Pazopanib (Votrient)

Pazopanib is a type of targeted cancer drug. It's pronounced pas-op-ann-ib. It is also known as Votrient. 

It is a treatment for advanced kidney cancer (renal cancer).

How does pazopanib work?

Pazopanib is a type of targeted cancer drug  called a tyrosine kinase inhibitor (TKI). Tyrosine kinase inhibitors work by blocking certain proteins (called tyrosine kinases) from acting on cells. Tyrosine kinases signal to cancer cells to grow.

Pazopanib blocks different types of tyrosine kinase and is called a multi kinase inhibitor (multi TKI). It stops cancer cells forming blood vessels that they need in order to grow. This is called anti angiogenesis treatment.

How do you have pazopanib?

You take pazopanib as tablets with a glass of water. You take them at least 1 hour before you eat or 2 hours afterwards. You take the tablets at the same time each day. Swallow the tablets whole. Do not break or crush them.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Don't take extra tablets if you forget to take a dose. Just take your next dose at the usual time. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You might also need to give urine samples for testing, and have tests to check how well your heart is working.

What are the side effects of pazopanib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Skin problems

Skin problems commonly include a skin rash. Other less common skin problems include dry skin, itching, reddening, and you might notice areas of skin that are lighter or have lost skin colour. Rarely your skin might be sensitive to sunlight.

Most problems usually go back to normal when your treatment finishes. Your doctor, nurse or pharmacist can tell you about the products you can use on your skin to help.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Change in hair colour

It might become lighter or change colour. 

Hair Loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

High blood pressure (hypertension)

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Taste changes 

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Rarely you may more serious liver problems needing treatment. You might have loose poo, indigestion, or yellowing of the eyes or skin (jaundice), or your liver may stop working properly (liver failure).

Protein in the urine

Small amounts of protein may be found when your nurse tests your urine. This usually goes away on its own. If there are large amounts of protein you may have tests to check how well your kidneys are working.

Soreness, redness and peeling on palms and soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Tummy (abdominal) pain and bloating

You might have tummy pain or less commonly might feel swollen and bloated. Tell your treatment team if you have this. They can check the cause and give you medicine to help

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• indigestion, symptoms include heartburn, bloating and burping

• low levels of thyroid hormones, symptoms might include feeling quite tired, being more sensitive to the cold, gaining weight, and being constipated

• low levels of a mineral in the blood called phosphate and rarely magnesium – you have regular blood tests to check for this

• breathlessness

• difficulty sleeping (insomnia)

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• dizziness - don't drive or operate machinery if you have this

• blurred vision, rarely you might have eyesight changes, pain, loss of vision or spots before your eyes, and your eyelashes may change colour. Tell your team straight away if you have eyesight changes

• swelling to different parts of the body such as your hands, feet, eyes and face

• numbness or tingling in the hands and feet

• prickling or crawling feeling on the skin (paraesthesia)

• sweating more than usual

• muscle pain and muscle cramps

• pain in your muscles, joints or chest, you might also get muscle cramps. Rarely you might get pain in the area of the cancer, in your bones, ligaments, tendons and nerves

• passing wind (flatulence)

• increased risk of getting an infection

• bruising, bleeding gums, or nosebleeds

• sore mouth or ulcers, your mouth might also get dry

• weight loss

• lack of fluid in your body (dehydration) – drink plenty of fluid while taking pazopanib

• sudden redness of the skin, you might also get other symptoms such as sweating and a feeling of warmth

• horse voice

• bleeding from different parts of the body such as coughing up blood. Rarely you might bleed from other areas such as your mouth, vagina or bottom, let your doctor or nurse know if you notice any bleeding

• difficulty breathing. Rarely you might have inflammation of the lungs – let your team straight away if you are finding it difficult to breathe

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• a hole in the bowel wall (bowel perforation)

• heart problems – such as your heart muscle not being able to pump blood around the body properly, blood supply problems to part of the heart or changes to the heart rhythm

• a stroke, symptoms include numbness or weakness on one side of your body, difficulty talking, headache or dizziness

• runny nose

• nail changes such as a change in colour, texture or breaking easily

• feeling extremely tired or drowsy (somnolence)

• a high number of red blood cells in your blood making it thicker and less able to run through your blood vessels easily causing blockages

• temporary lack of blood supply to the brain (transient ischaemic attack)

• collapsed lung with air trapped in the space between the lung and chest, often causing shortness of breath (pneumothorax)

• inflammation of the pancreas, symptoms might include feeling or being sick, diarrhoea, indigestion, high temperature and yellowing of the skin or whites of the eyes

• chills

• changes to your menstrual periods – they might be heavier or last longer

• low blood sugar (hypoglycaemia), symptoms might include sweating, feeling hungry, shaky, trembling, fast heartbeat, dizziness, changes to your mood, and tiredness

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Slow wound healing

This drug can slow wound healing. If you need to have an operation you may need to stop taking it for a while beforehand. Your doctor will let you know when you can start taking it again.

Pregnancy and contraception

This drug may harm a baby developing in your womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 2 weeks afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Men

You should use condoms during sexual intercourse even if you have had a vasectomy while you are taking pazopanib and for at least 2 weeks after your last dose.

Loss of fertility 

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.