What is tivozanib (Fotivda®)?

Tivozanib (Fotivda®) belongs to a group of  targeted therapy drugs called angiogenesis inhibitors.

Tivozanib stops the cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients so that the tumour shrinks or stops growing. 
It is best to read the information about this drug with our general information about targeted therapy drugs and the type of cancer you have.

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

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How tivozanib is given

Tivozanib comes as capsules you take at home. 

During treatment, you usually see a:

  • cancer doctor
  • cancer nurse or specialist nurse
  • specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

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

While you are taking tivozanib, you will have regular blood samples taken to check different things. For example, the level of your blood cells and how well your liver, kidneys and thyroid gland are working.

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

Your course of treatment

You take tivozanib once a day, every day, for 21 days. You then have a break of 7 days when you do not take it. These 28 days are called a cycle of treatment. 

You usually take tivozanib for as long as:

  • it is working for you
  • and the side effects can be managed.

Do not stop taking tivozanib without talking to your doctor first.

Taking your tivozanib capsules

The nurse or pharmacist will give you the capsules to take home. 

Your doctor, nurse or pharmacist will explain your treatment plan. Always take the capsules exactly as explained. This is to make sure they work as well as possible for you. 

Take the capsule whole with a glass of water.  Do not chew, dissolve, open or crush the capsule. Tivozanib can be taken with or without food.

If you forget to take your capsules or are sick after taking them, take your next dose at the usual time. Do not take a double dose.

Other things to remember:

  • keep the capsules in the original package and at room temperature
  • ay from moisture, heat and direct sunlight
  • keep the capsules safe and out of the sight and reach of children
  • get a new prescription before you run out of capsules
  • if you go on holiday, make sure you have plenty of capsules 
  • if you stop treatment, return any unused capsules to the pharmacist.

About side effects

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

  • drugs to help control some side effects 
  • advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Serious and life-threatening side effects

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Contact the hospital

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Common side effects

High blood pressure

Tivozanib can cause high blood pressure. You may need to take drugs to control this during your treatment. Tell your doctor or nurse if you have ever had high blood pressure or taken drugs for this.

Your doctor or nurse will check your blood pressure regularly. They may also show you how to check your blood pressure at home. Tell them if you have any headaches as this can be a symptom of high blood pressure. 

High blood pressure may increase the risk of a mini stroke or stroke. Call 999 to get help straight away if you or other people notice:

  • you are confused
  • you have difficulty speaking
  • your face is drooping 
  • you have numbness or weakness on one side of your body.


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

You may be given anti-diarrhoea tablets to take at home.

Feeling tired

Feeling tired is a common side effect. Try to pace yourself. Plan your day so you have time to rest. Gentle exercise, such as short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery. It may help to take your capsules in the evening.

Loss of appetite

This treatment can affect your appetite, which may make you lose weight. Tell your nurse or dietitian if you find it difficult to eat or you lose weight. They can give you advice. They might give you food or drink supplements.

Feeling sick

If you feel sick, your doctor can give you anti-sickness drugs to control this. Take the drugs exactly as your nurse or pharmacist tells you.

If you continue to feel sick or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They can give you advice. Your doctor or nurse can change the anti-sickness drug to one that works better for you.

Tummy pain and heartburn

Tivozanib can cause pain or discomfort in your tummy (abdomen). It can also cause heartburn (indigestion). Your doctor can give you drugs to help with these side effects. 

Rarely tummy pain can be a sign of a more serious problem. Always tell your doctor if the pain does not improve or gets worse.

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.

Contact the hospital straight away on the 24-hour number, if:

  • your mouth or throat is sore, or affecting how much fluid you can drink or food you can eat 
  • your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

  • drink plenty of fluids
  • avoid alcohol and tobacco
  • avoid food or drinks that irritate your mouth and throat.

Shortness of breath and cough

Contact the hospital for advice if you are short of breath or have a cough. 

Voice changes

Your voice may become hoarse or sound different to usual. This usually gets better after treatment ends. Tell your doctor or nurse if you have a sore throat.

