Niraparib (Zejula™)

OncoLink Team
Last Modified: March 31, 2017

Pronounced: Nir-a-puh-rib

Classification: PARP Inhibitor

About Niraparib (Zejula™)

Niraparib is a PARP (poly ADP ribose polymerase) inhibitor. Cancers related to BRCA 1 or 2 mutations seem to rely on PARP to repair damaged DNA in cancer cells, allowing them to continue to divide. By inhibiting PARP, tumor growth may be slowed or stopped.

How to Take Niraparib

Niraparib is a capsule taken by mouth once a day. It can be taken with or without food. You should take it the same time everyday. If you miss a dose or have vomiting after taking a dose, wait until the next scheduled dose to take your medicine again. Do not take two doses to make up for a missed dose.

Storage and Handling

Store this medication at room temperature in the original container. If you prefer to use a pillbox, discuss this with your oncology pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.

Where do I get this medication?

Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your pharmaceutical insurance coverage. Ask your health care provider or pharmacist for assistance in identifying where you can get this medication.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.

Possible Side Effects of Niraparib

There are a number of things you can do to manage the side effects of niraparib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects. 

Low Blood Counts

This medication causes your blood counts to be lower than normal. Below are the three types of blood counts affected and how to manage lower levels of these cells. Your oncology team will monitor your blood counts closely during treatment with this medication.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bath daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your doctor or nurse before scheduling dental appointments or procedures.
  • Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

  • Do not use a razor (an electric razor is fine).
  • Avoid contact sports and activities that can result in injury or bleeding.
  • Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
  • Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). This medication can also cause reflux and heartburn. If you experience this, try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Constipation

There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help.  Talk to your healthcare team for helpful tips on dealing with this side effect.

Mouth Ulcers (Sores)

Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.

  • Brush with a soft-bristle toothbrush or cotton swab twice a day.
  • Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily.
  • If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
  • Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.

Muscle or Joint Pain/Aches and Headache

Your healthcare provider can recommend medication and other strategies to relieve pain.

Decrease in Appetite

Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.

  • Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
  • If you are not eating enough, nutritional supplements may help.
  • You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
  • Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
  • Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.

High Blood Pressure

This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately. If hypertension cannot be controlled, the medication may be stopped. Report any headache or dizziness to your provider.

Secondary Malignancies

There is a very low risk of developing leukemia or another type of blood cancer, called myelodysplasia or MDS, due to treatment with this and other chemotherapy medications, which can occur during treatment or many years after.

Liver Toxicity

This medication can cause liver toxicity, which your healthcare provider will monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.

Shortness of Breath (Dyspnea)

Dyspnea is trouble breathing or difficulty catching your breath. This medication can cause shortness of breath. You should contact your healthcare provider if you experience chest pain, discolored or bloody sputum, breathing fast, swelling in your feet, ankles or calves or trouble sleeping when lying flat.

Anxiety

This medication can cause anxiety or make existing anxiety worse. Anxiety is the body’s natural reaction to fear and stress. If you are experiencing increased feelings of worry or panic, contact your healthcare provider.

Insomnia

Insomnia is a change in sleep and can include not being able to sleep or difficulty falling or staying asleep. This medication can cause or worsen pre-existing insomnia. Inform your healthcare provider if you are experiencing changes in your sleep.

Heart Palpitations

Heart palpitations cause you to feel like your heart is beating too fast, is beating harder than normal, skipping a beat or fluttering. Palpitations can be frightening, but usually are not harmful and subside on their own. This medication may cause palpitations. Be sure to report any of these symptoms to your health care provider.

Xerostomia (Dry Mouth)

This medication can cause xerostomia, also known as dry mouth. Xerostomia can be uncomfortable and can make speech and swallowing more difficult. Ways to manage this side effect include:

  • Perform frequent oral hygiene with toothpaste containing fluoride.
  • Rinse your mouth frequently and after meals to keep the mouth moist.
  • Sucking on sugar free candies or chewing sugar free gum can help stimulate saliva production.
  • Speak to your provider about over the counter and prescription gels and rinses that act as a saliva replacement if this side effect is bothersome.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 6 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.

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