Votrient

— THERAPEUTIC CATEGORIES —
  • Bladder, kidney, and other urologic cancers
  • Bone and connective tissue cancer

Votrient Generic Name & Formulations

General Description

Pazopanib 200mg; tabs.

Pharmacological Class

Tyrosine kinase inhibitor.

How Supplied

Tabs—120

Generic Availability

NO

Mechanism of Action

Pazopanib is a multi-kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, VEGFR-3, platelet-derived growth factor receptor-α and-β, fibroblast growth factor receptor-1, and -3, cytokine receptor, interleukin-2 receptor inducible T-cell kinase, leukocyte-specific protein tyrosine kinase, and transmembrane glycoprotein receptor tyrosine kinase.

Votrient Indications

Indications

Advanced renal cell carcinoma.

Votrient Dosage and Administration

Adult

Take on an empty stomach. Swallow whole. 800mg once daily until disease progression or unacceptable toxicity. Dose modifications for adverse reactions: see full labeling. Hepatic impairment (moderate): 200mg once daily; (severe): not recommended. Concomitant strong CYP3A4 inhibitors: avoid and use alternate drug; if warranted, reduce dose of pazopanib to 400mg. Concomitant strong CYP3A4 inducers: avoid and use alternate drug.

Children

Not established.

Administration

Take at least 1hr before or 2hrs after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12hrs until the next dose.

Nursing Considerations

Take at least 1 hour before or 2 hours after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12 hours until the next dose. Withhold treatment at least 1 week prior to scheduled surgery.

Votrient Contraindications

Not Applicable

Votrient Boxed Warnings

Boxed Warning

Hepatotoxicity.

Votrient Warnings/Precautions

Warnings/Precautions

Not indicated for use in combination with other cancer agents. Risk of severe and fatal hepatotoxicity (esp. ≥65yrs old). Monitor LFTs at baseline, and at Weeks 3, 5, 7, and 9, thereafter at Months 3 and 4, then periodically. Increase to weekly monitoring for those with elevated ALT until ALT returns to Grade 1 or baseline. Withhold therapy and resume at reduced dose with continued weekly monitoring for 8 weeks, or permanently discontinue with weekly monitoring until resolution based on severity of hepatotoxicity. Gilbert's syndrome (see full labeling). History of QT prolongation. Cardiac dysfunction risk (including previous anthracycline exposure): evaluate LVEF at baseline and periodically; monitor for CHF. Monitor ECG, electrolytes (eg, calcium, magnesium, potassium), thyroid function. Correct hypokalemia, hypomagnesemia, hypocalcemia prior to initiation and during treatment. Hemorrhagic events. Arterial thrombotic events. Monitor for VTE, PE, infection, proteinuria (reduce dose if 24-hour urine protein ≥3g), thrombotic microangiopathy, interstitial lung disease (ILD)/pneumonitis, GI perforation or fistula. Monitor BP and manage hypertension promptly. Closely monitor those at risk for tumor lysis syndrome (eg, rapidly growing tumors, a high tumor burden, renal dysfunction, dehydration). Impaired wound healing: withhold for ≥1 week prior to elective surgery; do not give for ≥2 weeks after major surgery and until adequate healing. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception and males (w. female partners; use condoms) during and for ≥2 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 2 weeks after the last dose).

Votrient Pharmacokinetics

Absorption

Median time to achieve peak concentrations: 2–4 hours.

Distribution

Plasma protein bound: >99%.

Metabolism

Hepatic (CYP3A4; CYP1A2, CYP2C8 [minor]).

Elimination

Fecal, renal (minor). Half-life: 31 hours.

Votrient Interactions

Interactions

See Adult dose. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole), grapefruit juice. Avoid concomitant strong Pgp or BCRP inhibitors. Antagonized by strong CYP3A4 inducers. Concomitant drugs with narrow therapeutic windows metabolized by CYP3A4, CYP2D6, or CYP2C8: not recommended. Increased risk of ALT elevations with concomitant simvastatin; increase to weekly liver function monitoring if occurs. Avoid concomitant with gastric acid-reducing agents (eg, PPIs, H2-blockers); if unavoidable, consider short-acting antacids. Separate dosing of short-acting antacids by several hours. Avoid concomitant drugs that prolong QT interval (eg, antiarrhythmics, others).

Votrient Adverse Reactions

Adverse Reactions

Diarrhea, hypertension, hair color changes, nausea, anorexia, vomiting, fatigue, decreased weight, decreased appetite, tumor pain, musculoskeletal pain, headache, dysgeusia, dyspnea, skin hypopigmentation; QT prolongation, hypothyroidism, posterior reversible encephalopathy syndrome (discontinue if occurs).

Votrient Clinical Trials

See Literature

Votrient Note

Not Applicable

Votrient Patient Counseling

See Literature

Votrient Generic Name & Formulations

General Description

Pazopanib 200mg; tabs.

