pazopanib (Rx)

Brand and Other Names:Votrient
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 200mg
  • 400mg

Advanced Renal Cell Carcinoma

Indicated for advanced renal cell carcinoma (RCC)

800 mg PO qDay on empty stomach (at least 1 hr ac or 2 hr pc)

Continue until disease progression or unacceptable toxicity

Soft Tissue Sarcomas

Indicated for advanced soft tissue sarcoma (STS) who have received prior chemotherapy

800 mg PO qDay on empty stomach (at least 1 hr ac or 2 hr pc)

Continue until disease progression or unacceptable toxicity

Dosage Modification

Dose reductions for adverse reactions

  • RCC
    • First dose reduction: 400 mg PO qDay
    • Second dose reduction: 200 mg PO qDay
    • Unable to tolerate second reduction: Permanently discontinue
  • STS
    • First dose reduction: 600 mg PO qDay
    • Second dose reduction: 400 mg PO qDay
    • Unable to tolerate second reduction: Permanently discontinue

Hepatic toxicity

  • Isolated ALT elevations (3-8x ULN): Continue and monitor liver function weekly until ALT returns to Grade 1 or baseline
  • Isolated ALT elevations >8x
    • Withhold until improvement to Grade 1 or baseline
    • If potential benefit for resuming treatment is considered to outweigh the risk for hepatotoxicity, then resume at a reduced dose of no more than 400 mg PO qDay and measure serum liver tests weekly for 8 weeks
    • Permanently discontinue if ALT elevations >3x ULN recur despite dose reduction(s)
  • ALT elevations >3x ULN AND bilirubin elevations >2x ULN
    • Permanently discontinue and continue to monitor until resolution
    • Manage per recommendations for isolated ALT elevations in patients with only a mild, indirect (unconjugated) hyperbilirubinemia, known as Gilbert’s syndrome, and ALT elevations >3x ULN

Left ventricular systolic dysfunction

  • Symptomatic or Grade 3: Withhold until improvement to Grade <3; resume treatment based on medical judgement
  • Grade 4: Permanently discontinue

Hemorrhagic events

  • Grade 2: Withhold until improvement to Grade ≤1; resume at reduced dose
  • Grade 2 recurs after dose interruption and reduction, Grade 3 or 4: Permanently discontinue

Venous thromboembolic events

  • Grade 3: Withhold and resume at same dose if managed with appropriate therapy for at least 1 week
  • Grade 4: Permanently discontinue

Gastrointestinal fistula

  • Grade 2 or 3: Withhold and resume based on medical judgement
  • Grade 4: Permanently discontinue

Hypertension

  • Grade 2 or 3: Reduce dose (see above) and initiate or adjust antihypertensive therapy
  • Grade 3 recurs despite dose reduction(s) and adjustment of antihypertensive therapy, Grade 4 or hypertensive crisis: Permanently discontinue

Proteinuria

  • 24-hr urine protein ≥3 grams
    • Withhold until improvement to Grade ≤1; resume at a reduced dose (see above)
    • Permanently discontinue if 24-hr urine protein ≥3 grams does not improve or recurs despite dose reductions
  • Confirmed nephrotic syndrome
    • Permanently discontinue

Permanently discontinue if these adverse reactions occur at any grade

  • Arterial thromboembolic events
  • Thrombotic microangiopathy
  • Gastrointestinal perforation
  • Gastrointestinal fistula
  • Interstitial lung disease (ILD)/pneumonitis
  • Posterior reversible encephalopathy syndrome (PRES)

CYP3A4 inhibitors or inducers

  • Strong CYP3A4 inhibitors
    • Avoid coadministration; use an alternative with no or minimal potential to inhibit CYP3A4
    • If coadministration is warranted, decrease pazopanib dose to 400 mg/day; further dose reduction may be needed if adverse effects occur
  • Strong CYP3A4 inducers
    • Avoid coadministration; use alternant medication with no or minimal potential to induce CYP3A4
    • Pazopanib not recommended in patients who cannot avoid chronic use of strong CYP3A4 inducers

Gastric acid-reducing agents

  • Avoid coadministration
  • If use cannot be avoided, consider short-acting antacid in place of proton pump inhibitors (PPIs) and H2-receptor antagonists; separate short-acting antacid and pazopanib dosing by several hours

Renal impairment

  • All severities: No dosage adjustment required

Hepatic impairment

  • Mild (bilirubin <1.5x ULN and any ALT): No dosage adjustment necessary
  • Moderate (bilirubin ≥1.5-3x ULN and any ALT): Reduce dose to 200 mg PO qDay
  • Severe (bilirubin >3x ULN and any ALT): Not recommended

Dosing Considerations

Limitation of use

  • Efficacy not demonstrated in adipocytic soft tissue sarcoma or gastrointestinal stromal tumors

Ovarian Cancer (Orphan)

Orphan designation for treatment of ovarian cancer

Orphan sponsor

  • Novartis Pharmaceuticals Corp; One Health Plaza, 337/B17.5F; East Hanover, New Jersey 07936

Hereditary Hemorrhagic Telangiectasia (Orphan)

Orphan designation for treatment of hereditary hemorrhagic telangiectasia

Sponsor

  • HHT Foundation International (d/b/a Cure HHT); 8 Henderson Hill Ct; Monkton, Maryland 21111

Safety and efficacy not established; not indicated for use in pediatric patients

Based on its mechanism of action, pazopanib may have severe effects on organ growth and maturation during early postnatal development, particularly in children younger than 2 years

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Interactions

Interaction Checker

and pazopanib

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            Contraindicated (5)

            • aluminum hydroxide

              aluminum hydroxide will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Contraindicated. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • atorvastatin

              atorvastatin increases toxicity of pazopanib by P-glycoprotein (MDR1) efflux transporter. Contraindicated.

