Pazopanib (Votrient®)

OncoLink Team
Last Modified: January 11, 2016

Pronounced: paz-OH-pa-nib
Classification: Tyrosine Kinase Inhibitor

About Pazopanib

Pazopanib is a type of targeted therapy called a tyrosine kinase inhibitor. This means it works by targeting receptors present on cancer cells. Pazopanib targets several different receptors, which, in turn, blocks tumor growth and angiogenesis (the development of a blood supply to the tumor).

How to Take Pazopanib

Pazopanib comes as a tablet to take by mouth. It is should be taken on an empty stomach once a day, at least 1 hour before or 2 hours after a meal. Take the tablets whole; do not crush, break or chew. Take pazopanib at around the same time every day. If you miss a dose and it has been less than 12 hours since your regular dose time, take it as soon as you remember. If it has been more than 12 hours, skip the dose. Do not take 2 doses at once to make up for a 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, dexamethasone, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.

You should not take pazopanib at the same time as "heartburn" medications (including proton pump inhibitors such as prilosec, nexium, protonix; and H2 blockers, such as tagamet, zantac; as these may effect how pazopanib is absorbed. If needed, take these medications 2 hours before or after vismodegib.

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?

Pazppanib 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. 

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 Pazopanib

There are a number of things you can do to manage the side effects of pazopanib. 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:

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). 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.

Diarrhea

Your oncology 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 on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Infection and Low White Blood Cell Count (Neutropenia)

This medication can cause life threatening infections, with or without a decrease in white blood cell counts. 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.

Decrease in Appetite and Taste Changes

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.

Skin, Hair & Nail Changes

Some patients may develop a rash, very dry, or itchy skin. You may notice changes in the color or tone of your skin. Use an alcohol free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your doctor or nurse can recommend a topical medication if itching is bothersome. Your nails may become dark, brittle or fall off. If your skin does crack or bleed or you lose a nail, be sure to keep the area clean to avoid infection.

While receiving this medication the hair on your head may become curly, fine or brittle. This tends to resolve once treatment is stopped. This medication can also cause changes to the color of your hair called depigmentation.

Be sure to notify your healthcare provider of any rash that develops, as this can be a reaction and can become severe. They can give you more tips on caring for your skin, hair and nails.

Heart and Blood Pressure Problems

This medication can cause cardiac problems. Be sure your provider is aware if you have or have had any heart problems in the past.

  • High blood pressure (hypertension). Your provider will monitor your blood pressure. Report any severe headache, dizziness, blurry vision, nausea/vomiting, or changes in mental status right away to your medical provider or go to an emergency room.
  • This medication can cause abnormal heart rhythm called QT prolongation. Your provider will perform ECG testing and monitor electrolytes with blood tests. Notify your healthcare provider right away if you feel abnormal heartbeats or if you feel dizzy or faint.
  • This medication can cause new or worsening heart failure. Your provider may monitor your heart function before and during treatment. Report any swelling, rapid weight gain, or shortness of breath.

Thyroid Problems

This medication can cause hypothyroidism (under active thyroid). Your provider will perform blood tests to check the function of your thyroid and treat this side effect if it develops. Symptoms of thyroid problems include: tiredness, feeling hot or cold, change in your voice, weight gain or loss, hair loss and muscle cramps.

Proteinuria

Pazopanib can cause an increase in the amounts of protein in your urine.  Your healthcare team will monitor your kidney function and protein in your urine throughout treatment with this medication.

Wound Healing

This medication can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that the medication be discontinued 1 week prior to any surgery. In addition, any surgical incision should be fully healed prior to starting or restarting the medication. If you have a surgical wound that has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.

GI Bleed & Tear

This medication can cause bleeding or a tear in the intestinal wall or a fistula (whole connecting two parts of your GI tract). 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.

Blood Clots, Heart Attack and Stroke

This medication 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.

Lung Changes

This medication may cause a collapsed lung (pneumothorax) or interstitial lung disease. Patients can also develop an inflammation of the lungs (called pneumonitis) while taking this medication. Notify your healthcare provider right away if you develop any new or worsening symptoms, including shortness of breath, trouble breathing, cough or fever. 

Liver Toxicity

This medication can cause liver toxicity, which your doctor may 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 pain in your abdomen, as these can be signs of liver toxicity.

Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome (TTP/HUS)                 

This medication can also cause another rare syndrome called thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS). Your healthcare team will monitor you for symptoms of TTP/HUS throughout your treatment. Notify your healthcare team if you have bruising or bleeding.

Posterior Reversible Encephalopathy Syndrome (PRES)

In rare cases this medication has caused a neurological disorder called posterior reversible encephalopathy syndrome (PRES). Symptoms of PRES include headache, seizure, lethargy, confusion, blindness and other visual and neurological disturbances. Report any of these symptoms to your healthcare team immediately.

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 consult with your healthcare team before breastfeeding while receiving this medication.

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