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Zejula

niraparib
Used for Ovarian Cancer
Used for Ovarian Cancer

Zejula (niraparib) is an oral medication used to treat adults with advanced ovarian cancer, after responding to recent chemotherapy. It’s a type of targeted anticancer treatment that can prevent or delay cancer from coming back, particularly for people with changes (mutations) in the BRCA gene. The usual dosage is to take one capsule by mouth once a day. Serious side effects of Zejula (niraparib) to watch out for include high blood pressure and low blood cell counts.

Reviewed by:
reviewer
Julia Lee, PharmD, BCOP
reviewer
Daisy Chau, PharmD
Last reviewed on December 11, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostAlternativesLatest newsReferencesPricesMedicare
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What is Zejula (niraparib)?

What is Zejula (niraparib) used for?

How Zejula (niraparib) works

Zejula (niraparib) is a PARP inhibitor, which means it stops the PARP protein in the body from working. The PARP protein normally helps cells, including cancer cells, grow and survive by fixing damaged DNA. By blocking PARP from working, Zejula (niraparib) prevents cancer cells from repairing their DNA, which kills them.

Drug Facts

Common BrandsZejula
Drug ClassPARP inhibitor
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Zejula (niraparib)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea (65%)
  • Low platelet count (60%)
  • Low red blood cells (56%)
  • Tiredness (55%)
  • Constipation (39%)
  • Muscle, bone, or joint pain (36%)
  • Stomach pain (35%)
  • Vomiting (33%)
  • Poor appetite (24%)

Other Side Effects

  • Difficulty sleeping
  • Headache
  • Difficulty breathing
  • Rash
  • Diarrhea
  • High blood pressure
  • Cough
  • Dizziness
  • Kidney problems
  • Urinary tract infection
  • Low magnesium levels

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

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
  • Increase in blood pressure
  • 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
  • Sudden and severe headache, confusion, change in vision, seizures, which may be signs of posterior reversible encephalopathy syndrome (PRES)
  • 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):

pros-and-cons

Pros and cons of Zejula (niraparib)

thumbs-up

Pros

Oral capsule taken once a day with or without food

Targeted treatment that works to prevent or delay your cancer from coming back

Can be used whether or not you have a BRCA mutation

thumbs-down

Cons

Raises your risk for infections, bleeding, or bruising

Might not be suitable for people with blood pressure that’s hard to control

Not safe in pregnancy or breastfeeding

pharmacist-tips

Pharmacist tips for Zejula (niraparib)

pharmacist

  • Zejula (niraparib) can be taken with or without food. Swallow tablets or capsules whole. Don’t open, cut, or chew the tablets or capsules.

    • Nausea can be common when taking Zejula (niraparib). If you experience nausea, taking the medication at bedtime might help with your symptoms..

      • If you miss a dose of Zejula (niraparib), skip your missed dose. Take your next dose at your next regularly scheduled time. Don't take two doses at the same time

        • You’ll need to get bloodwork done regularly while receiving this medication. Zejula (niraparib) can lower your blood cell counts and make you more at risk of bleeding or developing a serious infection. If your blood cell count drops too low, your provider might have you take a lower dose of the medication or stop it altogether.

          • Since Zejula (niraparib) can raise your blood pressure, ask your provider how often you’ll need to check your blood pressure while taking the medication. It's important to keep it under control and check regularly to make sure it doesn’t get serious.

            • If you’re able to become pregnant, use birth control, while taking Zejula (niraparib) and for at least 6 months after your last dose. It’s possible for the medication to cause harm to an unborn baby.

              • Let your provider know if you are allergic to aspirin. If you have an aspirin allergy, there’s a small chance you might also have an allergy to Zejula (niraparib) due to an ingredient in the dye of the capsules that’s similar to aspirin.

                faqs

                Frequently asked questions about Zejula (niraparib)

                Is Zejula (niraparib) a type of chemotherapy?
                No, Zejula (niraparib) is known as a targeted therapy. Rather than chemotherapy, which works against any rapidly growing cells in the body, Zejula (niraparib) targets a specific protein called PARP that cancer cells need to work normally. By blocking PARP, the cancer cells can’t grow and divide as easily.
                How long does Zejula (niraparib) extend life?
                In clinical studies, people with advanced ovarian cancer survived about 5 and a half months longer without their cancer getting worse when they took Zejula (niraparib), compared to those who took a placebo. Zejula (niraparib) has also been shown to lower the chance of cancer coming back. Talk to your provider if you have more questions about how well this medication can work for you.
                Does Zejula (niraparib) cause hair loss?
                Hair loss wasn't a reported side effect by people using Zejula (niraparib) in clinical trials. But if you do experience hair loss, let your provider know.
                How long do I take Zejula (niraparib) for?
                You should take Zejula (niraparib) as instructed by your provider. How long you take the medication depends on several factors, including how well it’s working to keep your cancer from returning and how well you tolerate it. Don’t stop taking Zejula (niraparib) without first discussing it with your provider.
                Is Zejula (niraparib) safe if I have liver problems?
                Let your provider know if you have problems with your liver, because you might be at higher risk of side effects from Zejula (niraparib), such as anemia and bleeding. With liver problems, your body might have a harder time getting rid of the medication. Depending on how severe your liver problems are, you might need to take a lower dose of Zejula (niraparib).
                Is Zejula (niraparib) safe while breastfeeding?
                Breastfeeding isn’t recommended while you’re taking Zejula (niraparib), and for 1 month after the last dose. It isn’t known whether Zejula (niraparib) can pass into human breast milk. But, if it does, it has a potential risk of causing serious harm to nursing babies. Talk to your provider if you have any questions about other ways to feed your baby while receiving this medication].
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                What are the risks and warnings for Zejula (niraparib)?

