selinexor (Rx)

Brand and Other Names:Xpovio

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 20mg
  • 40mg
  • 50mg
  • 60mg

Multiple Myeloma

In combination with bortezomib and dexamethasone (SVd)

  • Indicated, in combination with bortezomib and dexamethasone, for multiple myeloma (MM) have received ≥1 prior therapy
  • 35-day cycle
    • Selinexor 100 mg PO qWeek on Day 1; continue until disease progression or unacceptable toxicity
    • Bortezomib 1.3 mg/m2 SC qWeek on Day of each week x 4 weeks followed by 1 week off
    • Dexamethasone 20 mg PO twice weekly on Days 1 and 2 of each week
    • Refer to prescribing information of bortezomib and dexamethasone for additional dosing information

In combination with dexamethasone (Sd)

  • Indicated in combination with dexamethasone for adults with relapsed or refractory multiple myeloma (RRMM) who have received at least 4 prior therapies and whose disease is refractory to at least 2 proteasome inhibitors, at least 2 immunomodulatory agents, and an anti-CD38 monoclonal antibody
  • Selinexor 80 mg PO plus dexamethasone 20 mg PO on Days 1 and 3 of each week
  • Continue until disease progression or unacceptable toxicity
  • Refer to prescribing information of dexamethasone for additional dosing information

Diffuse Large B-Cell Lymphoma

Indicated for relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from follicular lymphoma, in patients previously treated with at least 2 lines of systemic therapy

60 mg PO on Days 1 and 3 of each week

Continue until disease progression or unacceptable toxicity

Dosage Modifications

Dosage reduction recommendations for adverse effects

  • SVd
    • Starting dose: 100 mg once weekly
    • First reduction: 80 mg once weekly
    • Second reduction: 60 mg once weekly
    • Third reduction: 40 mg once weekly
    • Fourth reduction: Permanently discontinue
  • Sd
    • Starting dose: 80 mg on Days 1 and 3 each week (160 mg/week)
    • First reduction: 100 mg once weekly
    • Second reduction: 80 mg once weekly
    • Third reduction: 60 mg once weekly
    • Fourth reduction: Permanently discontinue
  • DLBCL
    • Starting dose: 60 mg on Days 1 and 3 each week (120 mg/week)
    • First reduction: 40 mg Days 1 and 3 of each week (80 mg total per week)
    • Second reduction: 60 mg once weekly
    • Third reduction: 40 mg once weekly
    • Fourth reduction: Permanently discontinue

Thrombocytopenia (Sd and SVd)

  • Platelet count 25,000-75,000/mcL: Reduce by 1 dose level
  • Platelet count 25,000-75,000/mcL with bleeding: Interrupt dosing; restart at 1 dose level lower after bleeding resolved
  • Platelet count <25,000/mcL: Interrupt dosing; monitor until platelet count returns to ≥50,000/mcL, then restart at 1 dose level lower

Thrombocytopenia (DLBCL)

  • Platelet count 50,000 to <75,000/mcL: Interrupt 1 dose; restart at the same dose level
  • Platelet count 25,000 to <50,000/mcL without bleeding
    • First occurrence: Interrupt dose; monitor until platelet count returns to ≥50,000/mcL
    • Reduce by 1 dose level
  • Platelet count 25,000 to <50,000/mcL with concurrent bleeding
    • Interrupt dose; monitor until platelet count returns to ≥50,000/mcL
    • Restart at 1 dose level lower, after bleeding has resolved
    • Administer platelet transfusions per clinical guidelines
  • Platelet count <25,000/mcL
    • Interrupt dose; monitor until platelet count returns to ≥50,000/mcL
    • Restart at 1 dose level lower
    • Administer platelet transfusions per clinical guidelines

Neutropenia (Sd and SVd)

  • ANC 0.5-1 x 109/L without fever: Reduce by 1 dose level
  • ANC <0.5 x 109/L or febrile neutropenia: Interrupt dosing; monitor until neutrophil count returns to ≥1 x 109/L, then restart at 1 dose level lower