            • chloroquine

              chloroquine increases toxicity of pazopanib by QTc interval. Contraindicated.

            • elagolix

              pazopanib will increase the level or effect of elagolix by Other (see comment). Contraindicated. Concomitant use of elagolix and strong OATP1B1 inhibitors is contraindicated.

            • lefamulin

              lefamulin will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

            Serious - Use Alternative (91)

            • abametapir

              abametapir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • alfuzosin

              alfuzosin and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • aluminum hydroxide/magnesium carbonate

              aluminum hydroxide/magnesium carbonate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • aluminum hydroxide/magnesium trisilicate

              aluminum hydroxide/magnesium trisilicate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • apalutamide

              apalutamide will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • apomorphine

              apomorphine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • aprepitant

              aprepitant will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • aripiprazole

              aripiprazole and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • atazanavir

              atazanavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • atomoxetine

              atomoxetine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • calcium carbonate

              calcium carbonate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • carbamazepine

              carbamazepine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • chloramphenicol

              chloramphenicol will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • cimetidine

              cimetidine will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • citric acid/sodium bicarbonate

              citric acid/sodium bicarbonate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • clarithromycin

              clarithromycin will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • cobicistat

              cobicistat will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • conivaptan

              conivaptan will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • darifenacin

              darifenacin will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • darolutamide

              darolutamide will increase the level or effect of pazopanib by Other (see comment). Avoid or Use Alternate Drug. Darolutamide is a BCRP inhibitor. Avoid coadministration with BCRP inhibitors. If use is unavoidable, closely monitor for adverse reactions and consider dose reduction of BCRP substrate drug (refer BCRP substrate prescribing information).

            • darunavir

              darunavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • dasatinib

              dasatinib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • deferiprone

              deferiprone, pazopanib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

            • dexlansoprazole

              dexlansoprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • dronedarone

              dronedarone will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • eluxadoline

              pazopanib increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

            • entrectinib

              pazopanib and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • enzalutamide

              enzalutamide will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • erdafitinib

              erdafitinib will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

            • erythromycin base

              erythromycin base will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • escitalopram

              escitalopram increases toxicity of pazopanib by QTc interval. Avoid or Use Alternate Drug.

            • esomeprazole

              esomeprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • famotidine

              famotidine will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • fexinidazole

              fexinidazole and pazopanib both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              fexinidazole will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • fluconazole

              fluconazole will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • fluvoxamine

              fluvoxamine will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If it must be coadminister, decrease pazotinib dose to 400 mg/day

            • fosamprenavir

              fosamprenavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • glasdegib

              pazopanib and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • grapefruit

              grapefruit will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • ibuprofen/famotidine

              ibuprofen/famotidine will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • idelalisib

              idelalisib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • indinavir

              indinavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • inotuzumab

              inotuzumab and pazopanib both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • ivosidenib

              ivosidenib and pazopanib both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

              ivosidenib will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • ketoconazole

              ketoconazole will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • lansoprazole

              lansoprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • lapatinib

              lapatinib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • lasmiditan

              lasmiditan increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              lasmiditan increases levels of pazopanib by Other (see comment). Avoid or Use Alternate Drug. Comment: Lasmiditan inhibits BCRP in vitro. Avoid coadministration of lasmiditan with BCRP substrates.

            • lonafarnib

              pazopanib will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • lopinavir

              lopinavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • macimorelin

              macimorelin and pazopanib both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • magnesium hydroxide

              magnesium hydroxide will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • mefloquine

              mefloquine increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • mifepristone

              mifepristone will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • nefazodone

              nefazodone will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • nelfinavir

              nelfinavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • nilotinib

              nilotinib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • nizatidine

              nizatidine will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • omeprazole

              omeprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • ondansetron

              pazopanib and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • palifermin

              palifermin increases toxicity of pazopanib by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hr before, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

            • panobinostat

              pazopanib and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • pantoprazole

              pantoprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • posaconazole

              posaconazole will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • quinupristin/dalfopristin

              quinupristin/dalfopristin will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • rabeprazole

              rabeprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

            • revefenacin

              pazopanib increases levels of revefenacin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 and OATP1B3 transport inhibitors may increase systemic exposure of revefenacin's active metabolite. Coadministration not recommended.

            • ribociclib

              ribociclib increases toxicity of pazopanib by QTc interval. Avoid or Use Alternate Drug.

            • rifabutin

              rifabutin will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rifampin

              rifampin will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • ritonavir

              ritonavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • saquinavir

              saquinavir increases levels of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.

