Pacritinib (Vonjo®)

How to Take Pacritinib (Vonjo®)

This medication is taken as a capsule by mouth, with or without food, twice daily. Swallow the capsule whole. Do not crush, chew or open the capsules. If you miss a dose, take the next one when scheduled. Do not take 2 doses to make up for a missed dose.

It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.

Stop taking this medication 7 days before any surgery or invasive medical procedure, due to the risk of bleeding. Only start taking it again when your provider tells you to do so.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided.  These include clarithromycin, rifampin, fluconazole, bosentan, midazolam, omeprazole, metformin, digoxin, and rosuvastatin. Be sure to tell your provider about any medications, supplements, vitamins, or herbal products you are taking.

This medication can also reduce the effectiveness of hormonal birth control. You should use another non-hormonal (condoms, diaphragm, spermicide) while on treatment and for 30 days after your last dose.

Storage and Handling

Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pouring the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. 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?

This medication is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for the distribution of this medication and shipment directly to your home.

Insurance Information

 This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending on 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 Pacritinib

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, uncaffeinated fluid a day to prevent dehydration.

Nausea and/or Vomiting

Talk to your oncology care team 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 saltines or ginger ale to lessen symptoms.

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

Thrombocytopenia

Platelets help your blood clot, so when the count is low, you are at a higher risk of bleeding. Let your oncology care team 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/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc., as these can all increase the risk of bleeding. Please consult with your healthcare team regarding the use of these agents and all over-the-counter medications/supplements while on therapy.
• Do not floss or use toothpicks, and use a soft-bristle toothbrush to brush your teeth.

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 oncology care team 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.

Edema

Peripheral edema is swelling of the extremities caused by retention of fluid. It can cause swelling of the hands, arms, legs, ankles and feet. The swelling can become uncomfortable. Notify your oncology care team if you are experiencing any new or worsening swelling.

Important but Less Common Side Effects

• Bleeding: This medication can cause bleeding. Notify your healthcare team if you notice any bleeding or bruising, including bleeding that may seem minor, such as bleeding gums and nosebleeds. Contact your care team or go to the emergency room if you experience bright red or dark tar-like stools, vomit blood or vomit that looks like coffee grounds, or develop any signs of stroke, including a severe headache, trouble talking, weakness on one side of the body, or confusion.
• Prolonged QT: This medication can cause slow or abnormal heartbeats or an abnormal heart rhythm called QT prolongation. Notify your oncology care team right away if you feel abnormal heartbeats or if you feel dizzy or faint.
• Major Adverse Cardiac Events (MACE): If you are a smoker or have other heart issues, be sure to let your team know. This medication can increase the risk of a heart attack or stroke.
• Blood Clots: This medication can increase the risk of blood clots (DVT or PE). Symptoms can include: swelling, redness or pain in an extremity, or shortness of breath. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room.
• Secondary malignancies: There is a very low risk of developing lymphoma or non-melanoma skin cancer due to treatment with this medication, which can occur many years after treatment. If you are a smoker, your risk for a secondary malignancy associated with this medication may be higher. Because this medication has been associated with the development of skin cancers, it is important to practice sun safety. Avoid the sun between 10-2 pm, when it is strongest. Wear sunscreen (at least SPF 15) every day; wear sunglasses, a hat, and long sleeves/pants to protect your skin and seek out shade whenever possible.
• Infection: Let your provider know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Fertility Concerns

This medication may impact fertility in individuals who make sperm. Talk with your provider about your fertility options and sperm banking before starting treatment.

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. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication and for at least 2 weeks after the last dose.