Neutropenia (DLBCL)

  • ANC 0.5 to <1 x 10^9/L without fever
    • First occurrence: Interrupt dose; monitor until neutrophil counts return to ≥1 x 109/L; restart at the same dose level
    • Recurrence: Interrupt dose; monitor until neutrophil counts return to ≥1 x 109/L; administer growth factors per clinical guidelines; restart at 1 dose level lower
    • ANC <0.5 x 109/L or febrile neutropenia: Interrupt dosing; monitor until neutrophil count returns to ≥1 x 109/L; administer growth factors per clinical guidelines; restart at 1 dose level lower

Anemia

  • Hemoglobin <8 g/dL: Reduce by 1 dose level; administer blood transfusion and/or other treatments per clinical guidelines
  • Life-threatening consequences (urgent intervention indicated): Interrupt dosing; monitor until hemoglobin ≥8 g/dL, then restart at 1 dose level lower; administer blood transfusion and/or other treatments per clinical guidelines

Hyponatremia

  • Serum sodium <130 mmol/L: Interrupt dosing and provide supportive care
  • Monitor until sodium returns to ≥130 mmol/L
  • Restart at 1 dose level lower

Fatigue

  • Grade 2 lasting >7 days or Grade 3: Interrupt dosing
  • Monitor until fatigue resolves to Grade 1 or baseline
  • Restart at 1 dose level lower

Nausea & vomiting

  • Grade 1 or 2
    • Grade 1 or 2 nausea (decrease oral intake without significant weight loss, dehydration, or malnutrition) OR
    • Grade 1 or 2 vomiting (≤5 episodes/day)
    • Maintain dose and initiate additional antinausea medications
  • Grade ≥3
    • Grade 3 nausea (inadequate oral caloric or fluid intake) OR
    • Grade ≥3 vomiting (≥6 episodes/day)
    • Interrupt dosing; monitor until nausea/vomiting resolved to ≤Grade 2; initiate additional antinausea medications; restart at 1 dose level lower

Diarrhea

  • Grade 2 (inrease of 4-6 stools/day over baseline): If 1st episode, maintain dose and institute supportive care
  • Grade 2 (2nd and subsequent episodes): Reduce by 1 dose level; institute supportive care
  • Grade ≥3 (increase ≥7 stools/day over baseline; hospitalization indicated): Interrupt dosing and institute supportive care; monitor until resolved to Grade ≤2; restart at 1 dose level lower

Weight loss and anorexia

  • Weight loss of 10-20% or anorexia associated with significant weight loss or malnutrition
  • Interrupt and institute supportive care
  • Monitor until weight returns to >90% baseline
  • Restart at 1 dose level lower

Other nonhematologic adverse effects

  • Grade 3 or 4 (life-threatening)
    • Interrupt dosing
    • Monitor until resolved to Grade ≤2
    • Restart at 1 dose level lower

Renal impairment

  • Mild-to-severe (CrCl 15-89 mL/min): No significant differences in pharmacokinetics observed
  • ESRD (CrCl <15 mL/min) or hemodialysis: Effect on pharmacokinetics unknown

Hepatic impairment

  • Mild: No significant differences in pharmacokinetics observed
  • Moderate-to-severe: Effect on pharmacokinetics unknown

Dosing Considerations

Concomitant treatment

  • Maintain adequate fluid and caloric intake throughout treatment
  • Consider IV hydration for patients at risk of dehydration
  • Provide prophylactic concomitant treatment with a 5–HT3 antagonist and/or other antinausea agents before and during treatment

Monitor parameters

  • Monitor at baseline and as clinically indicated
  • Monitor more frequently during the first 3 months of treatment
  • Assess the need for dosage modifications for adverse reaction
  • CBC with differential
  • Standard blood chemistries
  • Body weight
  • Nutritional status
  • Volume status

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and selinexor

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            Contraindicated (0)

              Serious - Use Alternative (163)