            • sotorasib

              sotorasib will decrease the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

            • St John's Wort

              St John's Wort will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • tepotinib

              tepotinib will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

            • tipranavir

              tipranavir will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • toremifene

              pazopanib and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • tucatinib

              tucatinib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • umeclidinium bromide/vilanterol inhaled

              pazopanib increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              pazopanib, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and pazopanib both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended. Pazopanib may also increase levels of vemurafenib.

            • verapamil

              verapamil will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • vilanterol/fluticasone furoate inhaled

              pazopanib increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • voriconazole

              voriconazole will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • voxelotor

              voxelotor will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            • zafirlukast

              zafirlukast will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            Monitor Closely (178)

            • acalabrutinib

              acalabrutinib increases levels of pazopanib by Other (see comment). Use Caution/Monitor. Comment: Acalabrutinib may increase exposure to coadministered BCRP substrates by inhibition of intestinal BCRP.

              acalabrutinib, pazopanib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

            • albuterol

              albuterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              pazopanib and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • amiodarone

              amiodarone and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.

            • amitriptyline

              amitriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.

            • amobarbital

              amobarbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amoxapine

              amoxapine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • apalutamide

              apalutamide will decrease the level or effect of pazopanib by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces BCRP and may decrease systemic exposure of drugs that are BCRP substrates.

            • arformoterol

              arformoterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • armodafinil

              armodafinil will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • arsenic trioxide

              arsenic trioxide and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.

            • artemether/lumefantrine

              artemether/lumefantrine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              artemether/lumefantrine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • atorvastatin

              pazopanib increases toxicity of atorvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

            • avanafil

              pazopanib will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avapritinib

              pazopanib will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              pazopanib increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bedaquiline

              pazopanib and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • berotralstat

              berotralstat will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

            • bosentan

              bosentan will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bosutinib

              bosutinib increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • budesonide

              budesonide will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • butabarbital

              butabarbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • butalbital

              butalbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • chlorpromazine

              chlorpromazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • citalopram

              pazopanib and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clarithromycin

              clarithromycin and pazopanib both increase QTc interval. Use Caution/Monitor.

            • clomipramine

              clomipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • cortisone

              cortisone will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • crizotinib

              crizotinib increases levels of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

              crizotinib increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • crofelemer

              crofelemer increases levels of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • cyclosporine

              cyclosporine will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dabrafenib

              dabrafenib will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • deferasirox

              deferasirox will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • denosumab

              pazopanib, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

            • desipramine

              desipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • dexamethasone

              dexamethasone will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dextromethorphan

              pazopanib increases levels of dextromethorphan by decreasing metabolism. Use Caution/Monitor.

            • DHEA, herbal

              DHEA, herbal will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • diltiazem

              diltiazem will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • disopyramide

              disopyramide and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.

            • dofetilide

              dofetilide and pazopanib both increase QTc interval. Use Caution/Monitor.

            • doxepin

              doxepin and pazopanib both increase QTc interval. Use Caution/Monitor.

            • dronedarone

              dronedarone and pazopanib both increase QTc interval. Use Caution/Monitor.

            • droperidol

              droperidol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • duvelisib

              duvelisib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

            • efavirenz

              efavirenz will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              elagolix decreases levels of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • eliglustat

              eliglustat increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, pazopanib. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • erythromycin base

              erythromycin base and pazopanib both increase QTc interval. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate and pazopanib both increase QTc interval. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate and pazopanib both increase QTc interval. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate and pazopanib both increase QTc interval. Use Caution/Monitor.

            • eslicarbazepine acetate

              eslicarbazepine acetate will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • etravirine

              etravirine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ezogabine

              ezogabine, pazopanib. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fedratinib

              fedratinib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • finerenone

              pazopanib will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • fingolimod

              pazopanib increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

            • flibanserin

              pazopanib will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluconazole

              fluconazole and pazopanib both increase QTc interval. Use Caution/Monitor.

            • fluphenazine

              fluphenazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • fluvastatin

              pazopanib increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

            • formoterol

              formoterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fostamatinib

              fostamatinib will increase the level or effect of pazopanib by Other (see comment). Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp/BCRP substrate drugs. Monitor for toxicities of P-gp/BCRP substrate drug that may require dosage reduction when given concurrently with fostamatinib.

            • fostemsavir

              fostemsavir will increase the level or effect of pazopanib by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits BCRP transporters. If possible, avoid coadministration or modify dose of BCRP substrate coadministered with fostemsavir.

              pazopanib and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • gemtuzumab

              pazopanib and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • glecaprevir/pibrentasvir

              pazopanib will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with OATP1B1/OATP1B3 inhibitors

              glecaprevir/pibrentasvir will increase the level or effect of pazopanib by Other (see comment). Use Caution/Monitor. Glecaprevir/pibrentasvir may increase plasma concentration of P-gp and BCRP substrates.

            • goserelin

              goserelin increases toxicity of pazopanib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • griseofulvin

              griseofulvin will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • haloperidol

              haloperidol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • histrelin

              histrelin increases toxicity of pazopanib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • ibutilide

              ibutilide and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.

            • iloperidone

              iloperidone increases levels of pazopanib by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • imipramine

              imipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • indacaterol, inhaled

              indacaterol, inhaled, pazopanib. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • indapamide

              indapamide and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.

