palbociclib: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
palbociclib: clinical details
Prescribing considerations
- Initiation and supervision should be by a clinician experienced in anticancer treatment.
- Use with the appropriate endocrine partner; premenopausal or perimenopausal women require ovarian suppression.
- Review infection risk, pulmonary symptoms, venous-thromboembolism risk and interacting medicines.
- Use caution with moderate or severe hepatic or renal impairment and monitor for toxicity.
- Efficacy and safety have not been established in critical visceral disease or for breast carcinoma in children.
Contraindications and cautions
- Hypersensitivity to palbociclib or an excipient.
- Concurrent preparations containing St John’s wort.
Monitoring
- Full blood count before and during treatment, with additional checks when clinically indicated.
- Assess promptly for fever, infection and clinically significant cytopenias.
- Monitor for new or worsening respiratory symptoms suggestive of interstitial lung disease or pneumonitis.
- Monitor for signs of venous thromboembolism.
- Monitor hepatic and renal toxicity where clinically appropriate.
Clinical pharmacology
Palbociclib is a selective, reversible CDK4/6 inhibitor. It is principally metabolised through CYP3A and SULT2A1 and is a weak, time-dependent CYP3A inhibitor.
Formulation and product differences
- The selected formulation is a film-coated tablet that may be taken with or without food.
- Tablets must be swallowed intact and should not be chewed, crushed or split.
palbociclib preparations and strengths
Tablet
Route: Oral
Strengths: 75 mg, 100 mg, 125 mg
palbociclib interactions
Ask the oncology team or pharmacist to check all prescribed, over-the-counter and herbal products. Important examples include:
Strong CYP3A inhibitors, including clarithromycin, itraconazole, posaconazole and some HIV antivirals
They can increase palbociclib exposure and toxicity, so concurrent use should generally be avoided or specialist-managed.
Strong CYP3A inducers, including carbamazepine, phenytoin, rifampicin and enzalutamide
They can substantially reduce palbociclib exposure and may reduce its effectiveness.
St John’s wort
It reduces palbociclib exposure and is contraindicated with the selected product.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.