Classification: Tyrosine Kinase Inhibitor
About Ponatinib (Iclusig®)
Ponatinib is a tyrosine kinase inhibitor. It works by blocking proteins that cause the rapid growth of certain types of leukemia cells. This helps the bone marrow to start making normal blood cells again.
How to Take Ponatinib
Ponatinib comes as a tablet to take by mouth. It is usually taken once a day, with or without food. Take ponatinib at around the same time every day. Swallow the tablets whole, do not crush, chew, or break ponatinib tablets. If you miss a dose, take the next dose at the regular time and do not take 2 doses to make up for the missed dose.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, verapamil, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.
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?
Ponatinib is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment directly to your home.
Ponatinib may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Your care team can help you find these resources, if they are available.
Possible Side Effects of Ponatinib
There are a number of things you can do to manage the side effects of Ponatinib. 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 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.
This medication can cause high blood pressure. Your oncology provider will check your blood pressure regularly while on this therapy. Notify your provider if you develop headaches, dizziness, chest pain or shortness of breath.
Ponatinib can cause heart failure, irregular heartbeats and heart attack. If you develop chest pain, dizziness or lightheadedness, palpitations, feel short of breath, or feel your heart beating irregularly, you should seek medical assistance right away.
Nausea and 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). 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.
Peripheral Neuropathy (Numbness or Tingling in the Hands and/or Feet)
Peripheral neuropathy is a toxicity that affects the nerves. It causes a numbness or tingling feeling in the hands and feet, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the medication. In some people, the symptoms slowly resolve after the medication is stopped, but for some it never goes away completely. You should let your healthcare provider know if you experience numbness or tingling in the hands and feet, as they may need to adjust the doses of your medication.
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.
Blood Clots, Stroke and Heart Attack
Ponatinib can increase the risk of blood clots, stroke and heart attack. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes. Let your care team know if you have a history of previous blood clots, as you may require preventive medication.
This medication can cause liver toxicity, which your doctor may monitor for using blood tests, called liver function tests. If you develop elevations in your liver function tests, your healthcare provider may need to lower your dose or stop the medication. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity.
Ponatinib can cause fluid retention. This may result in swelling of the arms or legs, fluid in the lungs (pleural effusion) or heart (pericardial effusion). Notify your healthcare team if you develop swelling in your arms, legs, feet or abdomen, have an unexpected weight gain, racing heartbeat, shortness of breath or difficulty breathing, or if you develop a dry cough.
Wound Healing, Bleeding, GI Tear
This medication can cause bleeding or a tear in the intestinal wall (called perforation). Signs of these problems include: unexpected bleeding, blood in the stool or black stools, coughing up blood, vomiting blood, vomit that looks like coffee grounds, fever, severe pain in the abdomen or new abdominal swelling. If you experience any of these, contact your healthcare provider immediately or go to the emergency room.
Studies did not evaluate wound healing with ponatinib, but other medications in the same category do affect wound healing. Therefore, the manufacturer recommends stopping the medication at least 1 week before any surgical procedure and possibly not restarting until there is adequate wound healing.
Effects on the Eyes
This medication can cause eye problems. Your provider may have your eyes examined before and/or during treatment. Be sure to report any symptoms of eye problems to your oncology provider, including blurred vision, changes in vision, dry eye, eye pain, yellowing of colors or seeing "floaters" or spots in your field of vision.
Effects on the Pancreas
This medication can affect your pancreas and your oncology provider will monitor for this problem with blood tests. Let your provider know if you have a history of pancreatitis or excessive alcohol use, or if you develop abdominal pain or nausea and vomiting.
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. 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.