            • isoniazid

              isoniazid will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • istradefylline

              istradefylline will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              istradefylline will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

            • ivacaftor

              ivacaftor increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

            • ketoconazole

              ketoconazole and pazopanib both increase QTc interval. Use Caution/Monitor.

            • lemborexant

              pazopanib will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • lenvatinib

              pazopanib and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • letermovir

              pazopanib increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.

            • leuprolide

              leuprolide increases toxicity of pazopanib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • lofepramine

              lofepramine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • lomitapide

              pazopanib increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              lomitapide increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

            • lonafarnib

              lonafarnib will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

            • lorlatinib

              lorlatinib will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lumefantrine

              lumefantrine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              lumefantrine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • maprotiline

              maprotiline and pazopanib both increase QTc interval. Use Caution/Monitor.

            • marijuana

              marijuana will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • metronidazole

              metronidazole will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • midazolam

              pazopanib increases levels of midazolam by decreasing metabolism. Use Caution/Monitor.

            • midazolam intranasal

              pazopanib will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • mifepristone

              mifepristone will increase the level or effect of pazopanib by Other (see comment). Modify Therapy/Monitor Closely. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor; combination may increase QT interval. Use alternatives if available

            • mitotane

              mitotane decreases levels of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • modafinil

              modafinil will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • moxifloxacin

              moxifloxacin and pazopanib both increase QTc interval. Use Caution/Monitor.

            • nafcillin

              nafcillin will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nevirapine

              nevirapine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nifedipine

              nifedipine will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • nilotinib

              nilotinib and pazopanib both increase QTc interval. Use Caution/Monitor.

            • nilutamide

              nilutamide will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • nortriptyline

              nortriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.

            • octreotide

              octreotide and pazopanib both increase QTc interval. Use Caution/Monitor.

            • octreotide (Antidote)

              octreotide (Antidote) and pazopanib both increase QTc interval. Use Caution/Monitor.

            • ofatumumab SC

              ofatumumab SC, pazopanib. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

            • olodaterol inhaled

              pazopanib and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

              osilodrostat and pazopanib both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and pazopanib both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin, pazopanib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration with oxaliplatin may increase the risk of immunosuppression and myelosuppression.

              oxaliplatin will increase the level or effect of pazopanib by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxcarbazepine

              oxcarbazepine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ozanimod

              ozanimod and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paclitaxel

              pazopanib increases levels of paclitaxel by decreasing metabolism. Use Caution/Monitor.

            • paclitaxel protein bound

              pazopanib increases levels of paclitaxel protein bound by decreasing metabolism. Use Caution/Monitor.

            • pasireotide

              pazopanib and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pentamidine

              pazopanib and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely.

            • pentobarbital

              pentobarbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • perphenazine

              perphenazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • phenobarbital

              phenobarbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • phenytoin

              phenytoin will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • pimozide

              pazopanib and pimozide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pitavastatin

              pazopanib increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

            • ponatinib

              ponatinib increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • pravastatin

              pazopanib increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

            • primidone

              primidone will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • procainamide

              pazopanib and procainamide both increase QTc interval. Modify Therapy/Monitor Closely.

            • prochlorperazine

              prochlorperazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • promazine

              promazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • promethazine

              promethazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • protriptyline

              protriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.

            • quetiapine

              quetiapine, pazopanib. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinidine

              quinidine and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.

            • quinine

              pazopanib and quinine both increase QTc interval. Use Caution/Monitor.

            • regorafenib

              regorafenib will increase the level or effect of pazopanib by Other (see comment). Modify Therapy/Monitor Closely. Regorafenib likely inhibits BCRP (ABCG2) transport. Coadministration with a BCRP substrate may increase systemic exposure to the substrate and related toxicity.

            • ribociclib

              ribociclib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of pazopanib by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

            • romidepsin

              pazopanib and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

            • rosuvastatin

              pazopanib increases toxicity of rosuvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

            • rucaparib

              rucaparib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • rufinamide

              rufinamide will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • sacubitril/valsartan

              pazopanib will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

            • safinamide

              safinamide will increase the level or effect of pazopanib by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.

            • sarecycline

              sarecycline will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

            • secobarbital

              secobarbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • selpercatinib

              selpercatinib increases toxicity of pazopanib by QTc interval. Use Caution/Monitor.

            • simvastatin

              simvastatin increases toxicity of pazopanib by Other (see comment). Use Caution/Monitor. Comment: Increased risk of elevated LFTs with pazopanib when coadministered with simvastatin.

              pazopanib will increase the level or effect of simvastatin by Other (see comment). Use Caution/Monitor. OATP1B1 inhibitors may increase risk of myopathy

            • siponimod

              siponimod and pazopanib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • sipuleucel-T

              pazopanib decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

            • sodium zirconium cyclosilicate

              sodium zirconium cyclosilicate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.

            • sorafenib

              sorafenib and pazopanib both increase QTc interval. Use Caution/Monitor.

            • sotalol

              pazopanib and sotalol both increase QTc interval. Modify Therapy/Monitor Closely.

            • stiripentol

              stiripentol, pazopanib. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

              stiripentol will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

              stiripentol will increase the level or effect of pazopanib by Other (see comment). Modify Therapy/Monitor Closely. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.

