Pazopanib (Votrient ®)
Pazopanib (also known as Votrient ®) may be used to treat a type of kidney cancer called renal cell carcinoma (RCC). Pazopanib can also be used to treat certain types of soft tissue sarcoma.
This information describes pazopanib, how it is given and some of its possible side effects. It should ideally be read with our general information about your type of cancer.
Pazopanib is a type of treatment called a multi-kinase inhibitor. Kinases are important proteins in the body that regulate how the cells grow and divide.
Pazopanib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die.
Pazopanib can also stop the cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients, so that the tumour shrinks or stops growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors or anti-angiogenics.
When pazopanib is used
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Pazopanib is licensed to treat people with kidney cancer that has spread outside the kidney (advanced renal cell cancer). It may also be used to treat people with certain types of advanced soft tissue sarcoma, who have already been treated with chemotherapy.
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. Both NICE and the SMC recommend that pazopanib is only used for people with advanced kidney cancer who have not had treatment for their advanced kidney cancer before. In Scotland it can be used if a person has received previous treatment with interferon and interleukin.
NICE has not produced any guidance on the use of pazopanib to treat soft tissue sarcomas. The SMC has given guidance but do not recommend its use to treat these cancers.
If you live in Northern Ireland, you should speak to your cancer specialist about whether pazopanib is recommended to treat your type of cancer.
If pazopanib isn’t recommended for you, it may not be available on the NHS, although you may be given it as part of a clinical trial.
We have more information about what you can do if a treatment isn’t available.
What pazopanib looks like
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Pazopanib is a tablet. It comes in two strengths: 200mg tablets, which are pink, and 400mg tablets, which are white.
How pazopanib is taken
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The tablets should be swallowed whole and taken with a glass of water either an hour before you eat or at least two hours after eating. Pazopanib should not be taken with grapefruit juice. Food affects its absorption, and grapefruit juice can increase its side effects. The tablets should not be broken or crushed.
Pazopanib is normally given once a day, and should be taken at the same time each day.
Possible side effects of pazopanib
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Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described here won’t affect everyone having this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
High blood pressure
Pazopanib can cause high blood pressure in some people. You should let your doctor know if you already have high blood pressure before starting this treatment.
Your blood pressure will be checked regularly for the first six weeks of treatment. If high blood pressure develops, it’s most likely to happen within the first few weeks of taking the drug. If you develop high blood pressure, you will be prescribed medicines to help control it.
You may have frequent or loose bowel movements. This can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It’s important to drink plenty of fluids if you have diarrhoea.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having pazopanib. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
You may notice that food tastes different. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
If tiredness occurs it’s usually mild. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help.
Abdominal (tummy) pain
Some people have pain or discomfort in their tummy when taking pazopanib. Let your doctor know if this happens to you.
Effects on the hair
Your hair may lose colour and it may become thinner while you’re taking pazopanib. Changes to your hair are usually temporary and usually get better if you stop treatment. But for some people, hair changes can be permanent.
Changes in the skin such as a rash, redness, dryness or itching are quite common. Your skin may lose some of its colour and become lighter or more yellow in tone. These side effects are usually mild. Speak to your doctor or nurse if you have any of these symptoms. They can advise you about creams or lotions to use, or prescribe medicines to relieve itching.
Hand/foot skin reaction
You may notice redness of the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. There may also be changes in sensation, such as numbness or tingling. If you notice this, let your specialist know.
Occasionally, if soreness doesn’t settle or if blistering develops, your doctor may need to reduce the dose of pazopanib or interrupt the treatment. Very occasionally, people may need to stop having the treatment completely.
You may have hot flushes while taking pazopanib. Let your doctor know if these are troublesome.
Some people find that pazopanib causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Some people have muscle pain while having treatment. Your doctor can prescribe painkillers if you’re affected.
You may have some mild dizziness. Tell your doctor if this is troublesome. It may affect your ability to drive.
This can affect different parts of your body. Most commonly it causes swelling of the ankles or swelling around the eyes. Fluid retention often settles without treatment, but if it doesn’t, drugs that make you pass more urine (diuretics) can help get rid of some of the fluid. A short course of steroids may also be helpful.
Pazopanib may make your thyroid work less effectively. Symptoms of an underactive thyroid may include tiredness, weight gain, constipation, aches, feeling cold and dry skin and hair. If you have any new symptoms let your doctor know. You may need a blood test to check how well your thyroid is working.
Sore mouth and ulcers
Your mouth may become sore, or you may notice small mouth ulcers. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people find sucking on ice soothing. Tell your doctor or nurse if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.
Risk of infection
Pazopanib can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature
you notice any signs of infection.
You will have blood tests while you’re taking pazopanib to check the number of white blood cells. If the number of your blood cells (blood count) is too low, your doctor may ask you to stop taking pazopanib or reduce the dose for a time.
Bruising and bleeding
Pazopanib can reduce the production of platelets, which help the blood to clot. Tell your doctor straight away if you have any unexplained bruising or bleeding such as nosebleeds, bleeding gums, blood in your urine or stools, blood spots or rashes on the skin. If this happens, you may need to have a platelet transfusion. Rarely, bleeding may occur with pazopanib even when the production of platelets is normal.
Depending on the cause of the bleeding, your doctor may ask you to stop taking pazopanib or reduce the dose for a time.
Anaemia (low number of red blood cells)
Pazopanib can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if your number of red blood cells becomes too low.
Effects on the liver
Pazopanib may cause changes in the way your liver works. Your doctor will monitor this closely by taking regular blood samples to check your liver is working properly. Let your doctor know if you develop pain in your right side.
A very small number of people may notice a change in their heart rhythm. Heartbeats may become less regular or the heart may feel as if it’s beating too fast. If you notice any changes in your heart rhythm, tell your doctor immediately.
Very rarely, pazopanib can increase your risk of having a stroke. If you, or a relative or friend, notice that you have weakness or numbness in one or both of your arms, slurred speech or drooping of your face, mouth or eye; you should tell a doctor immediately.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having pazopanib. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of pazopanib on a developing baby. Therefore, it is not advisable to become pregnant or father a child while taking this drug.
It’s not known whether pazopanib is present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that pazopanib may be present in breast milk so women are advised not to breastfeed during treatment and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having pazopanib treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
Things to remember about pazopanib tablets
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It’s important to take your tablets as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you are taking a course of pazopanib tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in the original packaging.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don’t flush them down the toilet or throw them away.
If you’re sick just after taking the tablets, tell your doctor as you may need to take another dose. Don’t take another tablet without telling your doctor, nurse or pharmacist first.
If you forget to take a tablet, don’t take a double dose. Let your doctor know and keep to your regular dose schedule.
This information has been compiled using a number of reliable sources, including:
Pazopanib for the first-line treatment of advanced renal cell carcinoma (TA215). National Institute for Health and Clinical Excellence (NICE), February 2011.
676/10 – Pazopanib (Votrient). Scottish Medicines Consortium (SMC), March 2011.
820/12 – Pazopanib (Votrient). Scottish Medicines Consortium (SMC), December 2012
electronic Medicines Compendium (eMC). http://www.medicines.org.uk (accessed October 2012).
British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Thanks to Dr James Larkin, Consultant Medical Oncologist; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.