pazopanib

• Risk factors: Age greater than 65 years |Taking simvastatin (Zocor)

Votrient (pazopanib) can cause liver damage that can sometimes lead to life-threatening liver failure. Your risk for liver damage is higher if you take the cholesterol medication simvastatin (Zocor) with Votrient (pazopanib).

In studies, signs of liver damage appeared in the first 4 months of treatment. Your provider will check your liver through lab work at the start of treatment and regularly while you’re taking this medication. Tell your provider if you have symptoms of liver problems, such as tiredness, loss of appetite, nausea or vomiting, dark urine, right-side stomach pain, or yellowing of the eyes or skin. Your provider might check your liver more frequently, pause treatment until your symptoms get better, lower your dose, or stop the medication altogether.

• Risk factors: History of QT prolongation | Taking antiarrhythmics or other medications that can cause QT prolongation | Already have heart problems | Previous treatment with medications like doxorubicin

Some people taking Votrient (pazopanib) had heart problems, like a lowering of the heart’s ability to pump blood and heart failure. Some also had changes in the electrical activity of the heart called QT prolongation, which raises the risk for life-threatening, irregular heartbeats. To monitor your risk for heart problems, your provider might check your heart’s ability to pump using an echocardiogram (echo), check your electrolyte levels through blood testing, and check your heart’s electrical activity using an electrocardiogram (ECG).

Tell your provider right away if you have symptoms like chest pain, shortness of breath, swelling in the lower legs or feet, racing or irregular heartbeat, lightheadedness, or tiredness. These symptoms might suggest heart problems, and you might need to pause or stop treatment with Votrient (pazopanib) if they occur.

Some people who took Votrient (pazopanib) had unusual bleeding, such as nosebleeds and rectal bleeding (blood on toilet paper after you wipe). Let your healthcare provider know immediately if you have any unusual bleeding, especially bleeding that’s hard to stop.

Rarely, serious and fatal bleeding has happened. Serious bleeding can happen in any area of the body, including in the lungs, stomach, and brain. Get medical help right away if you feel nauseous, have a sudden or painful headache, notice a change in your vision, have stomach pain, or are coughing or spitting up blood. Your healthcare provider might stop treatment with Votrient (pazopanib) based on how severe the bleed is.

Votrient (pazopanib) can raise your risk for blood clots in your body. Sometimes, blood clots can be life-threatening and lead to stroke or heart attack. Symptoms of a blood clot might be different depending on the location of the clot. They can include trouble walking, blurry vision, breathing problems, chest pain, and swelling in the leg. Get medical attention as soon as possible if you have any of these symptoms. You’ll need to stop stop treatment with Votrient (pazopanib).

Votrient (pazopanib) can also cause blood clotting problems called thrombotic microangiopathy (TMA), which includes thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Your provider might monitor for signs of these problems through lab work. You’ll probably need to permanently stop treatment if you develop these conditions.

Though uncommon, some people who took Votrient (pazopanib) developed tears and fistulas (an abnormal connection from one part of the body to another) in the gut. These problems are serious and can sometimes be life-threatening. Notify your provider if you have symptoms of gut injuries or fistulas, like high fever, shivering, vomiting, severe constipation, pain in the anal area, or severe stomach pain (especially if it doesn’t go away). Your provider might permanently stop your Votrient (pazopanib) treatment.

Though rare, a few people who took Votrient (pazopanib) had serious lung problems, like lung inflammation and interstitial lung disease, which can be fatal. Tell your provider if you have any new or worsening breathing problems, such as shortness of breath, dry cough, and faster breathing. You might need to stop taking Votrient (pazopanib) if you develop lung inflammation or interstitial lung disease.

Posterior reversible encephalopathy syndrome (PRES) is a very rare, but sometimes fatal side effect of Votrient (pazopanib) that affects your nervous system. Let your provider know if you have any symptoms of PRES, like headache, feeling sluggish, confusion, and vision loss. If you develop symptoms, your provider will check for PRES by ordering a brain scan called an MRI (magnetic resonance imaging) for you. Your provider will stop your treatment if it’s confirmed that you have PRES.

Votrient (pazopanib) can raise your blood pressure, most commonly within the first 4 months of treatment. Don’t start taking this medication until your blood pressure gets under control (with guidance from your provider).

Once you’ve started Votrient (pazopanib), regularly check your blood pressure and contact your provider if it rises during treatment. You might need to start blood pressure medications to manage this side effect. Depending on your blood pressure, you also might need to take Votrient (pazopanib) at a lower dosage or even stop the medication. Tell your provider if you feel dizzy or tired or if you have headaches. And get medical help right away if you have signs of extremely high blood pressure, like changes in vision or speech, confusion, shortness of breath, weakness, or numbness.

Votrient (pazopanib) can make it harder for wounds to heal. Tell your provider if you’re planning to have a surgery or procedure. You shouldn’t take Votrient (pazopanib) a week before and at least 2 weeks after surgery and until your surgical wounds fully heal.

Votrient (pazopanib) can cause thyroid gland problems like hypothyroidism (low thyroid hormone levels). Symptoms of thyroid gland problems can include weight loss or weight gain, feeling nervous or anxious, depression, eye or neck swelling, feeling hot or cold, sweating, or changes in menstruation. Contact your healthcare provider if you have any of these symptoms. Your provider will check your thyroid hormone levels during treatment and start thyroid replacement therapy if needed.

It’s possible for Votrient (pazopanib) to cause kidney problems, sometimes causing more proteins than usual to seep into the urine. Your provider will regularly monitor your kidney health through blood tests and urine samples while you’re taking this medication.

If you develop kidney problems, your provider might pause treatment until your kidney gets better or stop treatment permanently depending on how severe the problem is. Talk to your provider if you notice any changes in how often you urinate (more or less), any blood in your urine, or any cloudy urine so they can check for kidney issues.

• Risk factors: Fast-growing tumor | High tumor burden | Kidney problems | Dehydration

Some people treated with Votrient (pazopanib) have had a serious and sometimes fatal reaction called tumor lysis syndrome (TLS). This reaction happens when many cancer cells quickly die and suddenly break down in your body. In the process, these cells release their inner contents, like uric acid, potassium, and phosphorus, into your blood.

High levels of uric acid and electrolytes in your body can cause serious problems, such as kidney damage and abnormal heart rhythms. Your provider will routinely order blood tests to check for signs of TLS. Tell your provider right away if you’re urinating less than usual or if you have dark urine, muscle cramps, or a racing heartbeat.

Votrient (pazopanib) can raise your risk of getting a serious infection, which can be fatal. To prevent getting sick, stay away from people who are sick and practice good hand hygiene (wash your hands often with soap and water). Tell your provider if you have any signs or symptoms of a new infection, like fever, chills, stuffy nose, cough, ear or sinus pain, pain while urinating, or wounds that won’t heal. If you have an infection, your provider might pause your treatment with Votrient (pazopanib) until you recover from it.

Votrient (pazopanib) can cause harm to an unborn baby when it’s taken during pregnancy. If you can have children, your provider might ask you to take a pregnancy test before you start treatment. And if you or your partner can become pregnant, use effective birth control once you start the medication. Continue using birth control for at least 2 weeks after your last dose. Tell your provider right away if you or your partner becomes pregnant during this time.