            • tadalafil

              pazopanib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tafamidis

              tafamidis will increase the level or effect of pazopanib by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

            • tafamidis meglumine

              tafamidis meglumine will increase the level or effect of pazopanib by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

            • tazemetostat

              tazemetostat will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              pazopanib will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • teriflunomide

              teriflunomide increases levels of pazopanib by Other (see comment). Use Caution/Monitor. Comment: Teriflunomide inhibits CYP2C8; caution when coadministered with CYP2C8 substrates.

            • thioridazine

              thioridazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • tinidazole

              pazopanib will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • topiramate

              topiramate will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • trastuzumab

              trastuzumab, pazopanib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trastuzumab deruxtecan

              trastuzumab deruxtecan, pazopanib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trazodone

              trazodone and pazopanib both increase QTc interval. Use Caution/Monitor.

            • triclabendazole

              triclabendazole and pazopanib both increase QTc interval. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • trimipramine

              trimipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

            • triptorelin

              triptorelin increases toxicity of pazopanib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • tucatinib

              tucatinib will increase the level or effect of pazopanib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

            • valsartan

              pazopanib will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

            • voclosporin

              voclosporin, pazopanib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ziprasidone

              pazopanib and ziprasidone both increase QTc interval. Use Caution/Monitor.

            Minor (22)

            • azithromycin

              azithromycin and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • dasatinib

              dasatinib and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • dolasetron

              dolasetron and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • flecainide

              flecainide and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • fluoxetine

              fluoxetine and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • foscarnet

              foscarnet and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • iloperidone

              iloperidone and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • lapatinib

              lapatinib and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • levofloxacin

              levofloxacin and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • methadone

              methadone and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • ofloxacin

              ofloxacin and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • paliperidone

              paliperidone and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • paroxetine

              paroxetine and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • posaconazole

              pazopanib and posaconazole both increase QTc interval. Minor/Significance Unknown.

            • ranolazine

              pazopanib and ranolazine both increase QTc interval. Minor/Significance Unknown.

            • risperidone

              pazopanib and risperidone both increase QTc interval. Minor/Significance Unknown.

            • ruxolitinib

              pazopanib will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sulfamethoxazole

              sulfamethoxazole and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • telavancin

              pazopanib and telavancin both increase QTc interval. Minor/Significance Unknown.

            • tropisetron

              pazopanib and tropisetron both increase QTc interval. Minor/Significance Unknown.

            • venlafaxine

              pazopanib and venlafaxine both increase QTc interval. Minor/Significance Unknown.

            • voriconazole

              pazopanib and voriconazole both increase QTc interval. Minor/Significance Unknown.

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            Adverse Effects

            >10% (RCC)

            All grades

            • ALT/AST increased (53%)
            • Diarrhea (52%)
            • Glucose increased (41%)
            • Hypertension (40%)
            • Hair color changes (38%)
            • Leukopenia (37%)
            • Total bilirubin increased (36%)
            • Phosphorous decreased (34%)
            • Neutropenia (34%)
            • Thrombocytopenia (32%)
            • Lymphocytopenia (31%)
            • Sodium decreased (31%)
            • Magnesium decreased (26%)
            • Nausea (26%)
            • Anorexia (22%)
            • Vomiting (21%)
            • Fatigue (19%)
            • Glucose decreased (17%)
            • Asthenia (14%)
            • Abdominal pain (11%)

            >10% (STS)

            All grades

            • Fatigue (65%)
            • Diarrhea (59%)
            • Nausea (56%)
            • AST increased (51%)
            • Weight decreased (48%)
            • ALT increased (46%)
            • Glucose increased (45%)
            • Leukopenia (44%)
            • Lymphocytopenia (43%)
            • Hypertension (42%)
            • Appetite decreased (40%)
            • Hair color changes (39%)
            • Thrombocytopenia (36%)
            • Albumin decreased (34%)
            • Neutropenia (33%)
            • Vomiting (33%)
            • Alkaline phosphatase increased (32%)
            • Sodium decreased (31%)
            • Total bilirubin increased (29%)
            • Tumor pain (29%)
            • Dysgeusia (28%)
            • Headache (23%)
            • Musculoskeletal pain (23%)
            • Myalgia (23%)
            • Gastrointestinal pain (23%)
            • Dyspnea (20%)
            • Exfoliative rash (18%)
            • Cough (17%)
            • Potassium increased (16%)
            • Peripheral edema (14%)
            • Mucositis (12%)
            • Alopecia (12%)
            • Dizziness (11%)
            • Skin disorder (11%)
            • Skin hypopigmentation (11%)
            • Stomatitis (11%)

            Grade 3-4

            • Fatigue (1-13%)

            1-10% (RCC)

            All grades

            • Headache (10%)
            • Proteinuria (9%)
            • Weight decreased (9%)
            • Rash (8%)
            • Alopecia (8%)
            • Dysgeusia (8%)
            • Palmoplantar erythrodysesthesia (6%)
            • Chest pain (5%)
            • Dyspepsia (5%)
            • Dysphonia (4%)
            • Skin depigmentation (3%)
            • Facial edema (1%)

