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Pazopanib (Votrient)

This page is about the biological therapy pazopanib and its possible side effects. There is information about

 

What pazopanib is

Pazopanib is pronounced pas-op-ann-ib. It is also called Votrient. It is a treatment for advanced kidney cancer (renal cancer) and some types of soft tissue sarcoma. 

Researchers are looking at pazopanib as a treatment for a number of other types of cancer.

 

How pazopanib works

Pazopanib is a type of biological therapy called a tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins which act as chemical messengers (enzymes) in cells. There are a number of different tyrosine kinases and they stimulate cancer cells to grow. Pazopanib blocks a number of these proteins and is called a multi tyrosine kinase inhibitor (multi TKI). It stops cancer cells forming blood vessels that they need in order to grow. This is called anti angiogenesis treatment.

 

How you have pazopanib

You take pazopanib as tablets once a day with a glass of water. Take them at about the same time each day. You should take the tablets at least an hour before you eat or 2 hours afterwards. It is very important that you take them according to the instructions your doctor or pharmacist gives you. Take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first. 

If you forget to take a dose don't take extra tablets to make up for it. Just take your next dose at the usual time.

You usually carry on taking pazopanib for as long as it works.

The side effects associated with pazopanib are listed below. Most people only have one or two or a few of them.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • Diarrhoea affects about 1 out of 2 people (50%) – it is usually mild but do tell your doctor or nurse as you can have medicines to control it
  • A rash, or red, dry itchy skin in about 3 out of 10 people (30%) – the skin may peel. If it is severe your doctor may reduce the dose or stop the treatment
  • Tiredness (fatigue) during and after treatment
  • Feeling weak, and lacking in energy and strength
  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Hair colour changes in 4 out of 10 people (40%) and less commonly hair thins
  • Feeling sick occurs in about 1 in 4 people (25%) but this is usually well controlled with anti sickness medicines
  • Raised blood pressure (hypertension) – if this happens your doctor can give you treatment to lower your blood pressure
  • An increased risk of bleeding such as nosebleeds or bleeding gums
  • Loss of appetite
  • Weight loss
  • Headaches
  • Stomach pain
  • An effect on the liver which is unlikely to cause symptoms – it usually goes back to normal after the treatment ends. You will have regular blood tests to check how your liver is working
  • Taste changes
  • A sore mouth
  • Pain in the area of the cancer
  • Loss of skin colour
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
  • Hand foot syndrome – soreness and redness of the palms of the hands and soles of the feet

 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Indigestion, bloating and wind (flatulence)
  • Changes to your thyroid gland – you will have blood tests to check your level of thyroid hormones
  • Low magnesium, calcium and other minerals in your blood – you will have regular blood tests to check the levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • A dry mouth and gum infections
  • Difficulty sleeping
  • Blood clots – tell your doctor know straight away if you suddenly become breathless. Also let them know if you have pain and redness or swelling of the legs as this could be a sign of a blood clot
  • Dizziness
  • Blurred vision
  • Hot flushes
  • Swelling of the face, ankles, lips or eyelids caused by fluid build up
  • Numbness and tingling in hands and feet – you may have a change in how things feel when you touch them. This can make doing fiddly things difficult (for example doing up buttons)
  • Sweating and lack of fluid in the body – drink plenty of fluids
  • Muscle or joint pain
  • Muscle spasms
  • Drowsiness – don't drive or operate machinery if you have this
  • Hair loss or thinning
  • A hoarse voice
  • Changes in the lungs causing breathlessness or a cough
  • Hiccups
  • Nail changes
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Severe lung problems – if you have a cough, high temperature and are short of breath contact your doctor or nurse urgently
  • A hole in the bowel wall has occurred but this is very rare – if you notice blood in your stool or vomit, contact your doctor or nurse straight away
  • Heart problems, causing changes to your blood pressure, dizziness, chest pain or changes in your heart beat. These are quite uncommon and nearly always get better when treatment stops. Tell your doctor if you have had heart problems before or if you have any of these side effects
  • Changes to the blood supply to the brain which can rarely lead to a stroke – contact your treatment centre urgently if you have symptoms of a stroke. The symptoms include your face drooping to one side or you can’t smile normally. You may not be able to lift your arms or they become weak or numb. Or your speech may be slurred or garbled
  • Heavy or irregular periods
  • A runny nose
  • Swelling of the brain – let your nurse or doctor know straight away if you have speech problems, eyesight changes, fits (seizures), or confusion
  • Increased sensitivity of the skin to sunlight – don’t sit out in the sun. Remember to cover up or use sun block on exposed skin
 

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines and foods

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Avoid grapefruit and grapefruit juice while having pazopanib treatment as they can increase the side effects.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don't breastfeed during this treatment and for at least 2 months afterwards because the drug may come through in the breast milk.

Slow wound healing

Pazopanib can slow wound healing. If you need to have surgery your doctor will ask you to stop taking pazopanib at least 7 days beforehand. 

 

Immunisations

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about pazopanib

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 17 February 2015