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VOTRIENT
Bladder, kidney, and other urologic cancers
Bone and connective tissue cancer
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Drug Name:

VOTRIENT Rx

Generic Name and Formulations:
Pazopanib 200mg; tabs.

Company:
GlaxoSmithKline

Therapeutic Use:

Indications for VOTRIENT:

Advanced renal cell carcinoma. Limitation of use: not for treating adipocytic soft tissue sarcoma or gastrointestinal stromal tumors.

Adult:

Take on an empty stomach. Swallow whole. 800mg once daily. Dose adjustments: see full labeling. Hepatic impairment: moderate: 200mg once daily; severe: not recommended. Concomitant strong CYP3A4 inhibitors (eg, ketoconazole, ritonavir, clarithromycin): avoid and consider alternate drug; if warranted, reduce dose of pazopanib to 400mg; may reduce further if toxicity occurs. Concomitant strong CYP3A4 inducers (eg, rifampin): avoid and consider alternate drug.

Children:

Not established (increased toxicity in developing organs).

Administration:

Take at least 1 hour before or 2 hours after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12 hours until the next dose.

Pharmacological Class:

Kinase inhibitor.

Warnings/Precautions:

Not indicated for use in combination with other cancer agents. Risk of severe and fatal hepatotoxicity. Monitor liver tests before starting and at Weeks 3, 5, 7, and 9, thereafter at Months 3 and 4, then periodically. If ALT between 3xULN and 8xULN continue therapy with weekly monitoring until ALT returns to Grade 1 or baseline. If ALT >8xULN interrupt therapy until ALT returns to Grade 1 or baseline; may consider reintroducing at a reduced dose, measure liver tests weekly for 8 weeks; if ALT>3xULN recurs, permanently discontinue. Permanently discontinue if ALT>3xULN and bilirubin >2xULN. Gilbert's syndrome (see full labeling). History of QT prolongation. Cardiac dysfunction risk: evaluate LVEF at baseline and periodically; monitor for CHF. Monitor ECG, electrolytes (eg, calcium, magnesium, potassium), thyroid. History of hemoptysis, cerebral, or clinically significant GI hemorrhage in the past 6 months: not recommended. Risk of arterial thrombotic events (within previous 6 months: not recommended). Monitor for VTE, PE, infection, proteinuria (reduce dose if 24-hour urine protein ≥3g), thrombotic microangiopathy, GI perforation or fistula. Monitor BP and manage hypertension promptly. Discontinue if severe and persistent hypertension (despite antihypertensives and dose reduction), if repeat episodes of proteinuria (despite dose reductions), thrombotic microangiopathy, or serious infection occurs. Stop therapy at least 7 days before surgery; discontinue in patients with wound dehiscence. Pregnancy (Cat.D), nursing mothers: not recommended.

Interactions:

See Adult dosing: Potentiated by strong CYP3A4 inhibitors, grapefruit juice. Avoid concomitant strong Pgp or BCRP inhibitors. Antagonized by strong CYP3A4 inducers. Concomitant drugs with narrow therapeutic windows metabolized by CYP3A4, CYP2D6, or CYP2C8: not recommended. Increased risk of ALT elevations with concomitant simvastatin; caution and monitor closely; follow dosing guidelines or consider alternatives to pazopanib, or discontinuing simvastatin if develops. Separate antacids by several hours. Caution with concomitant drugs that prolong QT interval (eg, antiarrhythmics).

Adverse Reactions:

Diarrhea, hypertension, hair color changes, nausea, anorexia, vomiting, fatigue, decreased weight, decreased appetite, tumor pain, musculoskeletal pain, headache, dysgeusia, dyspnea, skin hypopigmentation; hepatoxicity, QT prolongation, hemorrhagic events, arterial thrombotic events (eg, MI, angina, ischemic stroke, TIA), venous thrombotic events (eg, VTE, PE), GI perforation or fistula, impaired wound healing, hypothyroidism, proteinuria, infection, reversible posterior leukoencephalopathy syndrome (discontinue if occurs).

BBW:

Severe and fatal hepatotoxicity has been observed in clinical trials; monitor.

Metabolism:

Hepatic (CYP3A4; CYP1A2, CYP2C8 [minor]).

Elimination:

Fecal, renal (minor).

MOA:

Pazopanib is a multi-kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, VEGFR-3, platelet-derived growth factor receptor-α and-β, fibroblast growth factor receptor-1, and -3, cytokine receptor, interleukin-2 receptor inducible T-cell kinase, leukocyte-specific protein tyrosine kinase, and transmembrane glycoprotein receptor tyrosine kinase.

Monitoring Parameters:

Monitor hepatic function; perform serum liver tests before starting and at Weeks 3, 5, 7, and 9, thereafter at Months 3 and 4, then periodically. In cases of isolated ALT elevations (3–8x ULN), weekly monitoring of liver function should be performed until ALT returns to Grade 1 or baseline. Obtain baseline and periodic ECGs and electrolytes (eg, calcium, magnesium, potassium). Monitor BP and manage hypertension promptly. Monitor LVEF (in patients at risk of cardiac dysfunction). Monitor for VTE, PE, GI perforation or fistula, infection, thrombotic microangiopathy. Monitor thyroid function, urine protein.

Nursing Considerations:

Take at least 1 hour before or 2 hours after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12 hours until the next dose. Stop treatment at least 7 days prior to scheduled surgery.