            Grade 3-4

            • ALT increased (2-10%)
            • AST increased (≤7%)
            • Hypertension (4%)
            • Phosphorus decreased (4%)
            • Sodium decreased (1-4%)
            • Asthenia (3%)
            • Diarrhea (≤3%)
            • Total bilirubin increased (≤3%)
            • Anorexia (2%)
            • Vomiting (≤2%)
            • Abdominal pain (2%)
            • Magnesium decreased (≤1%)
            • Neutropenia (≤1%)

            1-10% (STS)

            All grades

            • Chest pain (10%)
            • Insomnia (9%)
            • Hypothyroidism (8%)
            • Dysphonia (8%)
            • Epistaxis (8%)
            • LVEF dysfunction (8%)
            • Dyspepsia (7%)
            • Dry skin (6%)
            • Chills (5%)
            • Vision blurred (5%)
            • Nail disorder (5%)

            Grade 3-4

            • Lymphocytopenia (10%)
            • Tumor pain (8%)
            • ALT increased (8%)
            • Hypertension (7%)
            • Appetite decreased (6%)
            • Diarrhea (5%)
            • Dyspnea (≤5%)
            • AST increased (5%)
            • Weight decreased (4%)
            • Neutropenia (4 %)
            • Sodium decreased (4%)
            • Thrombocytopenia (3%)
            • Alkaline phosphatase increased (3%)
            • Nausea (3%)
            • Vomiting (3%)
            • Gastrointestinal pain (3%)
            • Musculoskeletal pain (2%)
            • Myalgia (2%)
            • Peripheral edema (2%)
            • Mucositis (2%)
            • Skin disorder (2%)
            • Stomatitis (2%)
            • Dizziness (1%)
            • Headache (1%)
            • Albumin decreased (1%)
            • Total bilirubin increased (1%)
            • Potassium increased (1%)
            • Leukopenia (1%)

            <1% (RCC)

            Grade 3-4

            • Hair color changes
            • Nausea
            • Glucose increased
            • Glucose decreased
            • Thrombocytopenia

            <1% (STS)

            Grade 3-4

            • Exfoliative rash
            • Cough
            • Skin hypopigmentation
            • Glucose increased

            Postmarketing Reports

            Polycythemia

            Retinal detachment/tear

            Pancreatitis

            TLS (including fatal cases)

            Arterial (including aortic) aneurysms, dissections, and rupture

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            Warnings

            Black Box Warnings

            Hepatotoxicity

            Severe and fatal hepatotoxicity observed in clinical trials

            Patients aged >65 years are at greater risk for hepatotoxicity

            Monitor liver tests at baseline; at Weeks 3, 5, 7, and 9; at Month 3 and Month 4; and then periodically as clinically indicated

            Increase to weekly monitoring for patients with elevated ALT until ALT returns to Grade 1 or baseline

            Withhold dose and resume at reduced dose with continued weekly monitoring for 8 weeks, or permanently discontinue with weekly monitoring until resolution based on severity of hepatotoxicity

            Contraindications

            None

            Cautions

            Hepatotoxicity, manifested as increases in ALT, AST, and bilirubin, occurred (see Black Box Warnings)

            Mild, indirect (unconjugated) hyperbilirubinemia may occur in patients with Gilbert’s syndrome; manage elevation in ALT >3x ULN per dosing recommendations in such patients

            Fatal hemorrhage, fatal arterial thromboembolic events, and cerebral/intracranial hemorrhage have occurred

            Has not been studied in patients who have a history of hemoptysis, cerebral hemorrhage, patients who have had an arterial thromboembolic event within the previous 6 months, or clinically significant gastrointestinal hemorrhage in the past 6 months

            Venous thromboembolic events (VTEs), including venous thrombosis and fatal pulmonary embolus (PE) reported; monitor for signs and symptoms of VTE and PE

            Thrombotic microangiopathy (TMA), including thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), occurred in clinical trials

            Gastrointestinal perforation or fistula has been reported; monitor for signs and symptoms of gastrointestinal perforation or fistula; withhold in case of Grade 2 or 3 gastrointestinal fistula and resume based on medical judgement; permanently discontinue in case of gastrointestinal perforation or Grade 4 gastrointestinal fistula

            ILD/pneumonitis and PRES, which can be fatal, has been reported

            Hypothyroidism has occurred; monitor thyroid tests at baseline, during treatment and as clinically indicated and manage appropriately

            Proteinuria has been reported; perform baseline and periodic urinalysis during treatment with follow up measurement of 24-hr urine protein as clinically indicated

            Cases of TLS, including fatal cases, have been reported

            Can cause fetal harm when administered to a pregnant woman

            Serious infections (with or without neutropenia), some with fatal outcome, reported; monitor for signs and symptoms and treat active infection promptly; interrupt or discontinue therapy

            Based on its mechanism of action, pazopanib may have severe effects on organ growth and maturation during early postnatal development

            Not indicated for combination therapy; safe and effective combination dose has not been established

            Impaired wound healing

            • Impaired wound healing complications can occur; may have the potential to adversely affect wound healing
            • Withhold dose at least 1 week prior to elective surgery
            • Do not administer for at least 2 weeks following major surgery and until adequate wound healing
            • Safety of resuming therapy after resolution of wound healing complications has not been established

            Hypertension

            • Hypertension (systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥ 100 mmHg) and hypertensive crisis were observed
            • Do not initiate in patients with uncontrolled hypertension
            • Optimize blood pressure before initiating treatment
            • Monitor blood pressure as clinically indicated and initiate and adjust antihypertensive therapy as appropriate
            • Withhold and then reduce pazopanib dose or permanently discontinue based on severity of hypertension

