Uses
What is pazopanib used for?
Pazopanib is commonly used to treat certain types of the following cancers.

• Kidney cancer
• Soft tissue cancer

Pazopanib may also be used for other conditions as determined by your health care provider.

How does pazopanib work (mechanism of action)?
Pazopanib works by blocking certain proteins, which can prevent the growth of new blood vessels that tumors need to grow. This can prevent cancer cells from growing or spreading and cause the cells to die.

How is pazopanib supplied (dosage forms)?
Brands and other names

• Votrient

Dosage forms and strengths

• 200 mg oral tablets

How should I store pazopanib?
Pazopanib should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when you’re transporting it. Store it in a cool, dry place.

Side Effects
What are the most common side effects of pazopanib?
The most common side effects of pazopanib are listed below. Tell your health care provider if you have any of these side effects that bother you.

• Diarrhea
• Hair color changes
• Nausea and vomiting
• Loss of appetite
• Tiredness
• Weight loss
• Tumor pain
• Muscle or bone pain
• Stomach pain
• Headache
• Change in taste
• Shortness of breath
• Change in skin color
• High blood pressure (see below)

There may be other side effects of pazopanib that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of pazopanib?
While less common, the most serious side effects of pazopanib are described below, along with what to do if they happen.

Severe Allergic Reactions. Pazopanib may cause allergic reactions, which can be serious. Stop taking pazopanib and get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching or skin rash
• Bumps on the skin called hives that can be red, pink, white, or brown, depending on your skin tone
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking pazopanib. Call your health care provider right away if you have any of the following symptoms of liver damage.

• Nausea or vomiting
• Stomach or belly pain
• Fever
• Weakness or unusual tiredness
• Itching
• Loss of appetite
• Light-colored poop
• Dark-colored urine (pee)
• Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Heart Rhythm Changes. Pazopanib may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take medicines that can prolong the QT interval. Tell your health care provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Heart Failure. Pazopanib may increase your risk of heart failure. Tell your health care provider right away if you have any of the following symptoms of heart failure.

• Shortness of breath or trouble breathing, especially while lying down
• Swelling in your feet, ankles, or legs
• Unusually fast weight gain
• Unusual tiredness

Severe Bleeding. Pazopanib can increase your risk of severe bleeding that can lead to death. Some people with serious bleeding may need a blood transfusion or surgery. Pazopanib can also increase your risk of stomach bleeding and tears (perforation) in your gut. Call your health care provider right away if you have any of the following signs of severe bleeding while taking pazopanib.

• Pink, red, or brown urine (pee)
• Vomit with blood that looks like coffee grounds
• Red or black stools (look like tar)
• Coughing up blood or blood clots
• Stomach pain that does not go away
• Upset stomach
• Feeling faint

Heart Attack and Stroke. Pazopanib can increase your risk of a heart attack or stroke that can lead to death. This risk is higher in people who already have heart disease. Do not take pazopanib if you have had recent heart problems without talking to your health care provider. This could increase your risk of having a heart attack. Get emergency help if you have any of the following symptoms of a heart attack or stroke.

• Chest pain or pressure
• Fast or abnormal heartbeat
• Trouble breathing
• Pain in your back, jaw, throat, or arm
• Sweating, upset stomach, vomiting, or dizziness
• Sudden weakness on one side of your body
• Sudden and severe headache
• Slurred speech or trouble understanding speech

Blood Clots. Pazopanib may cause a blood clot in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism, including a blood clot in the lungs (pulmonary embolism) or deep vein thrombosis (DVT). Stop taking pazopanib and get emergency help if you have any of the following signs of blood clots.

• Chest pain or pressure
• Fast or abnormal heartbeat
• Trouble breathing
• Pain in your back, jaw, throat, or arm
• Sweating, upset stomach, vomiting, or dizziness
• Sudden weakness on one side of your body
• Sudden and severe headache
• Slurred speech or trouble understanding speech
• Pain, swelling, or tenderness in your arm or leg
• Vision loss
• Bulging eyes
• Double vision

Small Blood Vessel Clots (Thrombotic Microangiopathy). Pazopanib may cause thrombotic microangiopathy, which is when small blood clots form in blood vessels. Keep all your appointments to have your blood checked. This will help your health care provider tell if you have thrombotic microangiopathy.

Lung Problems. Pazopanib can cause inflammation in your lungs, also called interstitial lung disease or pneumonitis. This can be serious or even life-threatening. Get emergency help if you have trouble breathing. You may also have a cough, fever, or chest pain.

Posterior Reversible Encephalopathy Syndrome (PRES). Pazopanib may cause a rare but serious brain condition calledPRES. PRES involves swelling and narrowing of blood vessels in your brain. If PRES is not treated, it can lead to a stroke. Call your health care provider right away if you have the following symptoms of PRES.

• Changes in thinking or behavior
• Confusion or hallucinations
• Sudden decrease or change in vision
• Sudden severe headache
• Seizures

Increased Blood Pressure (Hypertension). Pazopanib may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while taking this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher, or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

• Sudden severe headache
• Chest pain
• Dizziness or confusion
• Trouble breathing
• Nausea or vomiting
• Blurry or other changes to vision
• Anxiety
• Buzzing in the ears
• Nosebleed
• Feeling of skipped heartbeats

Wound Healing Issues. Pazopanib can make it difficult for your body to heal wounds. Tell your health care provider if you have any planned or emergency surgeries or get any injuries while taking pazopanib.