How Supplied:

Tabs—120

VOTRIENT

  • 200mg tablets (Qty:30)
  • appx. price $2130.00
GoodRx

Indications for VOTRIENT:

Advanced soft tissue sarcoma in patients who have received prior chemotherapy. Limitation of use: not for treating adipocytic soft tissue sarcoma or gastrointestinal stromal tumors.

Adult:

Take on an empty stomach. Swallow whole. 800mg once daily. Dose adjustments: see full labeling. Hepatic impairment: moderate: 200mg once daily; severe: not recommended. Concomitant strong CYP3A4 inhibitors (eg, ketoconazole, ritonavir, clarithromycin): avoid and consider alternate drug; if warranted, reduce dose of pazopanib to 400mg; may reduce further if toxicity occurs. Concomitant strong CYP3A4 inducers (eg, rifampin): avoid and consider alternate drug.

Children:

Not established (increased toxicity in developing organs).

Administration:

Take at least 1 hour before or 2 hours after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12 hours until the next dose.

Pharmacological Class:

Kinase inhibitor.

Warnings/Precautions:

Not indicated for use in combination with other cancer agents. Risk of severe and fatal hepatotoxicity. Monitor liver tests before starting and at Weeks 3, 5, 7, and 9, thereafter at Months 3 and 4, then periodically. If ALT between 3xULN and 8xULN continue therapy with weekly monitoring until ALT returns to Grade 1 or baseline. If ALT >8xULN interrupt therapy until ALT returns to Grade 1 or baseline; may consider reintroducing at a reduced dose, measure liver tests weekly for 8 weeks; if ALT>3xULN recurs, permanently discontinue. Permanently discontinue if ALT>3xULN and bilirubin >2xULN. Gilbert's syndrome (see full labeling). History of QT prolongation. Cardiac dysfunction risk: evaluate LVEF at baseline and periodically; monitor for CHF. Monitor ECG, electrolytes (eg, calcium, magnesium, potassium), thyroid. History of hemoptysis, cerebral, or clinically significant GI hemorrhage in the past 6 months: not recommended. Risk of arterial thrombotic events (within previous 6 months: not recommended). Monitor for VTE, PE, infection, proteinuria (reduce dose if 24-hour urine protein ≥3g), thrombotic microangiopathy, GI perforation or fistula. Monitor BP and manage hypertension promptly. Discontinue if severe and persistent hypertension (despite antihypertensives and dose reduction), if repeat episodes of proteinuria (despite dose reductions), thrombotic microangiopathy, or serious infection occurs. Stop therapy at least 7 days before surgery; discontinue in patients with wound dehiscence. Pregnancy (Cat.D), nursing mothers: not recommended.

Interactions:

See Adult dosing: Potentiated by strong CYP3A4 inhibitors, grapefruit juice. Avoid concomitant strong Pgp or BCRP inhibitors. Antagonized by strong CYP3A4 inducers. Concomitant drugs with narrow therapeutic windows metabolized by CYP3A4, CYP2D6, or CYP2C8: not recommended. Increased risk of ALT elevations with concomitant simvastatin; caution and monitor closely; follow dosing guidelines or consider alternatives to pazopanib, or discontinuing simvastatin if develops. Separate antacids by several hours. Caution with concomitant drugs that prolong QT interval (eg, antiarrhythmics).

Adverse Reactions:

Diarrhea, hypertension, hair color changes, nausea, anorexia, vomiting, fatigue, decreased weight, decreased appetite, tumor pain, musculoskeletal pain, headache, dysgeusia, dyspnea, skin hypopigmentation; hepatoxicity, QT prolongation, hemorrhagic events, arterial thrombotic events (eg, MI, angina, ischemic stroke, TIA), venous thrombotic events (eg, VTE, PE), GI perforation or fistula, impaired wound healing, hypothyroidism, proteinuria, infection, reversible posterior leukoencephalopathy syndrome (discontinue if occurs).

BBW:

Severe and fatal hepatotoxicity has been observed in clinical trials; monitor.

Metabolism:

Hepatic (CYP3A4; CYP1A2, CYP2C8 [minor]).

Elimination:

Fecal, renal (minor).

MOA:

Pazopanib is a multi-kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, VEGFR-3, platelet-derived growth factor receptor-α and-β, fibroblast growth factor receptor-1, and -3, cytokine receptor, interleukin-2 receptor inducible T-cell kinase, leukocyte-specific protein tyrosine kinase, and transmembrane glycoprotein receptor tyrosine kinase.

Monitoring Parameters:

Monitor hepatic function; perform serum liver tests before starting and at Weeks 3, 5, 7, and 9, thereafter at Months 3 and 4, then periodically. In cases of isolated ALT elevations (3–8x ULN), weekly monitoring of liver function should be performed until ALT returns to Grade 1 or baseline. Obtain baseline and periodic ECGs and electrolytes (eg, calcium, magnesium, potassium). Monitor BP and manage hypertension promptly. Monitor LVEF (in patients at risk of cardiac dysfunction). Monitor for VTE, PE, GI perforation or fistula, infection, thrombotic microangiopathy. Monitor thyroid function, urine protein.

Nursing Considerations:

Take at least 1 hour before or 2 hours after a meal. Tablets should not be crushed. If dose is missed, it should not be taken if it is <12 hours until the next dose. Stop treatment at least 7 days prior to scheduled surgery.

How Supplied:

Tabs—120

VOTRIENT

  • 200mg tablets (Qty:30)
  • appx. price $2130.00
GoodRx

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