Xpovio
Xpovio (selinexor) is a targeted therapy medication used to treat multiple myeloma and diffuse large b-cell lymphoma. It's taken by mouth either weekly or twice weekly, depending on what other anticancer medications your provider prescribes. Xpovio (selinexor) can cause side effects such as nausea, bleeding, and confusion. This medication is brand name only.
What is Xpovio (selinexor)?
What is Xpovio (selinexor) used for?
Multiple myeloma after at least one previous therapy, given together with Velcade (bortezomib) and dexamethasone
Multiple myeloma after at least four previous therapies, given together with dexamethasone
Advanced diffuse large B-cell lymphoma after at least two previous therapies
How Xpovio (selinexor) works
One way healthy cells fight cancer is through tumor suppressor proteins, which monitor for and kill cancerous cells before they can grow. Healthy cells shuttle these proteins in and out of the cells using receptors called exportin-1 (XPO-1), depending on whether they’re needed or not.
When cells turn cancerous, some of them end up making a lot of XPO-1. Having too many XPO-1 means that the tumor suppressor proteins end up getting shuttled out, even when they’re needed to fight cancerous cells. This allows the cancer to grow and spread.
Xpovio (selinexor) works by blocking XPO-1. This helps keep these tumor suppressor proteins inside the cell, so they can fight cancer.
Drug Facts
What are the side effects of Xpovio (selinexor)?
Common Side Effects
- Low platelet levels (up to 92%)
- Low blood cell counts (up to 82%)
- Tiredness (up to 73%)
- Nausea (up to 72%)
- Higher blood sugar levels (up to 62%)
- Changes in lab tests, including protein and electrolyte levels (up to 62%)
- Lower appetite (up to 53%)
- Weight loss (up to 47%)
- Diarrhea (up to 44%)
- Vomiting (up to 41%)
- Tingling sensation in the hands and feet (32%)
Other Side Effects
- Constipation
- Upper respiratory tract infections
- Trouble breathing
- Cataract
- Fever
- Blurry vision
- Dizziness
- Taste changes
Serious Side Effects
- Severe bleeding: feeling weak, bruising that doesn't go away, bleeding that's hard to stop, nosebleeds, blood in urine, black and tarry stool
- Serious infections: fever, weakness, tiredness, sore throat, cough, body aches, muscle aches, chills
- Low sodium level in blood: nausea, vomiting, headache, confusion, muscle weakness or cramps, feeling tired, seizures
- Serious nervous system problems: confusion, hallucinations, difficulty staying awake, passing out, delirium
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision such as blurry vision, seeing halos around lights, vision loss
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Change in taste
- Constipation
- Diarrhea
- Fatigue
- Loss of appetite with weight loss
- Nausea
- Vomiting
Pros and cons of Xpovio (selinexor)
Pros
Recommended treatment option for people with multiple myeloma in people who have had at least one prior therapy
Taken by mouth, so good for people who don’t like needles
Can be taken with or without food, so more convenient
Cons
Might raise your risk for bleeding and infection
Requires regular lab tests to monitor for side effects, so more appointments
Commonly causes nausea
Pharmacist tips for Xpovio (selinexor)
If you have diarrhea while you’re taking Xpovio (selinexor), make sure you drink plenty of fluids. Avoid sugary sports drinks because they can make diarrhea worse. Your provider might recommend over-the-counter diarrhea medications, like loperamide (Imodium A-D), to help.
Sometimes, Xpovio (selinexor) can cause low white blood cell (WBC) counts, which means you’re more likely to get sick. You can help prevent infections by washing your hands often, avoiding crowds, and washing raw fruits and vegetables thoroughly before eating them.
Check your body temperature regularly, ideally once a day. Call your provider immediately if your temperature is 100.4 degrees Fahrenheit or higher; this means you have a fever. Sometimes a fever might be the only sign that you’re sick.
If you develop low platelets while taking Xpovio (selinexor), you’re at higher risk for serious bleeds. Your provider might recommend you avoid taking other medications that can raise your risk of bleeding, such as aspirin or ibuprofen (Advil). You might also avoid shaving with a blade razor, and use an electric razor instead.
Some people taking Xpovio (selinexor) experienced low sodium in their blood (hyponatremia). Your provider will monitor your sodium with lab tests, so it’s important you go to appointments as they recommend. If you have any symptoms of low sodium levels such as muscle cramps, severe tiredness, or seizures, seek medical help right away.
