Zolinza
Zolinza (vorinostat) is an anticancer medication used to treat skin problems in adults with cutaneous T-cell lymphoma (CTCL) when other treatments haven't worked or the condition has come back. It's a type of medication called a histone deacetylase (HDAC) inhibitor. You take Zolinza (vorinostat) by mouth, usually 400 mg once a day with food. Some common side effects include tiredness, nausea, and diarrhea.
What is Zolinza (vorinostat)?
What is Zolinza (vorinostat) used for?
Advanced cutaneous T-cell lymphoma (CTCL), after least two prior therapies
How Zolinza (vorinostat) works
In some cancer cells, such as lymphoma cells, certain proteins help send messages that tell the cells to grow and spread. One of these proteins is called histone deacetylase (HDAC).
Zolinza (vorinostat) is a histone deacetylase (HDAC) inhibitor. It blocks the histone deacetylase protein, which stops it from sending messages to the cell. When this protein is blocked, cancer cells don’t grow and spread as well.
Drug Facts
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What are the side effects of Zolinza (vorinostat)?
Common Side Effects
- Higher serum sugar levels (69%)
- Tiredness (52%)
- Diarrhea (52%)
- Protein in urine (51%)
- Higher serum creatinine (47%)
- Nausea (41%)
- Taste changes (28%)
- Lower platelet levels (26%)
- Low appetite (24%)
- Weight loss (21%)
Other Side Effects
- Muscle spasms
- Hair loss
- Dry mouth
- Chills
- Constipation
- Dizziness
- Vomiting
- Headache
- Itching
- Swelling in the arms and legs
Serious Side Effects
- Blood clot in the leg: pain and swelling (typically in one leg), redness or discolored skin
- Blood clot in the lungs: sudden and severe chest pain, trouble breathing, cough
- Serious bleeds: nosebleeds, bleeding that's difficult to stop, unexplained bruising, blood in urine, blood in stool, stomach pain
- Dangerously high blood sugar levels: feeling thirsty, dry skin and mouth, urinating more often, headache, blurry vision, nausea, feeling weak, trouble catching your breath
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
black, tarry stools
bleeding gums
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine or stools
body aches or pain
chills
confusion
decreased urine
dizziness or lightheadedness
ear congestion
fainting
fast or irregular heartbeat
headache
increased thirst
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
loss of appetite
loss of voice
lower back or side pain
mood changes
muscle pain or cramps
no blood pressure
no breathing
no pulse
numbness or tingling in the face, lips, arms, hands, feet, or legs
pain, redness, or swelling in the arm or leg
painful or difficult urination
pale skin
pinpoint red spots on the skin
rapid weight gain
seizures
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
trouble speaking, thinking, or walking
troubled breathing
troubled breathing with exertion
unusual bleeding or bruising
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
vomiting
Less common
Persistent non-healing sore
pink growth
reddish patch or irritated area
shiny bump
white, yellow, or waxy scar-like area
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Zolinza (vorinostat)
Pros
Taken by mouth once daily
Works in a way that targets cancer cells and not healthy cells
Recommended treatment option for the most common types of CTCL
Cons
Raises risk of dehydration, need to drink at least 2 liters of fluids a day
Need to take with food
Can lower platelet levels, which raises your risk for bleeding
Pharmacist tips for Zolinza (vorinostat)
It’s important to take Zolinza (vorinostat) whole with food. Don’t open up the capsules or crush them. If you accidentally get some of the powder inside the capsules on your skin, wash your skin with water right away and call your healthcare team.
Taking Zolinza (vorinostat) can make you dehydrated. To prevent this side effect, you should drink 8 glasses of water daily (8 ounces in each glass), which is about 2 liters of fluids per day.
You might experience diarrhea while taking Zolinza (vorinostat). If appropriate, your oncologist might recommend an over-the-counter medication, such as loperamide (Imodium-AD) to help manage your symptoms. It’s important to stay hydrated if you have diarrhea. But try to avoid sugary sports drinks because they can make diarrhea worse.
Zolinza (vorinostat) might cause nausea. Your oncologist might prescribe antiemetics for you to take before each dose, or in between doses if needed to manage it. Examples include prochlorperazine (Compazine) or ondansetron (Zofran).