              • acrivastine

                selinexor, acrivastine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • adalimumab

                selinexor, adalimumab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • aldesleukin

                selinexor, aldesleukin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • alfentanil

                selinexor, alfentanil. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • alprazolam

                selinexor, alprazolam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • amiodarone

                selinexor, amiodarone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • amitriptyline

                selinexor, amitriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • amobarbital

                selinexor, amobarbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • amoxapine

                selinexor, amoxapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • apomorphine

                selinexor, apomorphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • aripiprazole

                selinexor, aripiprazole. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • arsenic trioxide

                selinexor, arsenic trioxide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • asenapine

                selinexor, asenapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • asenapine transdermal

                selinexor, asenapine transdermal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • auranofin

                selinexor, auranofin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • baclofen

                selinexor, baclofen. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • belladonna and opium

                selinexor, belladonna and opium. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • benzhydrocodone/acetaminophen

                selinexor, benzhydrocodone/acetaminophen. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • bortezomib

                selinexor, bortezomib. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • brentuximab vedotin

                selinexor, brentuximab vedotin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • brexanolone

                selinexor, brexanolone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • brexpiprazole

                selinexor, brexpiprazole. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • brivaracetam

                selinexor, brivaracetam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • bromocriptine

                selinexor, bromocriptine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • brompheniramine

                selinexor, brompheniramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • buprenorphine

                selinexor, buprenorphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • buprenorphine buccal

                selinexor, buprenorphine buccal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • buprenorphine subdermal implant

                selinexor, buprenorphine subdermal implant. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • buprenorphine transdermal

                selinexor, buprenorphine transdermal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • buprenorphine, long-acting injection

                selinexor, buprenorphine, long-acting injection. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • buspirone

                selinexor, buspirone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • butabarbital

                selinexor, butabarbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • butalbital

                selinexor, butalbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • butorphanol

                selinexor, butorphanol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • carbamazepine

                selinexor, carbamazepine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • carbinoxamine

                selinexor, carbinoxamine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • cariprazine

                selinexor, cariprazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • carisoprodol

                selinexor, carisoprodol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • cetuximab

                selinexor, cetuximab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • chloral hydrate

                selinexor, chloral hydrate. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • chlordiazepoxide

                selinexor, chlordiazepoxide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • chlorpromazine

                selinexor, chlorpromazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • ciprofloxacin

                selinexor, ciprofloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • cisplatin

                cisplatin, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • citalopram

                selinexor, citalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • clobazam

                selinexor, clobazam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • clomipramine

                selinexor, clomipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • clonazepam

                selinexor, clonazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • clorazepate

                selinexor, clorazepate. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • clozapine

                selinexor, clozapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • codeine

                selinexor, codeine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • colchicine

                colchicine, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • dapsone

                dapsone, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • delafloxacin

                selinexor, delafloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • desipramine

                selinexor, desipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • diazepam

                selinexor, diazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • diazepam buccal

                selinexor, diazepam buccal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • diazepam intranasal

                selinexor, diazepam intranasal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • didanosine

                didanosine, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • disulfiram

                selinexor, disulfiram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • docetaxel

                selinexor, docetaxel. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • doxepin

                selinexor, doxepin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • doxylamine

                selinexor, doxylamine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • eribulin

                selinexor, eribulin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • escitalopram

                selinexor, escitalopram. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • estazolam

                selinexor, estazolam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • eszopiclone

                selinexor, eszopiclone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • etanercept

                selinexor, etanercept. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • etrasimod

                etrasimod, selinexor. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Risk of additive immune system effects with etrasimod has not been studied in combination with antineoplastic, immune-modulating, or noncorticosteroid immunosuppressive therapies. Avoid coadministration during and in the weeks following administration of etrasimod. .