Take Xpovio (selinexor) around the same time each day. Take the tablets whole and do not crush or split them. If you miss a dose, skip it and wait until the next scheduled dose.
If you have leftover medication, ask your provider how to dispose of it. They might allow you or a family member to bring it to their office or clinic for proper disposal.
Females taking Xpovio (selinexor)] should avoid breastfeeding during treatment and for 1 week after the last dose. We don’t know whether Xpovio (selinexor)] is found in breastmilk and whether it affects breastfed babies, but there’s a possible risk of harm.
Frequently asked questions about Xpovio (selinexor)
How to save using GoodRx
What are the risks and warnings for Xpovio (selinexor)?
Xpovio (selinexor) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of serious bleeds (from low platelet levels)
Xpovio (selinexor) commonly causes low platelet levels. This typically happens within the first few months after you start treatment. Platelets are the cells in your blood that form blood clots and prevent bleeding. So, when they’re low, your body can’t stop bleeding as well. Your provider will monitor your blood cell counts regularly while you’re taking Xpovio (selinexor)]. If your platelet levels are too low, your provider might need to stop, pause, or adjust your dose of Xpovio (selinexor)]. If you have signs of low platelets such as bruising, nose bleeds, or blood in stool or urine, contact your provider right away.
Low white blood cell counts
People who take Xpovio (selinexor)] often have low blood cell counts, particularly low white blood cells (neutropenia). White blood cells (WBCs) are an important part of your immune system, so when they’re low you might have a higher risk of serious infections. People tend to notice the drop in WBC count within the first month of treatment. Your provider will regularly monitor your blood cell counts while you’re taking Xpovio (selinexor)], and they might prescribe other medications such as antibiotics or antivirals to protect you from serious infections. You can lower your risk of getting sick by washing your hands often and avoiding crowds. Check your temperature regularly, and call your provider right away if your temperature is 100.4 degrees Fahrenheit or higher.
Serious infection
People taking Xpovio (selinexor) sometimes developed an infection. The most common types were lung infections such as pneumonia, which can be serious. Infection can happen at any time after you start taking Xpovio (selinexor). Additionally, having cancer can mean your immune system doesn’t work as well to fight infections. Because of this, it’s important to contact your provider right away if you have any signs or symptoms of infection such as fever, body aches, chills, cough, or low blood pressure.
Nausea, vomiting, and diarrhea
Most people taking Xpovio (selinexor) experience nausea, vomiting, and diarrhea. Nausea can happen several days after you take your Xpovio (selinexor) dose. It’s recommended that you take an antiemetic, such as ondansetron (Zofran), before receiving your dose. Your provider might also recommend other medications to either take with your Xpovio (selinexor) dose, or to take in between doses. If you have nausea and the medications you have aren’t working well to manage it, contact your provider.
If you experience diarrhea, your provider might recommend over-the-counter diarrhea medications, like loperamide (Imodium A-D), to help. If you have severe diarrhea that causes dehydration, you might need to receive intravenous (IV) fluids at a hospital.
If nausea, vomiting, or diarrhea are severe, you might have to pause or stop taking Xpovio (selinexor). Sometimes, these side effects cause people to lose their appetite, which can lead to weight loss. Your provider will likely recommend that you work with a dietician to make sure you get the proper nutrition in your diet.
Low sodium levels in the blood
Some people taking Xpovio (selinexor) experienced low sodium levels in their blood (hyponatremia). This can be serious and lead to seizures and coma if not treated. Your provider will monitor your sodium with lab tests, and if your sodium is too low, you might need to pause Xpovio (selinexor). Sometimes, if your sodium level improves, your provider can restart Xpovio (selinexor), but maybe at a lower dose. Other times, they might ask you to stop taking Xpovio (selinexor) altogether. If you have any symptoms of low sodium levels such as muscle cramps, severe tiredness, or seizures, seek medical help right away.
Nervous system problems
People taking Xpovio (selinexor) can develop problems with their nervous system. Examples include confusion, difficulty staying awake, delirium, hallucinations, dizziness, and passing out. These symptoms usually started around one month after starting Xpovio (selinexor). Most of the time, these symptoms go away after you stop taking Xpovio (selinexor). Because confusion is possible, it’s important for your family or caregiver to know about this side effect, in case they need to help describe your symptoms to your provider. If you have confusion, hallucinations, delirium, trouble staying awake, or pass out, contact your provider right away.
