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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-oh-pan-ib. It is also called Votrient. It 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.

Pazopanib is a treatment for advanced kidney (renal) cancer and some types of soft tissue sarcoma. Researchers are also looking at pazopanib as a treatment for a number of other types of cancer.

 

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 gave 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. Remember that 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 in 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%)
  • Tiredness (fatigue) during and after treatment
  • Feeling weak, and lacking in energy and strength
  • Hair colour changes in 4 out of 10 people (40%) and less commonly hair thinning
  • Feeling sick 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, and 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
 

Occasional side effects

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

  • Hand foot syndrome – soreness and redness of the palms of the hands and soles of the feet happens in less than 1 in 10 people (10%)
  • Indigestion, bloating and wind (flatulence)
  • Skin changes may include an itchy rash or blistering – if it is severe your doctor may reduce the dose or stop treatment
  • 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
  • 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, sore throat, pain passing urine or feel cold and shivery
  • 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 – let your doctor know straight away if you suddenly become breathless or have leg 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, which 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
  • Hair loss or thinning
  • A hoarse voice
  • Changes in the lungs causing a cough
  • Hiccups
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Severe lung problems occur in fewer than 1 in 100 (1%) people – 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, which include your face drooping to one side, you can’t smile normally, you can’t lift your arms or they become weak or numb, or your speech is slurred or garbled
  • Heavy or irregular periods
  • A runny nose
 

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

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.

You should avoid grapefruit and grapefruit juice as they can increase the side effects. Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together. 

Some drugs may increase the side effects of pazopanib and reduce how well it works. These include

  • Some antibiotics and anti fungal medicines
  • Some HIV medicines
  • Some drugs that lower cholesterol levels
  • Drugs that reduce stomach acid
  • Some anti depressants.

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. 

Pazopanib could harm a developing baby. Talk to your doctor or specialist nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant.

Pazopanib may be present in breast milk so women should not breastfeed during treatment or for 2 months after the last dose.

 

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: 10 May 2013