              • fentanyl

                selinexor, fentanyl. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • fentanyl intranasal

                selinexor, fentanyl intranasal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • fentanyl transdermal

                selinexor, fentanyl transdermal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • fentanyl transmucosal

                selinexor, fentanyl transmucosal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • fluoxetine

                selinexor, fluoxetine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • fluphenazine

                selinexor, fluphenazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • flurazepam

                selinexor, flurazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • fluvoxamine

                selinexor, fluvoxamine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • gemifloxacin

                selinexor, gemifloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • gold sodium thiomalate

                selinexor, gold sodium thiomalate. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • haloperidol

                selinexor, haloperidol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • hydrocodone

                selinexor, hydrocodone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • hydromorphone

                selinexor, hydromorphone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • iloperidone

                selinexor, iloperidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • imipramine

                selinexor, imipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • infliximab

                selinexor, infliximab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • ipilimumab

                selinexor, ipilimumab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • leflunomide

                selinexor, leflunomide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • lenalidomide

                selinexor, lenalidomide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • levofloxacin

                selinexor, levofloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • levorphanol

                selinexor, levorphanol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • lorazepam

                selinexor, lorazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • loxapine

                selinexor, loxapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • loxapine inhaled

                selinexor, loxapine inhaled. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • lurasidone

                selinexor, lurasidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • meperidine

                selinexor, meperidine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • mephobarbital

                selinexor, mephobarbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • methadone

                selinexor, methadone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • methohexital

                selinexor, methohexital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • metronidazole

                selinexor, metronidazole. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • midazolam

                selinexor, midazolam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • midazolam intranasal

                selinexor, midazolam intranasal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • molindone

                selinexor, molindone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • morphine

                selinexor, morphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • moxifloxacin

                selinexor, moxifloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • nalbuphine

                selinexor, nalbuphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • nitrofurantoin

                selinexor, nitrofurantoin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • nitrous oxide

                selinexor, nitrous oxide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • nivolumab

                selinexor, nivolumab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • norfloxacin

                selinexor, norfloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • nortriptyline

                selinexor, nortriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • ofloxacin

                selinexor, ofloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • olanzapine

                selinexor, olanzapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • oliceridine

                selinexor, oliceridine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • oxaliplatin

                oxaliplatin, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • oxazepam

                selinexor, oxazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • oxycodone

                selinexor, oxycodone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • oxymorphone

                selinexor, oxymorphone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • paclitaxel

                selinexor, paclitaxel. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • paliperidone

                selinexor, paliperidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • paroxetine

                selinexor, paroxetine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pembrolizumab

                selinexor, pembrolizumab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pentazocine

                selinexor, pentazocine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pentobarbital

                selinexor, pentobarbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • perphenazine

                selinexor, perphenazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • phenobarbital

                selinexor, phenobarbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pimavanserin

                selinexor, pimavanserin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pimozide

                selinexor, pimozide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pomalidomide

                selinexor, pomalidomide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • primidone

                selinexor, primidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • prochlorperazine

                selinexor, prochlorperazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • protriptyline

                selinexor, protriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • pyridoxine

                selinexor, pyridoxine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • quazepam

                selinexor, quazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • quetiapine

                selinexor, quetiapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • ramelteon

                selinexor, ramelteon. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • remifentanil

                selinexor, remifentanil. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • risperidone

                selinexor, risperidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • samidorphan

                selinexor, samidorphan. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • secobarbital

                selinexor, secobarbital. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sertraline

                selinexor, sertraline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sorafenib

                selinexor, sorafenib. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • stavudine

                selinexor, stavudine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sufentanil

                selinexor, sufentanil. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sufentanil SL

                selinexor, sufentanil SL. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sunitinib

                selinexor, sunitinib. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • suvorexant

                selinexor, suvorexant. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • tapentadol

                selinexor, tapentadol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • tasimelteon

                selinexor, tasimelteon. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • temazepam

                selinexor, temazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • thalidomide

                selinexor, thalidomide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • thioridazine

                selinexor, thioridazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • thiothixene

                selinexor, thiothixene. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • tramadol

                selinexor, tramadol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • triazolam

                selinexor, triazolam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • trifluoperazine

                selinexor, trifluoperazine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • trimipramine

                selinexor, trimipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • vinblastine

                selinexor, vinblastine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • vincristine

                selinexor, vincristine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • vincristine liposomal

                selinexor, vincristine liposomal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • vinorelbine

                selinexor, vinorelbine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • zaleplon

                selinexor, zaleplon. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • ziprasidone

                selinexor, ziprasidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • zolpidem

                selinexor, zolpidem. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              Monitor Closely (0)