                Zejula (niraparib) 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-warning

                Risk of bone marrow problems and blood cancers

                While rare, some people who received treatment with Zejula (niraparib) developed a bone marrow problem called myelodysplastic syndrome (MDS), or cancer of the blood called acute leukemia. This can happen from months to years after starting Zejula (niraparib) treatment. Talk to your provider if you’re concerned about your risk for other cancers.

                risk-warning

                Low blood cell counts

                Zejula (niraparib) can cause your red blood cell, white blood cell, and platelet counts to drop. When the number of these cells are lower than normal, you’re at risk of developing anemia, infections, and bleeding or bruising.

                Your provider will closely check your blood counts through routine lab work when you’re taking Zejula (niraparib). This can be as frequent as weekly lab checks the first month after starting. Let your provider know as soon as possible if you experience extreme tiredness, rapid breathing, fevers, chills, or bleeding and bruising that doesn’t stop or go away.

                risk-warning

                High blood pressure and heart problems

                • Risk factors: History of heart problems

                  Zejula (niraparib) can raise your blood pressure. In rare cases, this can be serious enough to need immediate medical attention. It’s important to check your blood pressure often while taking Zejula (niraparib), especially when first starting treatment. Ask your provider how often you should be checking your blood pressure at home. You might need to monitor more closely if you have existing heart problems, such as coronary artery disease or arrhythmias. Let your provider know if you experience irregular heartbeat, severe headaches, fatigue, or dizziness.

                  risk-warning

                  Posterior reversible encephalopathy syndrome (PRES)

                  Rare cases of a brain condition called posterior reversible encephalopathy syndrome (PRES) have happened with people taking Zejula (niraparib). Get medical help right away if you experience sudden severe headaches, sudden confusion, sudden vision loss or other vision changes, or seizures. You’ll have to stop the medication right away if you have PRES.

                  risk-warning

                  Harm to unborn baby

                  Because this medication causes DNA damage, Zejula (niraparib) can harm an unborn baby. If you are able to have children, use birth control during treatment with Zejula (niraparib) to prevent pregnancy. After the end of treatment, continue to use birth control for at least another 6 months. Let your provider know right away if you or your partner becomes pregnant during this time.

                  dosage

                  Zejula (niraparib) dosage forms

                  Typical dosing for Zejula (niraparib)

                  Maintenance treatment for advanced ovarian cancer:

                  • Weighing less than 77 kg (170 lbs) OR with a platelet level of less than 150,000/mcL: The typical dose is 200 mg by mouth once a day.

                  • Weighing 77 kg (170 lbs) or more AND with a platelet level of 150,000/mcL or more: The typical dose is 300 mg by mouth once a day.

                  Maintenance treatment for recurrent ovarian cancer with BRCA mutations: The typical dose is 300 mg by mouth once a day.

                  Your dose might be different if you have liver problems or experience side effects from the medication.

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                  How much does Zejula (niraparib) cost?

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                  Zejula (brand)
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                  alternatives

                  What are alternatives to Zejula (niraparib)?

                  There are a number of medications that your doctor can prescribe in place of Zejula (niraparib). Compare a few possible alternatives below.
                  Zejula (niraparib)
                  Used for:
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                  Lynparza (olaparib)
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                  References

                  Best studies we found

                  American Cancer Society. (2021). How targeted therapies are used treat cancer.

                  American Cancer Society. (2022). Targeted drug therapy for ovarian cancer

                  American Cancer Society. (2023). Neutropenia (low white blood cell counts).

                  View All References (9)

                  American Red Cross. (n.d.). Red blood cells and why they are important.

                  Dipalma, J. R. (1990). Tartrazine sensitivity. American Family Physician.

                  GlaxoSmithKline LLC. (2023). Zejula- niraparib capsule [package insert]. DailyMed.

                  González-Martín, A., et al. (2019). Niraparib in patients with newly diagnosed advanced ovarian cancer. The New England Journal of Medicine.

                  Javle, M., et al. (2011). The role of PARP in DNA repair and its therapeutic exploitation. British Journal of Cancer.

                  Mirza, M. R., et al. (2016). Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer. The New England Journal of Medicine.

                  National Cancer Institute. (2020). BRCA gene mutations: Cancer risk and genetic testing.

                  National Cancer Institute. (n.d.). Ovarian, fallopian tube, and primary peritoneal cancer—Patient version.

                  Sudulagunta, S. R., et al. (2017). Posterior reversible encephalopathy syndrome (PRES). Oxford Medical Case Reports.

                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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