Pazopanib

Pazopanib is used to treat a type of kidney cancer called renal cell carcinoma. It can also treat some soft tissue sarcomas.

What is pazopanib (Votrient®)?

Pazopanib (Votrient®) is used to treat a type of kidney cancer, called renal cell carcinoma, when it has spread outside of the kidney. 

Sometimes it is used to treat some soft tissue sarcomas when they have spread to other parts of the body and you have already had chemotherapy treatment.

It is best to read this information with our general information about the type of cancer you have

Pazopanib is a type of treatment called a tyrosine kinase inhibitor (TKI), also known as a cancer growth inhibitor. Kinases are important proteins in the body that regulate how the cells grow and divide. Pazopanib blocks the proteins (kinases) from sending signals to cancer cells to grow. 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. This is known as anti-angiogenesis treatment.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment. 

How pazopanib is given

Pazopanib comes as tablets you take at home. During treatment, you usually 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

While you are taking pazopanib, a nurse or person trained to take blood (phlebotomist) will take blood samples from you. These samples may be used to check:

  • the level of your blood cells
  • how well your liver, kidneys and thyroid gland are working.

You may also have a urine test before, and possibly during, treatment to check your kidneys.

Your doctor, nurse or pharmacist will discuss your treatment plan with you. They will give you the tablets to take home with you.

You will usually carry on taking pazopanib for as long as it is working for you. Do not stop taking pazopanib without talking to your doctor first.

If you have certain side effects, or changes in your blood test results, your doctor may tell you to stop taking pazopanib for a short time or to reduce the dose you take.

Taking pazopanib

Always take your tablets exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.

You take pazopanib once a day. 

There are some important things to remember when taking your tablets:

  • Take pazopanib at least 2 hours after a meal or 1 hour before a meal. This is because food can affect how pazopanib is absorbed. 
  • Take the tablets with a glass of water, one after the other.
  • The tablets should be swallowed whole. Do not chew, break, or crush the tablets before you take them.
  • Do not eat grapefruit or drink grapefruit juice during your treatment. This can increase the chance of side effects.
  • If you forget to take your tablets or are sick after taking them, just take your next dose at the usual time – do not take a double dose.
  • Keep the tablets in the original packaging and at room temperature, away from heat and direct sunlight.
  • Keep the tablets in a safe place, out of the sight and reach of children.
  • Get a new prescription before you run out of tablets and make sure you have plenty for the holidays.
  • If treatment is stopped, return any remaining tablets to the pharmacist.

Possible side effects of pazopanib

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.

More information

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.

Common side effects

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 when you are taking pazopanib. If your blood pressure goes up, it is most likely to happen in the first few weeks of taking the drug. If you develop high blood pressure, you will be prescribed medicines to help control it.

Diarrhoea

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 (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.

Sore mouth and throat

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat 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 and throat.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

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.

Tiredness

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.

Pazopanib may affect how well you sleep. If you feel sleepy, do not drive, or operate machinery.

Effects on the hair

Your hair may lose colour and it may become thinner while you are taking pazopanib. Changes to your hair are usually temporary and get better if you stop treatment. But for some people, hair changes can be permanent.

Effects on the skin

Pazopanib can affect the skin and nails. You may develop a rash and your skin may feel dry and itchy or peel. Some people notice their skin loses some of its colour. Tell your doctor or specialist nurse if you notice any skin changes. They can advise you about creams or lotions to help with dryness and can prescribe medicines to relieve itching.

In some people, pazopanib can cause skin to be more sensitive to sunlight. If you are out in the sun, use a sun cream with a high sun protection factor (at least SPF 30) to protect your skin.

Sore and red palms of hands and soles of feet

You may get sore and red palms of hands and soles of feet. You may also notice numbness or tingling in them. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends. 

Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:

  • keep your hands and feet cool
  • moisturise your hands and feet regularly
  • avoid tight-fitting socks, shoes and gloves.