                Minor (0)

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                  Adverse Effects

                  >10%

                  All grades

                  • SVd
                    • Platelet count decrease (92%)
                    • Lymphocyte count decreased (77%)
                    • Hemoglobin decrease (71%)
                    • Glucose increase (62%)
                    • Phosphate increase (61%)
                    • Fatigue (59%)
                    • Sodium decrease (58%)
                    • Calcium decrease (55%)
                    • Nausea (50%)
                    • Neutrophil count decrease (48%)
                    • BUN increase (41%)
                    • ALT increase (33%)
                    • Peripheral neuropathy (32%)
                    • Diarrhea (32%)
                    • Upper respiratory tract infection (29%)
                    • Creatinine increase (28%)
                    • Albumin decrease (27%)
                    • Potassium decrease (27%)
                    • Magnesium decrease (27%)
                    • Appetite decrease (26%)
                    • AST increase (24%)
                    • Cataract (22%)
                    • Vomiting (21%)
                    • Potassium increase (18%)
                    • Bilirubin increase (16%)
                    • Pyrexia (15%)
                    • Blurred vision (13%)
                    • Dizziness (12%)
                    • ALP increase (12%)
                  • Sd
                    • Thrombocytopenia (74%)
                    • Fatigue (73%)
                    • Nausea (72%)
                    • Anemia (59%)
                    • Decreased appetite (53%)
                    • Weight decreased (47%)
                    • Diarrhea (44%)
                    • Vomiting (41%)
                    • Hyponatremia (39%)
                    • Neutropenia (34%)
                    • Leukopenia (28%)
                    • Constipation (25%)
                    • Dyspnea (24%)
                    • Upper respiratory tract infection (21%)
                    • Cough (16%)
                    • Mental status changes (16%)
                    • Pyrexia (16%)
                    • Hyperglycemia (15%)
                    • Dizziness (15%)
                    • Insomnia (15%)
                    • Lymphopenia (15%)
                    • Dehydration (14%)
                    • Hypercreatinemia (14%)
                    • Pneumonia (13%)
                    • Epistaxis (12%)
                    • Hypokalemia (12%)
                    • Dysgeusia (11%)
                  • DLBCL
                    • Fatigue (63%)
                    • Nausea (57%)
                    • Diarrhea (37%)
                    • Appetite decrease (37%)
                    • Weight decrease (30%)
                    • Constipation (29%)
                    • Vomiting (28%)
                    • Pyrexia (22%)
                    • Cough (18%)
                    • Edema (17%)
                    • Upper respiratory tract infection (17%)
                    • Dizziness (16%)
                    • Musculoskeletal pain (15%)
                    • Taste disorder (13%)
                    • Hypotension (13%)
                    • Mental status changes (11%)

                  Grade 3 or 4

                  • SVd
                  • Platelet count decrease (43%)
                  • Lymphocyte count decrease (38%)
                  • Fatigue (28%)
                  • Phosphate decrease (23%)
                  • Hemoglobin decrease (17%)
                  • Sodium decrease (14%)
                  • Neutrophil count decrease (12%)
                  • Sd H5
                  • Thrombocytopenia (61%)
                  • Anemia (40%)
                  • Fatigue (22%)
                  • Hyponatremia (22%)
                  • Neutropenia (21%)
                  • Leukopenia (11%)
                  • DLBCL H5
                  • Fatigue (15%)

                  1-10%

                  All grades

                  • Sd
                    • Vision blurred (10%)
                    • Headache (10%)
                  • DLBCL
                    • Abdominal pain (10%)
                    • Dyspnea (10%)
                    • Pneumonia (10%)
                    • Urinary tract infection (10%)
                    • Peripheral neuropathy, sensory (10%)
                    • Hemorrhage (10%)