Though uncommon, it’s possible for people taking Zolinza (vorinostat) to develop blood clots. Seek medical help right away if you have swelling in one arm or one leg, sudden chest pain, or sudden trouble breathing.
If you’re female, Zolinza (vorinostat) might lower your ability to get pregnant in the future. Talk to your oncologist about fertility preservation options.
Zolinza (vorinostat) might interact with some medications. For example, taking warfarin (Coumadin) at the same time can raise your risk of bleeding. Make sure your healthcare team has an up-to-date medication list before you start taking Zolinza (vorinostat). Let them know if you start or stop any new medications while you’re taking Zolinza (vorinostat).
We don’t know if Zolinza (vorinostat) passes into human milk. But based on the way this medication works, it might harm a nursing infant. You shouldn’t breastfeed while taking Zolinza (vorinostat) and for 1 week after the last dose.
Frequently asked questions about Zolinza (vorinostat)
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What are the risks and warnings for Zolinza (vorinostat)?
Zolinza (vorinostat) 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.
Blood clots
Risk factors: Past blood clots
Though rare, some people taking Zolinza (vorinostat) developed blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE). If you have swelling in one arm or one leg, sudden chest pain and sudden trouble breathing, seek medical help right away. These might be signs of a blood clot.
Lower blood cell counts
Zolinza (vorinostat) can cause your red blood cells (RBCs) and platelet levels to drop. Your RBCs carry oxygen through your body. So when their levels are low, you might feel tired and feel as if you can’t breathe as well.
Your platelets help clot blood. So when their levels are low, your body can’t stop bleeding as well. People taking other histone deacetylase inhibitors (HDACs), such as valproic acid, together with Zolinza (vorinostat) are at even higher risk for bleeding.
Your oncologist will monitor your RBC and platelet levels with a lab test called a complete blood count every 2 weeks for the first two months after you start Zolinza (vorinostat), then monthly after that. If your levels are too low, they might ask you to pause treatment or take a lower dose of the medication. Contact your oncology care team if you have unusual bruising or bleeding, or feel severe tiredness.
Nausea, vomiting, and diarrhea
People taking Zolinza (vorinostat) have experienced nausea, vomiting, and diarrhea. Your oncologist might recommend an antiemetic medication for you to take to manage nausea or vomiting. Examples include ondansetron (Zofran) or prochlorperazine (Compazine). They might also recommend you meet with a dietician to discuss ways to eat to help prevent stomach upset.
If you experience diarrhea, there are several over-the-counter medications your healthcare team might recommend, such as loperamide (Imodium-AD). In addition, you should drink plenty of fluids to stay hydrated. Avoid sugary sports drinks because these can make diarrhea worse. If you have nausea, vomiting, or diarrhea that doesn’t get better with medications, contact your oncologist.
Higher blood sugar levels
Some people taking Zolinza (vorinostat) have developed higher blood sugar levels (hyperglycemia). Most of the time, this change was mild, but about 5% of people who took Zolinza (vorinostat) in clinical studies experienced severely high blood sugar. Your oncologist will check your blood sugar with a blood test every 2 weeks during the first 2 months of treatment with Zolinza (vorinostat). If you have diabetes or have a history of high blood sugar, they might recommend you to monitor your blood sugar at home. If you have symptoms of dangerously high blood sugar, such as feeling very thirsty and urinating often, contact your oncologist right away.
Changes in electrolyte levels
Risk factors: Diarrhea | Vomiting
Zolinza (vorinostat) can cause changes in electrolyte levels, including blood potassium, magnesium, and calcium levels. Your oncologist will monitor your electrolytes with a blood test every 2 weeks for 2 months when you first start this medication, then monthly after that. If your electrolyte levels are too low, they might prescribe a supplement by mouth or as an intravenous infusion to raise the levels to a safe range. Let your healthcare team know right away if you experience symptoms of low electrolyte levels, including nausea, vomiting, and diarrhea.
Harm to unborn baby
Zolinza (vorinostat) hasn’t been studied in human pregnancy. But, based on animal studies and the way the medication works, it could harm an unborn baby and cause pregnancy loss (miscarriage). If you’re able to get pregnant, you should use effective birth control while you’re taking Zolinza (vorinostat) and for 6 months after the last dose. If you’re able to get your partner pregnant, you should use effective birth control such as condoms while taking Zolinza (vorinostat) and for 3 months after the last dose.