            Cardiac dysfunction

            • Cardiac dysfunction, including decreased LVEF and congestive heart failure, occurred
            • Monitor blood pressure and manage appropriately
            • Monitor for clinical signs or symptoms of congestive heart failure
            • Conduct baseline and periodic evaluation of LVEF in patients at risk of cardiac dysfunction, including previous anthracycline exposure
            • Withhold or permanently discontinue based on severity of cardiac dysfunction

            QT prolongation

            • QT prolongation and Torsades de Pointes occurred
            • Monitor patients who are at significant risk of developing QTc prolongation, including patients with a history of QT interval prolongation, in patients taking antiarrhythmics or other medications that may prolong QT interval, and those with relevant preexisting cardiac disease
            • Monitor ECG and electrolytes (eg, calcium, magnesium, potassium) at baseline and as clinically indicated. Correct electrolyte imbalances before initiating and during treatment

            Drug interaction overview

            Pazopanib is CYP3A4, P-gp, and BCRP substrate; moderate CYP3A4, CYP2D6, and CYP2C8 inhibitor

            • Strong CYP3A4 inhibitors
              • Avoid coadministration
              • Strong CYP3A4 inhibitors increases pazopanib concentrations
              • If unable to avoid, adjust pazopanib dose
            • Strong CYP3A4 inducers
              • Avoid coadministration
              • Strong CYP3A4 inducers may decrease plasma pazopanib concentrations
            • Transporters
              • Avoid coadministration
              • Strong inhibitors of P-gp or BCRP may increase pazopanib concentrations
              • Consider selection of alternative concomitant medicinal products with no or minimal potential to inhibit P-gp or BCRP
            • CYP3A4, CYP2D6, or CYP2C8 substrates with narrow therapeutic use
              • Not recommended
              • Coadministration with agents with narrow therapeutic windows that are metabolized by CYP3A4, CYP2D6, or CYP2C8 may inhibit the metabolism of these products and increase the risk for toxicities
            • Gastric acid-reducing agents
              • Avoid use
              • Coadministration with esomeprazole, a PPI, decreased the exposure of pazopanib
            • Simvastatin
              • Coadministration of simvastatin increases the risk of ALT elevations
              • Insufficient data are available to assess the risk of concomitant use of alternative statins with pazopanib
            • Drugs that prolong the QT interval
              • Avoid coadministration
              • Therapy is associated with QTc interval prolongation
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            Pregnancy & Lactation

            Pregnancy

            Based on animal studies and its mechanism of action, fetal harm may occur when administered to pregnant females

            No data available on use in pregnant females to evaluate drug-associated risk

            Verify pregnancy status of females of reproductive potential before starting treatment

            Contraception

            • Females of reproductive potential: Use effective contraception during treatment and for at least 2 weeks after last dose
            • Males (including those who have had vasectomies) with female partners of reproductive potential: Use condoms during treatment and for at least 2 weeks after last dose

            Infertility

            • Based on findings from animal studies, fertility may be impaired in females and males of reproductive potential while receiving treatment

            Animal studies

            • Oral administration of pazopanib to pregnant rats and rabbits throughout organogenesis resulted in teratogenicity, and abortion at systemic exposures lower than that observed at the maximum recommended human dose of 800 mg

            Lactation

            No data available on the drug presence or its metabolites in human milk or the effects on the breastfed infant or milk production

            Advise females not to breastfeed during treatment and for 2 weeks after last dose

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Multikinase inhibitor (including VEGF & PDGF receptor tyrosine kinases) some of which are implicated in tumor growth, angiogenesis, & metastasis

            Absorption

            Peak Plasma Time: 2-4 hr

            Peak Plasma Concentration: 58.1 mcg/mL

            AUC: 1,037 hr•mcg/mL

            Cmax and AUC increased 2-fold with food; also increased if table crushed

            Distribution

            Protein Bound: >99%

            Pgp substrate

            Metabolism

            Metabolized by CYP3A4 (major), CYP1A2 and CYP2C8 (minor)

            Elimination

            Half-Life: 30.9 hr

            Excretion: Feces (Primarily); urine (<4%)

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            Administration

            Oral Administration

            Take without food at least 1 hr ac or 2 hr pc

            Do not crush or chew (increases bioavailability and absorption rate, with possible increased toxicity)

            Food also increases bioavailability, possibly resulting in increased toxicity

            Storage

            Store at room temperature between 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Votrient oral
            -
            200 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            pazopanib oral

            PAZOPANIB - ORAL

            (paz-OH-pa-nib)

            COMMON BRAND NAME(S): Votrient

            WARNING: Pazopanib can rarely cause very serious (possibly fatal) liver disease. Your doctor will order blood tests to check your liver before you start and while you are taking pazopanib. During the first 2 months of treatment, liver tests will be done frequently, usually every 2 weeks. After 2 months, liver testing will be less frequent. Tell your doctor right away if you develop symptoms of liver disease such as dark urine, yellow eyes/skin, persistent nausea/vomiting, stomach/abdominal pain. Your doctor may need to change your dosage or discontinue the drug.