                  Grade 3 or 4

                  • SVd
                    • Cataract (9%)
                    • Mental status changes (9%)
                    • Nausea (8%)
                    • Diarrhea (6%)
                    • Potassium decrease (6%)
                    • BUN increase (5%)
                    • Peripheral neuropathy (4.6%)
                    • Vomiting (4.1%)
                    • Potassium increase (4.1%)
                    • Glucose increase (3.8%)
                    • Decreased appetite (3.6%)
                    • Creatinine increase (3.6%)
                    • Syncope (3.6%)
                    • ALT increase (3.1%)
                    • Decreased weight (2.1%)
                    • Calcium decrease (2.1%)
                    • Pyrexia (1.5%)
                    • AST increase (1.5%)
                    • Bilirubin increase (1%)
                  • Sd
                    • Lymphopenia (10%)
                    • Nausea (9%)
                    • Pneumonia (9%)
                    • Mental status changes (7%)
                    • Hyperglycemia (7%)
                    • Diarrhea (6%)
                    • Decreased appetite (4.5%)
                    • Vomiting (3.5%)
                    • Dyspnea (3.5%)
                    • Dehydration (3.5%)
                    • Hypokalemia (3.5%)
                    • Upper respiratory tract infection (3%)
                    • Insomnia (2%)
                    • Hypercreatinemia (2%)
                    • Constipation (1.5%)
                  • DLBCL
                    • Nausea (6%)
                    • Pneumonia (6%)
                    • Pyrexia (4.5%)
                    • Appetite decrease (3.7%)
                    • Mental status changes (3.7%)
                    • Diarrhea (3%)
                    • Urinary tract infection (3%)
                    • Hypotension (3%)
                    • Edema (2.2%)
                    • Musculoskeletal pain (2.2%)
                    • Vomiting (1.5%)
                    • Dyspnea (1.5%)
                    • Upper respiratory tract infection (1.5%)

                  <1%

                  Grade 3 or 4

                  • SVd
                    • Dizziness
                    • Blurred vision
                    • Albumin decrease
                    • Magnesium decrease
                  • Sd
                    • Weight decreased
                    • Pyrexia
                    • Epistaxis
                    • Vision blurred
                  • DLBCL
                    • Hemorrhage
                    • Dizziness
                    • Blurred vision
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                  Warnings

                  Contraindications

                  None

                  Cautions

                  Life-threatening thrombocytopenia, potentially leading to hemorrhage may occur; monitor platelet counts at baseline and during treatment; institute platelet transfusion and/or other treatments as clinically indicated; monitor patients for signs and symptoms of bleeding and evaluate promptly; interrupt, reduce dose, or permanently discontinue based on severity of adverse reaction

                  Neutropenia commonly reported, potentially increasing infection risk; obtain white blood cell counts with differential at baseline and throughout treatment; monitor more frequently during first three months of treatment; monitor patients for signs and symptoms of concomitant infection and evaluate promptly; consider supportive measures, including antimicrobials and growth factors (eg, G-CSF); interrupt, reduce dose or permanently discontinue based on severity of adverse reaction

                  Nausea and/or vomiting commonly occurs; follow recommendations for adequate hydration and prophylactic antiemetics; provide prophylactic antiemetics; administer 5-HT3 receptor antagonists and other anti-nausea agents prior to and during treatment; interrupt, reduce dose or permanently discontinue based on severity of adverse reaction; administer intravenous fluids to prevent dehydration and replace electrolytes as clinically indicated

                  Diarrhea commonly reported; monitor for dehydration and provide supportive care as required; interrupt, reduce dose or permanently discontinue based on severity of adverse reaction; provide standard anti-diarrheal agents, administer intravenous fluids to prevent dehydration and replace electrolytes as clinically indicated

                  Anorexia and weight loss reported; monitor weight, nutritional status, and volume status at baseline and throughout treatment; monitor more frequently during first three months of treatment; interrupt, reduce dose or permanently discontinue based on severity of adverse reaction; provide nutritional support, fluids, and electrolyte repletion as clinically indicated