Zolinza (vorinostat) dosage forms
Typical dosing for Zolinza (vorinostat)
Adults: The typical dose is 400 mg by mouth once a day with food.
Your dose might be lower if you have liver problems or experience serious side effects.
Interactions between Zolinza (vorinostat) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Cisapride
- Dronedarone
- Mesoridazine
- Pimozide
- Piperaquine
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amiodarone
- Amisulpride
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Buprenorphine
- Buserelin
- Ceritinib
- Chloroquine
- Clarithromycin
- Clofazimine
- Clozapine
- Crizotinib
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Deslorelin
- Deutetrabenazine
- Domperidone
- Donepezil
- Efavirenz
- Encorafenib
- Entrectinib
- Escitalopram
- Fingolimod
- Fluconazole
- Fluoxetine
- Formoterol
- Foscarnet
- Fostemsavir
- Glasdegib
- Gonadorelin
- Goserelin
- Histrelin
- Hydroxychloroquine
- Hydroxyzine
- Inotuzumab Ozogamicin
- Ivabradine
- Ivosidenib
- Ketoconazole
- Lefamulin
- Lenvatinib
- Levofloxacin
- Lofexidine
- Macimorelin
- Methadone
- Metronidazole
- Mirtazapine
- Moxifloxacin
- Nafarelin
- Nilotinib
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Panobinostat
- Pasireotide
- Pazopanib
- Pimavanserin
- Pitolisant
- Ponesimod
- Posaconazole
- Quetiapine
- Ribociclib
- Selpercatinib
- Sertraline
- Sevoflurane
- Siponimod
- Solifenacin
- Sotalol
- Sulpiride
- Sunitinib
- Tacrolimus
- Trazodone
- Triclabendazole
- Triptorelin
- Valproic Acid
- Vandetanib
- Vemurafenib
- Vinflunine
- Voclosporin
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Dicumarol
- Phenprocoumon
- Warfarin
How much does Zolinza (vorinostat) cost?
What are alternatives to Zolinza (vorinostat)?
Advanced cutaneous T-cell lymphoma (CTCL), after least two prior therapies
Cutaneous T-cell lymphoma (CTCL), after at least one other treatment has stopped working
Zolinza (vorinostat) images
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References
Best studies we foundEunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What is fertility preservation?
Gryder, B. E., et al. (2012). Targeted cancer therapy: Giving histone deacetylase inhibitors all they need to succeed. Future Medicinal Chemistry.
Lane, A. A., et al. (2009). Histone deacetylase inhibitors in cancer therapy. Journal of Clinical Oncology.
Ludmann, P. (2023). Cutaneous T-cell lymphoma: Overview. American Academy of Dermatology Association.Â
Ludmann, P. (2023). Cutaneous T-cell lymphoma: Symptoms. American Academy of Dermatology Association.Â
McMillin, J. M. (1990). Chapter 141 Blood glucose. Clinical Methods: The History, Physical, and Laboratory Examinations, 3rd edition.
Merck Sharp & Dohme LLC. (2024). Zolinza- vorinostat capsule [package insert]. DailyMed.
Mir-Bonafé, J. F., et al. (2019). Adverse hair reactions to new targeted therapies for cancer. Actas Dermo-Sifiliográficas.
National Cancer Institute. (n.d.). Histone deacetylase inhibitor.
National Cancer Institute. (n.d.). Vorinostat.
National Cancer Institute. (2022). Chemotherapy to treat cancer.
National Cancer Institute. (2024). Diarrhea and cancer treatment.
National Comprehensive Cancer Network. (2024). Cutaneous T-cell lymphomas.
Shanmugam, G., et al. (2022). HDAC inhibitors: Targets for tumor therapy, immune modulation and lung diseases. Translational Oncology.
Xue, K., et al. (2016). Vorinostat, a histone deacetylase (HDAC) inhibitor, promotes cell cycle arrest and re-sensitizes rituximab- and chemo-resistant lymphoma cells to chemotherapy agents. Journal of Cancer Research and Clinical Oncology.
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