            USES: Pazopanib is used to treat certain types of cancer (kidney, soft tissue sarcoma). Pazopanib belongs to a class of drugs known as tyrosine kinase inhibitors. It works by decreasing the blood supply to the cancer tumor to slow tumor growth.This medication should not be used by children, especially those younger than 2 years of age, because of the risk of serious side effects.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking pazopanib and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth without food as directed by your doctor, usually once daily. It is very important to take this medication on an empty stomach, at least 1 hour before or 2 hours after food.Swallow this medication whole. Do not crush, chew, or break the tablets. Doing so can release all of the drug at once, increasing the risk of side effects.Avoid eating grapefruit or drinking grapefruit juice while taking this medication. Grapefruit can increase the amount of this medication in your bloodstream. Consult your doctor or pharmacist for more details.Medications that reduce/block stomach acid (such as antacids, H2 blockers such as famotidine/ranitidine, proton pump inhibitors-PPIs such as omeprazole/lansoprazole) may reduce the absorption of pazopanib, making it work less well. Do not take H2 blockers or PPIs while using this medication. If you are taking antacids, ask your pharmacist about how to best take them, such as taking antacids at least several hours apart from when you take pazopanib. Ask your doctor or pharmacist if you are taking any of these medications.Dosage is based on your medical condition, laboratory tests, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Your doctor will order lab tests to find the best dose for you. Keep all medical and lab appointments.Do not increase your dose or take this drug more often than prescribed. Your condition will not improve any faster, and your risk of serious side effects will increase. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Follow your doctor's instructions carefully.Since this medication can be absorbed through the skin and lungs, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets.Tell your doctor if your condition worsens.

            SIDE EFFECTS: See also Warning section.Diarrhea, nausea/vomiting, headache, loss of appetite, weight loss, altered sense of taste, numbness/tingling/redness in hands/feet, or feeling tired/weak may occur. If these effects persist or worsen, tell your doctor or pharmacist promptly.Temporary hair loss and/or change in hair or skin color may occur. Normal hair growth should return after treatment has ended.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: symptoms of heart failure (such as swelling ankles/feet, unusual tiredness), signs of an underactive thyroid (such as unusual weight gain, cold intolerance, slow heartbeat), signs of infection (such as fever, chills, persistent sore throat, cough), wounds that do not heal.This drug can cause serious (rarely fatal) bleeding. Tell your doctor right away if you have any signs of unusual bleeding such as: bloody/black stools, easy bleeding/bruising (such as nose bleed or bloody/pinkish urine), vomit that looks like coffee grounds, severe stomach/abdominal pain, coughing up blood.Pazopanib sometimes causes side effects due to the rapid destruction of cancer cells (tumor lysis syndrome). To lower your risk, your doctor may add a medication and tell you to drink plenty of fluids. Tell your doctor right away if you have symptoms such as: signs of kidney problems (such as painful urination, pink/bloody urine, change in the amount of urine), muscle spasms/weakness.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high. Your doctor may control your blood pressure with medication.Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating), signs of a stroke (such as weakness on one side of the body, trouble speaking, vision changes, confusion), pain/redness/swelling in the arm/leg/calf/groin, signs of a certain brain condition (such as headache, seizure, decreased alertness, blindness), sudden/severe back pain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking pazopanib, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, chest pain/heart attack, high blood pressure, stroke, recent surgery/injury, bleeding/clotting problem, blood vessel problems (such as an aneurysm or a tear/break in the aorta or other blood vessels), intestinal or stomach problems (such as ulcer, fistula, pancreatitis), underactive thyroid.Pazopanib may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using pazopanib, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using pazopanib safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may cause wounds to heal slowly or poorly. Before having surgery, talk with your doctor about the risks and benefits of this medication. Your doctor may tell you to temporarily stop treatment with this medication at least 1 week before surgery. Ask your doctor for specific instructions about when to stop and when to restart treatment with pazopanib. Tell your doctor right away if you have wounds that are not healing well.To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Older adults may be more sensitive to the side effects of this drug, especially liver disease or QT prolongation (see above).Tell your doctor if you are pregnant or plan to become pregnant. Your doctor will give you a pregnancy test before starting treatment. You should not become pregnant while using pazopanib. Pazopanib may harm an unborn baby. Women and men should ask about reliable forms of birth control to use during treatment with this medication and for at least 2 weeks after stopping treatment. If you or your female partner becomes pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breast-feeding is not recommended while using this drug and for 2 weeks after stopping treatment. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: irinotecan, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin).Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Other medications can affect the removal of pazopanib from your body, which may affect how pazopanib works. Examples include azole antifungals (such as ketoconazole), nefazodone, rifamycins (such as rifabutin, rifampin), St. John's wort, drugs used to treat seizures (such as carbamazepine, phenobarbital, phenytoin, primidone), HIV protease inhibitors (such as ritonavir), among others.Many drugs besides pazopanib may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as clarithromycin, erythromycin), among others. Before using this drug, report all medications you are currently using to your doctor or pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as EKG, blood pressure, complete blood count, liver/thyroid function, blood minerals, urine protein) should be performed regularly to monitor your progress or check for side effects. Consult your doctor for more details.Keep all medical and laboratory appointments.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is less than 12 hours before your next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.