Pharmacological Class

Tyrosine kinase inhibitor.

How Supplied

Tabs—120

Generic Availability

NO

Mechanism of Action

Pazopanib is a multi-kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, VEGFR-3, platelet-derived growth factor receptor-α and-β, fibroblast growth factor receptor-1, and -3, cytokine receptor, interleukin-2 receptor inducible T-cell kinase, leukocyte-specific protein tyrosine kinase, and transmembrane glycoprotein receptor tyrosine kinase.

Votrient Indications

Indications

Advanced soft tissue sarcoma in adults who have received prior chemotherapy.

Limitations of Use

The efficacy for treating adipocytic soft tissue sarcoma or GI stromal tumors has not been demonstrated.

Votrient Dosage and Administration

Adult

Take on an empty stomach. Swallow whole. 800mg once daily until disease progression or unacceptable toxicity. Dose modifications for adverse reactions: see full labeling. Hepatic impairment (moderate): 200mg once daily; (severe): not recommended. Concomitant strong CYP3A4 inhibitors: avoid and use alternate drug; if warranted, reduce dose of pazopanib to 400mg. Concomitant strong CYP3A4 inducers: avoid and use alternate drug.

Children

Not established.

Administration

Take at least 1hr before or 2hrs after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12hrs until the next dose.

Nursing Considerations

Take at least 1 hour before or 2 hours after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12 hours until the next dose. Withhold treatment at least 1 week prior to scheduled surgery.

Votrient Contraindications

Not Applicable

Votrient Boxed Warnings

Boxed Warning

Hepatotoxicity.

Votrient Warnings/Precautions

Warnings/Precautions

Not indicated for use in combination with other cancer agents. Risk of severe and fatal hepatotoxicity (esp. ≥65yrs old). Monitor LFTs at baseline, and at Weeks 3, 5, 7, and 9, thereafter at Months 3 and 4, then periodically. Increase to weekly monitoring for those with elevated ALT until ALT returns to Grade 1 or baseline. Withhold therapy and resume at reduced dose with continued weekly monitoring for 8 weeks, or permanently discontinue with weekly monitoring until resolution based on severity of hepatotoxicity. Gilbert's syndrome (see full labeling). History of QT prolongation. Cardiac dysfunction risk (including previous anthracycline exposure): evaluate LVEF at baseline and periodically; monitor for CHF. Monitor ECG, electrolytes (eg, calcium, magnesium, potassium), thyroid function. Correct hypokalemia, hypomagnesemia, hypocalcemia prior to initiation and during treatment. Hemorrhagic events. Arterial thrombotic events. Monitor for VTE, PE, infection, proteinuria (reduce dose if 24-hour urine protein ≥3g), thrombotic microangiopathy, interstitial lung disease (ILD)/pneumonitis, GI perforation or fistula. Monitor BP and manage hypertension promptly. Closely monitor those at risk for tumor lysis syndrome (eg, rapidly growing tumors, a high tumor burden, renal dysfunction, dehydration). Impaired wound healing: withhold for ≥1 week prior to elective surgery; do not give for ≥2 weeks after major surgery and until adequate healing. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception and males (w. female partners; use condoms) during and for ≥2 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 2 weeks after the last dose).

Votrient Pharmacokinetics

Absorption

Median time to achieve peak concentrations: 2–4 hours.

Distribution

Plasma protein bound: >99%.

Metabolism

Hepatic (CYP3A4; CYP1A2, CYP2C8 [minor]).

Elimination

Fecal, renal (minor). Half-life: 31 hours.

Votrient Interactions

Interactions

See Adult dose. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole), grapefruit juice. Avoid concomitant strong Pgp or BCRP inhibitors. Antagonized by strong CYP3A4 inducers. Concomitant drugs with narrow therapeutic windows metabolized by CYP3A4, CYP2D6, or CYP2C8: not recommended. Increased risk of ALT elevations with concomitant simvastatin; increase to weekly liver function monitoring if occurs. Avoid concomitant with gastric acid-reducing agents (eg, PPIs, H2-blockers); if unavoidable, consider short-acting antacids. Separate dosing of short-acting antacids by several hours. Avoid concomitant drugs that prolong QT interval (eg, antiarrhythmics, others).

Votrient Adverse Reactions

Adverse Reactions

Diarrhea, hypertension, hair color changes, nausea, anorexia, vomiting, fatigue, decreased weight, decreased appetite, tumor pain, musculoskeletal pain, headache, dysgeusia, dyspnea, skin hypopigmentation; QT prolongation, hypothyroidism, posterior reversible encephalopathy syndrome (discontinue if occurs).

Votrient Clinical Trials

See Literature

Votrient Note

Not Applicable

Votrient Patient Counseling

See Literature

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