Classification: Histone Deacetylase Inhibitor
Romidepsin belongs to a class of drugs called histone deacetylase (HDAC) inhibitors. HDACs are enzymes that control histones, which are important proteins in the expression of DNA. Romidepsin blocks HDACs so histones cannot be modulated properly. This interferes with the genetic make up of cancer cells, leading to cell death.
Romidepsin is given by intravenous (into a vein) infusion over a 4-hour period. It is usually given on days 1, 8, and 15 of a 28-day cycle. The actual dose is based on your body size.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, dexamethasone, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.
There are a number of things you can do to manage the side effects of Romidepsin. 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:
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:
For more suggestions, read the Neutropenia Tip Sheet.
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. Read the anemia tip sheet for more information.
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 count becomes too low, you may receive a transfusion of platelets.
Read the thrombocytopenia tip sheet for more information.
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. 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. Read the Nausea & Vomiting Tip Sheet for more suggestions.
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.
While on cancer treatment 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 and see OncoLink’s section on fatigue for helpful tips on dealing with this side effect.
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 your sperm is affected. Romidepsin can reduce the effectiveness of estrogen-containing birth control (pills, patches, IUDs) and additional effective methods of birth control should be used.
Romidepsin can cause elevated INR levels in patients taking warfarin (coumadin) and these levels should be monitored closely.
Tell your oncology team if you have any cardiac (heart) problems, including irregular heartbeat or a condition called QT prolongation. This medication can cause changes in the electrical activity of your heart, resulting in changes seen on an electrocardiogram (ECG or EKG). Report any feelings of rapid or abnormal heartbeat, chest pain or shortness of breath to your healthcare team.