Pazopanib Hydrochloride interactions

Food & lifestyle

• grapefruit juice

  Major

  Metabolism

  Grapefruit juice may increase the plasma concentrations of pazopanib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

  What to do: Patients treated with pazopanib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Pazopanib should be administered at least one hour before or two hours after a meal.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

Conditions

Conditions in which Pazopanib Hydrochloride needs care, as documented in this source.

• Hemorrhage

  Major

  Pazopanib may increase the risk of bleeding. Patients who have a history of hemoptysis, cerebral hemorrhage or those who have experienced clinically significant gastrointestinal hemorrhage in the past 6 months should not use this agent.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

• Liver Diseases

  Major

  Severe and fatal hepatotoxicity has been observed with the use of pazopanib. No dose adjustment is required in patients with mild hepatic impairment. Pazopanib dose should be reduced to 200 mg per day in patients with moderate hepatic impairment. Pazopanib is not recommended in patients with severe hepatic impairment. It is recommended to monitor serum liver tests before starting treatment with pazopanib and at weeks 3, 5, 7, and 9. Thereafter, monitor at month 3 and at month 4, and as clinically indicated; periodic monitoring should then continue monthly. The use of this agent should be interrupted in patients presenting significant hepatic dysfunction and restart therapy only if clinically necessary and according to clinical recommendations.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

• Peptic Ulcer Perforation

  Major

  Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

  3 sources

  1. "Product Information. Avastin (bevacizumab)." Genentech (2004):
  2. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):
  3. "Product Information. Cyramza (ramucirumab)." Eli Lilly and Company (2014):

• Cardiovascular Diseases

  Moderate

  Patients should be carefully monitored for clinical signs or symptoms of congestive heart failure. Baseline and periodic evaluation of LVEF is recommended in patients at risk of cardiac dysfunction including previous anthracycline exposure.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

• Hypertension

  Moderate

  Inhibitors of vascular endothelial growth factor receptors (VEGFR) have been associated with severe increases in blood pressure. Therapy with these agents should be administered cautiously in patients with preexisting hypertension. Blood pressure should be assessed prior to initiating treatment, regularly during treatment and after discontinuation in patients with bevacizumab -induced or -exacerbated hypertension. Temporarily suspend these agents in patients with severe hypertension that is not controlled with medical management. Discontinue these agents in patients with hypertensive crisis or hypertensive encephalopathy.

  3 sources

  1. "Product Information. Avastin (bevacizumab)." Genentech (2004):
  2. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):
  3. "Product Information. Cyramza (ramucirumab)." Eli Lilly and Company (2014):

• Hypothyroidism

  Moderate

  Hypothyroidism has been reported in patients taking pazopanib. Therapy with pazopanib should be administered cautiously to patients with thyroid dysfunction. Baseline laboratory measurement of thyroid function is recommended and if appropriate, treatment per standard medical practice should be given prior to initiation of therapy. Clinical monitoring of thyroid function is recommended during therapy.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

• Liver Diseases

  Moderate

  Interstitial Lung Disease (ILD)/Pneumonitis has been reported with the use of pazopanib. Monitor patients for pulmonary symptoms indicative of ILD/pneumonitis and discontinue pazopanib in patients developing ILD or pneumonitis.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

• Long QT Syndrome

  Moderate

  Pazopanib can cause QT prolongation which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. This agent should be administered with caution in patients with a history of QT interval prolongation, in patients taking antiarrhythmics or other medications that may prolong QT interval. Serum electrolytes should be corrected before initiating therapy with this agent. Periodic monitoring of ECGs and electrolytes is recommended in these patients.

  1 source

  1. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):

• Posterior Leukoencephalopathy Syndrome

  Moderate

  Posterior Reversible Encephalopathy Syndrome (PRES) has been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR) in clinical studies. PRES is a neurological disorder which can present with headache, seizure, lethargy, confusion, blindness and other visual and neurologic disturbances. It is recommended to discontinue these agents in patients developing PRES. The safety of restarting therapy is not known. Cation is recommended if therapy is reinitiating in patients previously experiencing PRES.

  3 sources

  1. "Product Information. Avastin (bevacizumab)." Genentech (2004):
  2. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):
  3. "Product Information. Cyramza (ramucirumab)." Eli Lilly and Company (2014):

• Proteinuria

  Moderate

  The incidence and severity of proteinuria is increased in patients taking inhibitors of vascular endothelial growth factor receptors (VEGFR). Therapy with these agents should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. It is recommended to temporarily suspend these agents in patients with moderate to severe proteinuria and to discontinue therapy in patients with nephrotic syndrome.

  3 sources

  1. "Product Information. Avastin (bevacizumab)." Genentech (2004):
  2. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):
  3. "Product Information. Cyramza (ramucirumab)." Eli Lilly and Company (2014):

• Thromboembolism

  Moderate

  Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

  3 sources

  1. "Product Information. Avastin (bevacizumab)." Genentech (2004):
  2. "Product Information. Votrient (pazopanib)." GlaxoSmithKline (2009):
  3. "Product Information. Cyramza (ramucirumab)." Eli Lilly and Company (2014):