogen receptors. These are alternative endocrine partners, selected by the team. Ovarian suppression is needed in pre/perimenopausal patients.
The endocrine medicine continues during the ribociclib week off. Report troublesome joint, menopausal or injection-site symptoms.
This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.
The usual metastatic starting dose is ribociclib 600 mg once daily on Days 1–21 followed by Days 22–28 off. Continue the prescribed AI daily or fulvestrant on its own injection schedule; add ovarian suppression when indicated. Continue while beneficial and tolerated.
There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.
Columns show sequence and general intervals, not equal periods or booked appointments. The team confirms who arranges each test, who reviews results and who authorises treatment or restart.
| Check | Before first dose | Cycles 1–2 | Cycles 3–6 | Later treatment | Completion / change |
|---|---|---|---|---|---|
| Ribociclib and endocrine partner | Confirm metastatic 600 mg / AI or fulvestrant plan | Days 1–21 on; Days 22–28 off; fulvestrant loading visits if chosen | Repeat if cleared; endocrine partner continues | While beneficial and tolerated | Review endocrine continuation separately |
| Blood counts / renal / liver | Baseline profiles | Every two weeks in both cycles | Before each cycle | As clinically indicated; more often if abnormal | Follow abnormalities before restart or after stopping |
| ECG / heart rhythm | Baseline ECG; check QTcF eligibility | Repeat around cycle 1 Day 14 | Further ECG when clinically indicated | Repeat for symptoms, QT change or interacting medicines | No automatic restart after a QT-related hold |
| Electrolytes | Potassium, calcium, magnesium and phosphorus | Before each cycle; correct abnormalities | Before each cycle through cycle 6 | As clinically indicated | Review unresolved abnormalities |
| Bone / endocrine health | Assess AI/OFS bone and menopausal risks | Support symptoms and adherence | AI/OFS and any injections follow their own plan | Repeat bone assessment according to risk | Longer endocrine and bone plan continues |
| Cancer response | Baseline disease assessment | Assess new symptoms promptly | Imaging according to consultant plan | Continue response and symptom review | Progression prompts new treatment decision |
HR-positive / HER2-negative metastatic breast cancer
The usual metastatic starting dose is ribociclib 600 mg once daily on Days 1–21 followed by Days 22–28 off. Continue the prescribed AI daily or fulvestrant on its own injection schedule; add ovarian suppression when indicated. Continue while beneficial and tolerated.
On a small screen, swipe the map sideways. The checks below give the same timing in words.
| Care / check | Before first dose | Cycles 1–2 | Cycles 3–6 | Later treatment | Completion / change |
|---|---|---|---|---|---|
| Ribociclib and endocrine partnerNCCP 00525 · SMPC | Confirm metastatic 600 mg / AI or fulvestrant plan | Days 1–21 on; Days 22–28 off; fulvestrant loading visits if chosen | Repeat if cleared; endocrine partner continues | While beneficial and tolerated | Review endocrine continuation separately |
| Blood counts / renal / liverNCCP 00525 · SMPC | Baseline profiles | Every two weeks in both cycles | Before each cycle | As clinically indicated; more often if abnormal | Follow abnormalities before restart or after stopping |
| ECG / heart rhythmNCCP 00525 · SMPC | Baseline ECG; check QTcF eligibility | Repeat around cycle 1 Day 14 | Further ECG when clinically indicated | Repeat for symptoms, QT change or interacting medicines | No automatic restart after a QT-related hold |
| ElectrolytesNCCP 00525 · SMPC | Potassium, calcium, magnesium and phosphorus | Before each cycle; correct abnormalities | Before each cycle through cycle 6 | As clinically indicated | Review unresolved abnormalities |
| Bone / endocrine healthNCCP 00525 · SMPC | Assess AI/OFS bone and menopausal risks | Support symptoms and adherence | AI/OFS and any injections follow their own plan | Repeat bone assessment according to risk | Longer endocrine and bone plan continues |
| Cancer responseNCCP 00525 · SMPC | Baseline disease assessment | Assess new symptoms promptly | Imaging according to consultant plan | Continue response and symptom review | Progression prompts new treatment decision |
Check eligibility, organ function and the exact treatment/support plan.
Ask / act: Confirm who arranges each check and who reviews it.
Sources: NCCP 00525 · SMPC
Important toxicity can begin before the first routine review.
Ask / act: Keep early appointments and use the agreed symptom-contact plan.
Sources: NCCP 00525 · SMPC
Longer-term treatment still needs clinical review.
Ask / act: Ask about symptom support, results and the next decision.
Sources: NCCP 00525 · SMPC
The targeted medicine and endocrine partner may have different stop dates.
Ask / act: Confirm each medicine and the ongoing follow-up plan.
Sources: NCCP 00525
This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.
Numbered symptom boxes connect to the anatomical illustration. The medicine responsible may be uncertain; report the symptom.
Baseline ECG and an ECG around Cycle 1 Day 14. Fainting or palpitations need urgent advice.
Blood counts guide whether the next cycle can start. Fever, shivers or sudden illness: contact oncology immediately.
A widespread painful rash, blisters or peeling skin needs urgent assessment.
123456Keep liver blood tests. Yellow skin / eyes, dark urine or marked upper-abdominal discomfort: call promptly.
New cough or breathlessness needs prompt assessment, even between visits.
Discuss joint symptoms and keep the agreed bone-risk and DXA plan.
This map links possible effects to the medicine that can cause them. It does not show how likely they are or diagnose a new symptom.
NCCP classifies ribociclib as oral moderate–high emetic risk. The team chooses preventive or rescue antiemetics using local policy, symptoms, QT risk and drug interactions; do not reuse another regimen’s prescription.
Correct abnormal potassium, calcium, magnesium and phosphate as directed. Attend the baseline and cycle 1 Day-14 ECG; fainting or palpitations need urgent advice.
Keep the early two-weekly blood tests and subsequent monitoring. Report fever, shivers, jaundice or dark urine promptly.
The AI or fulvestrant, and ovarian suppression when prescribed, continue on their own timetable. Discuss joint, menopausal, bone and injection-site symptoms.
Avoid grapefruit and check interactions. Do not replace a missed or vomited dose. A clinical hold requires explicit instructions about which medicine stops and who authorises restart.
Acute Oncology Service
Ask for medical oncology
Other hospitals: use the contacts your own team provides.
Two-page medicine-specific guide
Open visual guideReusable review sheets, symptoms and test ownership
Open treatment passportMedicine, schedule and contacts
Open treatment cardOne-page consent aid · Individual discussion draft · Supportive-care plan
https://sactcheck.com/patient/00525/
Public information only. No personal information is encoded.
The NCCP regimen supplies the treatment rules. Separate guidelines supply the longer-term monitoring recommendations, with their qualifications retained.
Source reconciled; independent clinical, pharmacy and patient/PPI review pending