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Ponatinib (Iclusig)

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This page tells you about the cancer drug treatment ponatinib (pronounced pon-att-in-ib). There are sections on


What ponatinib is

Ponatinib is also called by its brand name Iclusig. It is a treatment for

  • Chronic myeloid leukaemia where the leukaemic cells have the T315I gene change (mutation)
  • Acute lymphoblastic leukaemia that is Philadelphia chromosome positive or has the T315I mutation

You may also have it as part of clinical trials for other cancers.


How ponatinib works

Ponatinib is a type of drug called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that act as chemical messengers to stimulate cancer cells to grow. Ponatinib blocks and interferes with how cells make a number of protein kinases. It is called a multi kinase inhibitor.


How you have ponatinib

Ponatinib comes as tablets. You swallow the tablets whole with a glass of water once a day. You can take them with or without food. You usually carry on taking ponatinib for as long as it works, unless the side effects get too bad.  

It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. So check the pack leaflet and follow the instructions it gives. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

The side effects associated with ponatinib are listed below. Remember that you may only have a few of them. For more information look in our cancer drug side effects section.


Common side effects

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

  • 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
  • Tiredness and breathlessness from a drop in red blood cells (anaemia). You may need a blood transfusion
  • Bruising more easily from a drop in platelets – you may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Skin changes happen in just over 4 in 10 people (40%) – you may have a rash or red, dry, itchy skin. This can be difficult to cope with so tell your doctor or nurse and they can give you creams
  • Pain in the bone, back, neck or tummy (abdomen) affects about 1 in 4 people (25%)
  • Headaches affect 2 in 10 people (20%)
  • Aching joints affect about 2 in 10 people (20%)
  • Dizziness – don’t drive or operate machinery if you have this
  • Your blood pressure may be higher than normal
  • Shortness of breath and a cough
  • Loss of appetite
  • Problems with sleeping
  • Tiredness happens in 2 in 10 people (20%) during and after treatment. Most people find their energy levels are back to normal within 6 months to a year
  • Feeling or being sick happens in about 2 in 10 people (20%). This is usually well controlled with anti sickness medicines
  • Fluid build up in the body – you may need to take tablets to reduce the amount of fluid. It can build up anywhere including your legs, face and around your body organs
  • Constipation affects 2 in 10 people (20%). Your doctor or nurse may give you medicines to help prevent this but tell them if you are constipated for more than 3 days
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if you are worried about how bad it is, or if it continues for more than 3 days
  • 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

Occasional side effects

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

  • Flu like symptoms – you may have a fever, chills and muscle aches. Taking paracetamol can help
  • Sharp pains in the upper area of the tummy (abdomen) due to inflammation of the pancreas (pancreatitis) – let your doctor or nurse know straight away if you have this
  • Heart problems including chest pain. Contact your doctor as soon as possible if you have any pain
  • Weight loss
  • Dehydration – drink plenty of fluids (around 2 litres a day) to prevent dehydration
  • An increased risk of a stroke, heart attack or short term loss of blood supply to the brain – let your doctor or nurse know straight away if you have sudden headaches, dizziness, or faintness
  • Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons
  • An increased risk of blood clots – your doctor may give you aspirin when you start treatment to prevent any clots. Tell your doctor or nurse straight away if you have a sharp pain in your chest or your leg becomes swollen
  • Fluid around the lungs (pleural effusion) – this can be a serious problem so if you are breathless or have a cough contact your doctor or nurse straight away
  • Voice changes
  • Eye problems – these include blurred vision, dry eyes and infections
  • Men may have difficulty getting an erection
  • Liver changes that are very mild and unlikely to cause symptoms. The liver will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • Changes in blood sugar levels – if you have diabetes you may need to check your blood sugar levels more often than usual

Rare side effects

Fewer than 1 in 100 people have these side effects.

  • Yellowing of the skin and eyes (jaundice)
  • A stomach bleed – let your doctor or nurse know straight away if you have sudden sharp pains in the tummy, or blood in your vomit or stool
  • High uric acid levels in the blood due to the breakdown of tumour cells (tumour lysis syndrome) – you will have regular blood tests to check your uric acid levels. You may also have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid

Important points to remember

You may have a few of the side effects mentioned on this page. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much 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 that 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. Ponatinib can react with other medicines.

In particular, medicines, foods and herbal supplements that contain CYP enzymes can interfere with how ponatinib works.

Don’t eat grapefruit or drink grapefruit juice while having treatment with ponatinib. It can change the amount of ponatinib you absorb and make the side effects worse.

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 with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Don’t breastfeed during this treatment because the drug may come through in the breast milk.

Possible long term effects

Ponatinib is a fairly new drug in cancer treatment. This means that there is limited information available at the moment about possible longer term effects that it may cause. Tell your doctor if you notice anything that is not normal for you.



You should not have immunisations with live vaccines while you are having this 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 ponatinib treatment

We don’t 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/emc.

If you have a side effect we don’t list here and you think it may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority (MHRA). Go to www.mhra.gov.uk.

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Updated: 24 February 2015