7 Tips for Taking Verzenio: Foods to Avoid, Side Effect Management, and More

If it becomes time to talk about breast cancer medications, you may end up feeling like your head is spinning with all the options. A seemingly endless number of oral and injectable breast cancer medications are now available.

Verzenio (abemaciclib) is one targeted medication that your oncologist may consider prescribing you. It’s a beneficial treatment for early and advanced hormone receptor-positive (HR-positive) and human epidermal growth factor 2-negative (HER2-negative) breast cancer. But, like with any medication, Verzenio has the potential to cause side effects. And it can interact with other medications and certain foods.

If you’ve been prescribed this medication, it’s normal to have questions. Let’s review seven tips for taking Verzenio to ensure your treatment is as safe and effective as possible. 

1. Interactions with Verzenio: Avoid these foods and medications

All medications eventually need to be broken down and removed from the body. Proteins called enzymes are often tasked with this duty. The enzyme cytochrome P450 3A4 (CYP3A4) is responsible for breaking down many medications in the body, including Verzenio.

CYP3A4 inhibitors

Medications called CYP3A4 inhibitors block the activity of CYP3A4. This can prevent Verzenio from being broken down, causing blood levels to build up in the body. The end result is an increased chance of side effects from Verzenio. 

Ketoconazole (Nizoral) is an oral medication for fungal infections that strongly blocks CYP3A4 activity. For this reason, you should avoid taking it with Verzenio. 

There are many other medications that also block CYP3A4. However, they can often be taken with Verzenio, as long as the Verzenio dosage is lowered. Examples include:

• Other antifungal medications, such as fluconazole (Diflucan)

• Antiviral medications that include ritonavir, such as nirmatrelvir / ritonavir (Paxlovid)

• Heart medications like diltiazem (Cardizem) and verapamil (Calan SR, Verelan)

• Antibiotics like erythromycin (Ery-Tab)

CYP3A4 inducers

On the flip side, medications called CYP3A4 inducers can speed up the activity of CYP3A4. This can cause Verzenio to be broken down too quickly, making it less effective. You should avoid taking any CYP3A4 inducers while you’re taking Verzenio. 

EXPERT PICKS: WHAT TO READ NEXT

• Receptor review: Learn about the different breast cancer types and how they affect treatment options.

• BRAT diet: Understand the specifics of this stomach-friendly diet that’s commonly recommended for lessening diarrhea and nausea.

• Want to learn more about Verzenio interactions? Dive into the specifics of which medications can interact with Verzenio and how to manage potential interactions.

Some examples of common CYP3A4 inducers are anti-seizure medications like carbamazepine (Tegretol, Equetro) and phenytoin (Dilantin), antibiotics like rifampin (Rifadin), and even herbal supplements like St. John’s wort. 

It’s difficult to keep track of all the potential Verzenio interactions. Your pharmacist can help you figure out if any medications or supplements you take have the potential to interact.

Grapefruit products

Medications aren’t the only offenders when it comes to Verzenio interactions. Grapefruit and grapefruit juice interact in a similar way. They can increase the likelihood of experiencing Verzenio side effects. So it’s best to avoid all grapefruit-containing products, if possible, while taking Verzenio. 

If you enjoy having a glass of juice with breakfast, know that not all juices have the same effect as grapefruit juice. Apple, orange, and tomato juice are all fine to drink while taking Verzenio.

2. Keep the logistics of taking Verzenio in mind

Verzenio comes in four tablet doses: 50 mg, 100 mg, 150 mg, and 200 mg. The most common starting dosage of Verzenio is 150 mg twice a day.

Many people don’t take Verzenio by itself though; it’s common to be prescribed another medication — either an aromatase inhibitor (AI) like Femara (letrozole) or an injection called Faslodex (fulvestrant) — alongside it. These medications work together with Verzenio to fight breast cancer.

If you have metastatic HR-positive, HER2-negative breast cancer — meaning, cancer that has spread to other parts of your body — and you’ve already tried a few treatments, your oncologist may prescribe you a Verzenio dosage of 200 mg twice a day. In this case, you likely won’t need to take it with other medications.

Good to know: Verzenio’s manufacturer dispenses the medication in blister packs that each contain a 7-day supply. So, if your oncologist prescribes you a 30-day supply of Verzenio, you’ll receive four blister packs each month.

3. Be careful with alcohol while taking Verzenio

Many people enjoy alcohol in a social setting. And it’s understandable that you might want to enjoy an occasional drink to celebrate or relax. However, alcohol could potentially worsen Verzenio side effects such as diarrhea, nausea, and dehydration. 

