Niraparib (Zejula®) belongs to a group of targeted therapy drugs nown as PARP inhibitors. PARPs are proteins that help damaged cells repair themselves.
Niraparib blocks (inhibits) how PARP proteins work. Without PARP proteins, cancer cells may become too damaged to survive and die.
Niraparib is used to treat some types of ovarian, fallopian tube or primary peritoneal cancer that have come back after other treatments. It may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a research trial and sometimes for other cancer types.
If a drug is not available on the NHS, there may be different ways you can still have it. Your cancer doctor can give you advice. We have more information about what to do if a treatment is not available.
It is best to read this information with our general information about the type of cancer you have. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
How niraparib is given
During treatment you will see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
You have chemotherapy before you start taking niraparib. The chemotherapy gets rid of as much of the cancer as possible. You then take niraparib to stop the cancer growing again. Your doctor or nurse will explain how long you can keep taking niraparib. Do not stop taking it without talking to your doctor.
Niraparib is given as capsules. This means you can take it at home.
Niraparib can reduce the number of blood cells in your blood. You will have regular blood tests during your treatment. If your blood cell levels get too low, your doctor may tell you to stop taking niraparib for a short time until this improves.
Taking niraparib capsules
You take niraparib once a day. Your doctor, nurse or pharmacist will tell you how many capsules to take. Always take them exactly as you are told to. This is important to make sure they work as well as possible for you.
Try to take the capsules at the same time each day. Feeling sick can be a side effect of niraparib. Taking your capsules at bedtime may help control sickness. Swallow the capsules whole with water. Do not chew, dissolve or open them. If you forget to take the capsules, do not take a double dose. Take your next dose at the usual time and let your doctor or nurse know.
Other things to remember about your capsules:
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
- If your treatment is stopped return any unused capsules to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection.
If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Niraparib can make you feel or be sick. Taking your capsules at bedtime may help control sickness. Your doctor can also give you anti-sickness drugs.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
This treatment can cause constipation. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (31/2 pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
You may get pain in your tummy (abdomen), or have indigestion. Your doctor can give you drugs to help improve these symptoms. Tell them if the pain gets worse or does not get better.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Tummy pain and heartburn
You may get pain in your tummy (abdomen), or have heartburn (indigestion). Your doctor can give you drugs to help improve these symptoms. Tell them if the pain gets worse or does not get better.
Changes to your taste
You may get a bitter or metallic taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.
Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Sleep problems and mood changes
You may have difficulty sleeping while you are taking niraparib. Some people taking niraparib may become low in mood or anxious. Talk to your doctor or specialist nurse if you notice any of these side effects.
High blood pressure
Niraparib may cause high blood pressure. Tell your doctor or nurse if you have ever had problems with high blood pressure or take drugs for this. Your nurse will check your blood pressure regularly during treatment. Let them know if you have any headaches.
You may feel dizzy during this treatment. Tell your doctor or nurse if this is difficult to cope with. If you feel dizzy, do not drive or operate machinery.
Back, joint or muscle pain
You may get pain in your back, joints or muscles during treatment with niraparib. If this happens, tell your doctor. They can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Effects on the heart
You may feel your heart is beating too fast or your heartbeat is not regular. This is a common side effect of niraparib. It is not usually serious. But you should tell your doctor or nurse so they can check.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco and foods that irritate your mouth.
This treatment can cause a mild rash. It may also make your skin sensitive to sunlight. Use a sun cream with a sun protection factor (SPF) of at least 30. Cover up with clothing and a hat in the sun. Tell your doctor or nurse if you have any skin changes. They can prescribe creams and drugs to help.
Build-up of fluid
Your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if this happens.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can affect niraparib or be harmful when you are having it. This may include common medicines such as some painkillers and antibiotics. Always ask your cancer doctor about any drugs you are taking, including:
- medicines you are given on prescription
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.
Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Some cancer drugs can increase the risk of developing other types of cancer or leukaemia later in life. This is rare. Your doctors will consider the small increase in risk of this happening against the benefit of the drug in treating your cancer.
Lactose and tartrazine
Niraparib capsules contain lactose. They also contain a food colouring called tartrazine. If you have an intolerance to some sugars, or are allergic to tartrazine, talk to your doctor before you start this treatment.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.