                  Hyponatremia may rapidly occur (median onset 8 days) and may be severe; monitor sodium level at baseline and throughout treatment; monitor more frequently during first two months of treatment; correct sodium levels for concurrent hyperglycemia (serum glucose >150 mg/dL) and high serum paraprotein levels; assess hydration status and manage hyponatremia per clinical guidelines, including intravenous saline and/or salt tablets as appropriate and dietary review; interrupt, reduce dose or permanently discontinue based on severity of adverse reaction

                  Serious and fatal infections reported; most infections were not associated with neutropenia and were caused by nonopportunistic organisms; monitor for signs and symptoms of infection, evaluate and treat promptly

                  Neurological toxicity may occur, including dizziness, syncope, depressed level of consciousness, and mental status changes (including delirium and confused state); advise patients to refrain from driving and engaging in hazardous occupations or activities, such as operating heavy or potentially dangerous machinery, until neurological toxicity fully resolves; optimize hydration status, hemoglobin level, and concomitant medications to avoid exacerbating dizziness or mental status changes; institute fall precautions as appropriate

                  Embryofetal toxicity can occur

                  New onset or exacerbation of cataracts has occurred; median time to new onset was 228 days and 237 days for worsening of cataract in patients with cataract at start of therapy; treatment usually requires surgical removal of cataract

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                  Pregnancy

                  Pregnancy

                  Based on animal studies and its mechanism of action, selinexor can cause fetal harm if administered to pregnant women

                  Verify pregnancy status of females of reproductive potential before initiating selinexor

                  Animal studies

                  • Administration to pregnant rats during organogenesis resulted in structural abnormalities and alterations to growth at exposures below those clinically recommended for humans

                  Contraception

                  • Females of reproductive potential: Use effective contraception during treatment and for 1 week after the last dose
                  • Males with female partner of reproductive potential: Use effective contraception during treatment and for 1 week after the last dose

                  Infertility

                  • Based on animal studies, selinexor may impair fertility in females and males

                  Lactation

                  No data are available regarding the presence of selinexor or its metabolites in human milk, or their effects on the breastfed child or milk production

                  Because of the potential for serious adverse reactions in breastfed children, advise women not to breastfeed during treatment and for 1 week after the 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

                  Selective inhibitor of nuclear export (SINE) of tumor suppressor proteins (TSPs), growth regulators, and mRNAs of oncogenic proteins by blocking exportin 1 (XPO1)

                  XPO1 inhibition leads to accumulation of TSPs in the nucleus, reductions in several oncoproteins (eg, c–myc, cyclin D1), cell cycle arrest, and apoptosis of cancer cells

                  Selinexor demonstrated proapoptotic activity in vitro in multiple myeloma cell lines, patient tumor samples, and murine xenograft model

                  Absorption

                  Peak plasma time: 4 hr

                  Peak plasma concentration

                  • 60 mg-dose: 442 ng/mL
                  • 80 mg-dose: 680 ng/mL

                  AUC

                  • 60 mg-dose: 4,096 ng⋅hr/mL
                  • 80 mg-dose: 5,386 ng⋅hr/mL

                  Distribution

                  Vd: 133 L

                  Protein bound: 95%

                  Metabolism

                  Metabolized by CYP3A4, multiple UGTs, and glutathione S-transferases

                  Elimination

                  Half-life: 6-8 hr

                  Clearance: 18.6 L/hr

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                  Administration

                  Oral Administration

                  May take with or without food

                  Swallow tablet whole; do not break, chew, crush, or divide

                  On scheduled administration day, take tablet at about the same time of day

                  Missed, delayed, or vomited dose

                  • Take next dose at the next regularly scheduled time
                  • Vomited dose: Do not repeat dose; wait until next scheduled dose

                  Storage

                  Store at or below 30ºC (86ºF)

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                  Images

                  No images available for this drug.
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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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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.