Low Thyroid Hormones (Hypothyroidism). Pazopanib can cause the function of your thyroid gland to change, which can lead to low thyroid levels. Keep all appointments to have your blood checked. Tell your health care provider if you have any of the following signs of low thyroid hormones.

• Weight gain
• Feeling cold
• Tiredness that does not go away or continues to worsen
• Constipation

Protein in Urine. Pazopanib can cause a high amount of protein in urine (proteinuria), which can be a sign of kidney damage. Tell your health care provider if you have the following symptoms of protein in your urine.

• Foamy or bubbly pee
• Swelling in your hands, feet, belly, or face
• Peeing more often than usual
• Shortness of breath
• Tiredness
• Loss of appetite

Tumor Lysis Syndrome. Pazopanib can cause a fast breakdown of cancer cells. This can lead to a condition called tumor lysis syndrome, which can be serious. It is important to drink plenty of water while taking pazopanib and to keep all appointments for bloodwork so your health care provider can see how your body is responding to pazopanib. Tell your health care provider right away if you have any of the following signs of tumor lysis syndrome while taking pazopanib.

• Nausea and vomiting
• Weakness
• Swelling or fluid retention
• Shortness of breath
• Muscle cramps
• Seizures

Infections. Pazopanib can increase your risk of infections, including serious infections. Call your health care provider right away if you have an infection or any of the following symptoms.

• Burning or stinging when you pee
• Cough or coughing up blood
• Fever, sweats, chills, or muscle aches
• Shortness of breath
• Diarrhea or stomach pain
• Weight loss

Warnings & Precautions
Who should not use pazopanib?
Allergies to Ingredients. People who are allergic to any of the following should not take pazopanib.

• Pazopanib
• Votrient
• Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific pazopanib products they stock.

What should I know about pazopanib before using it?
Do not take pazopanib unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not share pazopanib with other people, even if they have the same condition as you. It may harm them.

Pazopanib may make it hard for you to get pregnant or get your partner pregnant. If you have concerns, talk to your health care provider.

Keep pazopanib out of the reach of children

Pazopanib should be taken without food and on an empty stomach at least one hour before or two hours after eating. Swallow pazopanib whole and do not crush, split, dissolve, or chew the tablets.

Your health care provider will have you do regular blood, urine, and heart tests before taking and while taking pazopanib. Make sure to go to all appointments so they can make sure that pazopanib is safe for you.

What should I tell my health care provider before using pazopanib?
Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them tell if pazopanib is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

• Liver problems
• High blood pressure
• Heart problems, including cardiomyopathy, heart failure, heart rhythm changes, and QT prolongation
• Any family members who have heart problems like QT prolongation
• Blood clot problems, including prior strokes
• Headaches
• Seizures
• Eye problems
• Stomach or digestive problems, including stomach ulcers
• Coughed up blood previously
• Thyroid problems
• Kidney problems
• Prior or planned surgery
• Wounds that are healing
• Current infection

Other Medicines and Supplements. Pazopanib may interact with other medicines and supplements. Before taking pazopanib, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Pazopanib may harm an unborn baby. Your health care provider will give you a test to make sure you are not pregnant before you start taking pazopanib. If you can get pregnant, you should use birth control while taking pazopanib and for two weeks after your last dose. If you are able to get a partner pregnant, you should use condoms while taking pazopanib and for two weeks after your last dose. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if pazopanib passes into breast milk. You should not breastfeed while taking pazopanib and for two weeks after your last dose. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions
Does pazopanib interact with foods or drinks?

Pazopanib should be taken without food and on an empty stomach at least one hour before or two hours after eating.

Grapefruit interacts with pazopanib. It is important to avoid eating grapefruit or drinking grapefruit juice while taking pazopanib. This is because grapefruit can make your body less able to break down pazopanib, which can lead to high levels of the medicine and an increased risk of side effects.

It is unknown if drinking alcohol will affect pazopanib, but heavy drinking can slow your immune response and make it harder for your body to fight cancer.

Does pazopanib interact with other medicines (drug interactions)?
Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. 

In particular, make sure that you discuss if you are using any of the following before taking pazopanib.

• St. John’s wort, which is a supplement that may be used for depression
• A proton pump inhibitor (PPI), such as esomeprazole (Nexium)
• Any medicine that can cause QT prolongation, which is a potentially dangerous heart rhythm problem
• Dextromethorphan, a medicine used to treat a cough caused by the common cold or other illness
• Ketoconazole, which is a medicine used for fungal infections
• Lapatinib (Tykerb), which is a medicine used to treat certain types of breast cancer
• Midazolam, a medicine used to relieve anxiety before surgery
• Simvastatin, which is a medicine to lower cholesterol

Many other medicines may alter the blood levels of pazopanib, and vice versa. Tell your health care provider about all medicines that you take or have recently taken

This may not be a complete list of medicines that can interact with pazopanib. Always check with your health care provider.

Overdose/ Missed Dose
What should I do if I accidentally use too much pazopanib?
If you or someone else has used too much pazopanib, get medical help right away, or contact a Poison Control center.

What should I do if I miss a dose of pazopanib?
If you miss a dose, take it as soon as you remember. If it is less than 12 hours until your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.