What’s more, alcohol and Verzenio are both broken down by the liver. Drinking alcohol while taking Verzenio could potentially overwhelm your liver, causing irritation or liver damage.

The less alcohol you drink with Verzenio, the better. A good rule is to limit your intake to no more than 2 drinks per day if you’re a man, and no more than 1 drink per day if you’re a woman. But this may be different depending on what (if any) side effects you’re experiencing, how your liver is working, and other factors. So it’s best to check in with your oncologist before indulging in an adult beverage while taking Verzenio.

4. It doesn’t matter if you take Verzenio with or without food

You can take Verzenio with or without food. It won’t make a difference in how well it works. The only foods you shouldn’t combine with Verzenio are grapefruit products, as mentioned above. 

However, if you feel a little nauseous after taking Verzenio, try taking your next dose with a meal or light snack. Having food in your stomach may help lessen stomach irritation.

5. There are ways to manage side effects from Verzenio

Diarrhea is Verzenio’s most common side effect, with 9 out of 10 people experiencing some sort of diarrhea related to the medication. This side effect typically happens in the first month of taking the medication, so you should be armed with tools to manage it when you start taking Verzenio.

Make sure you have an over-the-counter antidiarrheal medication, such as loperamide (Imodium A-D), on hand before you start treatment. At the first sign of diarrhea, you should take loperamide. Diarrhea can also make you dehydrated, so make sure you up your fluid intake by drinking clear liquids like water, broth, or electrolyte drinks. 

Diarrhea from Verzenio can sometimes be severe, so it’s important to catch it early. You should call your oncology team as soon as it starts so they can give you further instructions on how to keep a handle on it.

Managing nausea

Nausea and a reduced appetite are two other potential side effects that can make you feel crummy. If you experience these side effects, there are a few things you can do. 

If you’ve already tried taking Verzenio with food, ask your oncologist if they can prescribe you an anti-nausea medication like Zofran (ondansetron). Sometimes, taking Zofran a half hour before your Verzenio doses can help. You can also try some diet-related changes, such as avoiding spicy or greasy foods and eating smaller meals throughout the day.

Managing blood cell changes

Low levels of white blood cells called neutrophils are also possible with Verzenio. These white blood cells are important for fighting off infection.

While there isn’t much you can do to prevent low neutrophils (neutropenia), you can take steps to help prevent an infection. This includes washing your hands regularly, avoiding crowded places and people who are sick, and keeping the surfaces of your house clean. 

Call your oncology team immediately if you have flu-like symptoms or have a fever of 100.4°F or higher.

Managing more severe side effects

Verzenio can cause liver irritation and, in rarer cases, lung inflammation and blood clots. While there isn’t much you can do to manage these risks on your own, you should let your oncology team know if you have any of the following symptoms:

• Trouble breathing

• New cough

• Chest or stomach pain

• Yellowing of the eyes or skin

• Dark urine

• Pain or swelling in your arms or legs

• Fast heartbeat

6. Verzenio dosage adjustments may be necessary

Sometimes, a dosage adjustment is the best option for managing side effects. It’s OK if you need a dosage adjustment; everyone is different in how they tolerate medications. 

These are some common situations that require a lower Verzenio dosage:

• Use with strong CYP3A4 inhibitors (other than ketoconazole)

• Low white or red blood cell counts that force you to stop taking Verzenio more than once

• Several episodes of diarrhea per day

• Diarrhea that requires hospitalization

• Liver problems before and during Verzenio treatment

• Lung irritation (pneumonitis) that is severe or doesn’t improve quickly with a corticosteroid like prednisone

Most likely, you’ll still take Verzenio twice a day, but with a lower tablet dose. If you have a liver problem like cirrhosis before starting Verzenio treatment, your oncologist may have you take the medication just once a day instead.

Although rare, your oncology team may actually increase your Verzenio dosage at some point. For example, if you had to take a lower Verzenio dosage due to a potential drug interaction and you decide to stop the other medication, your oncologist may later increase your Verzenio dosage.

7. Vomiting soon after you take Verzenio? Here’s what to do next

If you vomit soon after taking Verzenio, wait until your next scheduled dose to take the medication again. Even if you can see the pill after vomiting, taking another dose too soon isn’t worth the risk. Doing so could increase your risk of side effects from Verzenio. 

How to save on Verzenio

There are ways to save on Verzenio, which is only available as a brand-name medication. GoodRx can help you navigate copay savings cards and patient assistance programs to save money on your prescription:

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 per month for Verzenio using a savings card from the manufacturer.

• Save with a patient assistance program. If you’re uninsured or underinsured, you may be eligible for Verzenio’s patient assistance program, which offers the medication free of charge.

Why trust our experts?

Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

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