Harm to unborn baby
Based on animal studies, Xpovio (selinexor)] might harm an unborn baby or raise the risk for miscarriage (pregnancy loss) when taken during pregnancy. Because of these risks, if you’re a female who can get pregnant, you should use birth control while taking Xpovio (selinexor)] and for 1 week after the last dose. Your provider might require a negative pregnancy test before you start treatment. Let your provider know right away if you become pregnant while taking Xpovio (selinexor)]. Males who are sexually active with a female who can get pregnant should use birth control such as condoms while taking Xpovio (selinexor) and for 1 week after the last dose.
Cataract
Risk factors: Previous cataract
Some people taking Xpovio (selinexor) developed a cataract, which is a cloudy spot in your eye that can make it difficult to see. This happened both in people who already had cataracts, and whose symptoms got worse, and also new cataracts developed in people who’d never had one before. This usually happens after you’ve been on Xpovio (selinexor) for several months. If you have any changes or cloudy spots in your vision, contact your provider right away.
Xpovio (selinexor) dosage forms
Typical dosing for Xpovio (selinexor)
Multiple myeloma
In combination with bortezomib (Velcade) and dexamethasone: The typical dose is 100 mg by mouth weekly (on day 1 of each week).
In combination with dexamethasone only: The typical dose is 80 mg by mouth twice weekly (on days 1 and 3 of each week).
Diffuse large B-cell lymphoma
The typical dose is 60 mg by mouth twice weekly (on days 1 and 3 of each week).
What are alternatives to Xpovio (selinexor)?
Multiple myeloma after at least one previous therapy, given together with Velcade (bortezomib) and dexamethasone
Multiple myeloma after at least four previous therapies, given together with dexamethasone
Advanced diffuse large B-cell lymphoma after at least two previous therapies
Multiple myeloma in people who’ve already taken 1 to 3 therapies; given with lenalidomide (Revlimid) and dexamethasone
Multiple myeloma in people who’ve already taken at least 2 therapies; given with Pomalyst (pomalidomide) and dexamethasone
Adults newly diagnosed with multiple myeloma (MM), but not able to receive stem cell transplant (in combination with other anticancer medications)
Adults newly diagnosed with MM and able to receive stem cell transplant (in combination with other anticancer medications)
Adults with advanced MM who already received but didn’t respond well to at least one prior anticancer treatment (in combination with other anticancer medications)
Adults with advanced MM who already received but didn’t respond well to at least three prior anticancer treatments (given alone)
Get savings updates for Xpovio (selinexor)
Receive price alerts, news, and other messages from GoodRx about Xpovio (selinexor) and other healthcare topics and relevant savings offers.By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.
References
Best studies we foundAmerican Cancer Society. (2020). Fever.
American Cancer Society. (2020). Why people with cancer are more likely to get infections.
American Cancer Society. (2021). How targeted therapies are used to treat cancer.
American Cancer Society. (2023). Low white blood cell counts (neutropenia).
American Cancer Society. (2024). Nutrition for People With Cancer.
American Red Cross. (2021). The function of platelets: 5 things you might not know.
Azizian, N. G., et al. (2020). XPO1-dependent nuclear export as a target for cancer therapy. Journal of Hematology & Oncology.
Cancer.net. (2019). Safe storage and disposal of cancer medications.
Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.
Chaudhury, S., (2010). Hallucinations: Clinical aspects and management. Industrial Psychiatry Journal.
Cooper, G. M. (2000). Tumor suppressor genes. The Cell: A Molecular Approach, 2nd edition.
Gavriatopoulou, M., et al. (2020). Integrated safety profile of selinexor in multiple myeloma: experience from 437 patients enrolled in clinical trials. Leukemia.
Karyopharm Therapeutics Inc. (2022). Zpovio- selinexor tablet, film coated [package insert]. DailyMed.
Lymphoma Research Foundation. (n.d.). Diffuse large B-cell lymphoma.
National Comprehensive Cancer Network. (2021). Anemia and neutropenia: Low red and white blood cell counts.
National Comprehensive Cancer Network. (2022). Nausea and vomiting.
National Kidney Foundation. (n.d.). Hyponatremia (low sodium level in the blood).
Peterson, T. J., et al. (2020). Selinexor: A first-in-class nuclear export inhibitor for management of multiply relapsed multiple myeloma. The Annals of Pharmacotherapy.
Browse medications
View AllResearch prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.