Hand-foot (palmar-plantar) syndrome

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

  • be sore
  • be painful, tingle, or swell
  • peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

  • keeping your hands and feet cool by washing in cool water
  • gently moisturising your hands and feet regularly
  • wearing gloves to protect your hands and nails when working in the house or garden
  • wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Effects on the skin

Tivozanib can affect the skin. You may develop a rash and your skin may feel dry and itchy. It may peel. Tell your doctor or specialist nurse if you notice any skin changes. They can advise you about creams or lotions to help with dryness. They can also prescribe medicines to help with itching.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

  • very low in energy
  • breathless 
  • dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.


You may get headaches with this treatment. Tell your doctor if this happens.  Sometimes headaches can be a sign of high blood pressure.


You may get pain in your back, muscles or joints. You may get pain in the area where the cancer is. Tell your doctor if this happens, so they can give you painkillers. Tell them if the pain does not get better. 

Less common side effects

Changes to your taste

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

  • sucking sugar-free sour or boiled sweets
  • eating cold foods
  • eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

Difficulty sleeping (insomnia)

Sometimes this treatment can affect your sleep. Tell your doctor, nurse or pharmacist if cancer treatment makes it difficult to sleep.

Runny or blocked nose

Tivozanib may cause you to have a runny or blocked nose. This is usually mild. Tell your doctor or nurse if this is a problem for you. They can give you advice.


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.

Fluid build-up

Your ankles and legs may swell because of fluid building up. Tell your doctor, nurse or pharmacist if this happens.

Eyesight and hearing changes

This treatment may affect your vision. Or you may develop mild ringing in your ears (tinnitus). Tell your doctor or nurse if this happens.

Hair loss

Your hair may get thinner but you are unlikely to lose all the hair from your head. Your nurse can talk to you about ways to cope with hair loss.

Effects on the heart

This treatment can affect how the heart works. You may have tests to check 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 the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • breathlessness
  • dizziness
  • changes to your heartbeat
  • swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

Always call 999 if you have:

  • chest pain, pressure, heaviness, tightness or squeezing across the chest
  • difficulty breathing.

Bruising and bleeding

Tivozanib 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
  • coughing or vomiting blood
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red or purple spots on your skin that may look like a rash.

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

Effects on the nervous system

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

  • headaches
  • seizures (fits)
  • extreme tiredness
  • confusion
  • loss of eyesight or other eyesight changes
  • weakness in an arm or leg.

Contact the hospital straight away if you have any of these symptoms. If you notice these symptoms, do not to drive or operate machinery.

Effects on the thyroid gland

Tivozanib can affect the way your thyroid gland works. This side effect is usually mild and may not cause symptoms. It will go back to normal after treatment.

You will have regular blood tests to check your levels of hormones made by the thyroid. Your doctor may give you drugs to take if your hormone levels are low.

Effects on the kidneys and liver

This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment finishes. You will have regular blood and urine tests during your treatment to check how well your kidneys and liver are working.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. It usually improves slowly after treatment finishes.

Constipation and wind

This treatment can cause constipation and wind. Tell your doctor or nurse if this is difficult to manage. They can give you drugs and advice to help.

Slow wound-healing

Tivozanib may cause wounds to take longer to heal. If you need an operation, your doctor will tell you to stop taking tivozanib before the operation and for a few weeks after. 

You may also need to stop taking tivozanib for a few days if you are having dental treatment. Talk to your doctor if you need to have surgery or dental treatment.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • throbbing pain or swelling in a leg or arm
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
  • suddenly feeling breathless or coughing.

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Other medicines

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


Tivozanib capsules contain a food colouring called tartrazine. If you are allergic to tartrazine, talk to your doctor before taking this treatment.


Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.


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.


Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

  • what types of contraception to use 
  • how long after treatment you should continue to use contraception. 


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

Your doctor, nurse or pharmacist can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 July 2023
Next review: 01 July 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.