Vorasidenib (Voranigo®)
Pronounce: VOR-a-SID-e-nib
Classification: Antineoplastic Isocitrate dehydrogenase (IDH1 and IDH2) inhibitor
About Vorasidenib (Voranigo®)
This medication is a type of targeted therapy called an isocitrate dehydrogenase (IDH) inhibitor. Vorasidenib works by targeting and blocking both IDH 1 and IDH 2 enzymes. In some cancers, these overactive enzymes cause cells to grow and divide too fast. By inhibiting these enzymes, this medication can slow tumor growth. Your oncology team will test your tumor for these abnormalities, which must be present in order to receive the medication.
How to Take This Medication
This medication comes in tablet form that you take by mouth once daily, at about the same time each day. This medication may be taken with or without food. Do not break, crush or chew the tablets.
If a dose is missed, take the dose as soon as you remember, but no more than six hours after the missed dose. Return to the normal schedule for the next dose. If you vomit a dose, do not take a replacement 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.
The blood levels of this medication can be affected by certain medications including ciprofloxacin, fluvoxamine, phenytoin, or rifampin, among others. Be sure to tell your healthcare provider about all medications and supplements you take. Smoking tobacco can also affect the blood levels of this medication so do not smoke while taking it.
Storage and Handling
Store your medication in the original container with the label. If you want to use a pillbox, talk to your pharmacist. Keep it in a dry place at room temperature unless your provider or pharmacist tells you otherwise. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour 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 people should not prepare the dose for you. Ask your provider 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?
Some cancer medications are only available through specialty pharmacies. Your provider or pharmacist will start this process. Your insurance plan may also affect where you can get your medication. Call your prescription plan provider to find out which specialty pharmacies are in-network.
Insurance Information
This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.
Possible Side Effects
These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.
Liver Toxicity
This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:
- Yellowing of your skin or eyes.
- Dark or brown urine.
- Pain in your abdomen (belly).
Tell your provider if you have any of these symptoms.
Fatigue
Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.
Infection with Covid-19
This medication may raise your risk of becoming infected with Covid-19. Call your provider if you have symptoms of Covid-19, such as stuffy nose, sore throat, new or worsening cough, diarrhea, etc.
Muscle or Joint Pain/Aches and Headache
You may have joint or muscle pain/aches and headaches while taking this medication. Your provider can recommend medications and other ways to help relieve your pain.
Diarrhea
Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.
Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy.
Some forms of hormonal contraception (such as pills, patches, inserted devices) don’t work as well while taking this medication. You may need to use barrier contraception (such as condoms, diaphragms, spermicide, etc.) while on this medication. Talk with your provider about what kind of birth control is safest for you and your partner.
If you can become pregnant, you will need to use effective birth control during treatment and for 3 months after the last dose of this medication, even if your menstrual cycle has stopped or changed.
If you can get someone pregnant, you will need to use effective birth control during treatment and for 3 months after the last dose of this medication, even if you believe you are not producing sperm.
You should not breastfeed during treatment and for 2 months after the last dose of this medication.
Fertility
This medication may affect your reproductive system, causing changes to your menstrual cycle or sperm. You may have menopausal effects, such as hot flashes and vaginal dryness or be unable to get or keep an erection. Your desire for sex may decrease during treatment. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.