Your doctor may tell you to reduce the dose of pazopanib or to stop taking the tablets to let this side effect improve.

Tummy pain

Some people have pain or discomfort in their tummy when taking pazopanib. Let your doctor know if this happens to you.

Very rarely, pazopanib can cause a hole (perforation) in the small bowel. Contact your doctor immediately if you have severe pain in the tummy and sickness and vomiting. It is also very important to let them know if you:

  • are bleeding from the back passage
  • have black stools
  • are vomiting up blood 
  • have vomit that looks like coffee grounds.

Headaches

This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.

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 sometimes called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given 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
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

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, until your cell count increases.

Bruising and bleeding

Pazopanib can increase your risk of bleeding. Rarely this can be serious. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo) 
  • coughing up blood
  • tiny red or purple spots on the skin that may look like a rash.

Contact the hospital straight away if you have any bleeding that does not stop.

Dizziness

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.

Pain

You may get pain in your muscles or joints, or in the area where your cancer is. 

If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help. 

Fluid build-up

You may gain weight, or your face, ankles and legs may swell. This improves slowly after your treatment has finished. Your doctor may give you drugs to help reduce the swelling.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Hot flushes

Occasionally people have hot flushes while taking this treatment. If you are affected tell your doctor or specialist nurse, who can give you advice on coping with them.

Slow wound-healing

Wounds may take longer to heal while you are having treatment with pazopanib. If you need an operation, your doctor will tell you to stop taking pazopanib before it, and for a few weeks afterwards. You may also need to stop taking pazopanib for a few days if you are having dental treatment. Talk to your doctor if you need to have surgery or dental treatment.

Less commonly, pazopanib can cause a fistula from the bowel to the skin. A fistula is an opening between areas of the body that are not usually connected.

Less common side effects

Effects on the heart

This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
  • pain or tightness in your chest
  • breathlessness
  • dizziness
  • changes to your heartbeat.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

Stroke

Pazopanib can increase the risk of having a stroke. It is important to be aware of the possible signs of stroke such as:

  • Face: Weakness on one side of the face such as drooping eyelid or difficulty smiling
  • Arms: Being unable to raise both arms and keep them up
  • Speech: Not being able to speak clearly or slurred speech
  • Time: If you have any of these three signs, call 999 to get immediate medical help.

Other possible symptoms of stroke include:

  • Sudden weakness or numbness on one side of the body, including legs, hands or feet.
  • Sudden blurred vision or loss of sight in one or both eyes.
  • Sudden memory loss or confusion, and dizziness or a sudden fall.
  • A sudden, severe headache.

If you or someone you know notices you have any of these symptoms, you should tell a doctor immediately.

Effects on the thyroid gland

Pazopanib can affect the way thyroid gland works. It will go back to normal after treatment.

You will have regular blood tests to check your levels of hormones that are made by the thyroid. This side effect is usually mild and may not cause symptoms. Your doctor may give you drugs to take if your hormone levels are low. 

Effects on the liver

Pazopanib may cause changes in the way your liver works. This does not generally cause any symptoms and usually goes back to normal when treatment stops. Your doctor will monitor your liver with regular blood tests.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes.

Rarely, the kidneys can be affected by blood clots, or by cancer cells breaking down quickly.

You will have blood and urine tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual. It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.

Effects on the nervous system

This treatment can affect the nervous system. Very rarely, it can cause a brain condition called RPLS (reversible posterior leukoencephalopathy syndrome). Symptoms include:

  • difficulty speaking
  • confusion
  • changes in your eyesight
  • seizures (fits).

Contact the hospital straight away if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • throbbing pain, redness or swelling in a leg or arm
  • suddenly feeling breathless or coughing
  • sharp chest pain, which may be worse when you cough or take a deep breath.

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.

You can help reduce the risk of developing a blood clot by:

  • staying active during treatment
  • drinking plenty of fluids, especially water.

You may be given anticoagulants to help prevent a clot.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

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 and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses 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.