pazopanib hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
pazopanib hydrochloride: clinical details
Prescribing considerations
- Initiation should be by a clinician experienced with anticancer treatments.
- Assess hepatic function and control blood pressure before starting.
- Review cardiovascular disease, QT prolongation, thrombotic or bleeding history, gastrointestinal perforation risk, aneurysm risk, thyroid disease and renal impairment.
- Consider impaired wound healing around planned surgery.
- Avoid combining with other systemic anticancer treatments unless supported by a specialist protocol; increased toxicity has occurred in studied combinations.
Contraindications and cautions
- Hypersensitivity to pazopanib or any product excipient.
- Severe hepatic impairment is not a formal contraindication but treatment is not recommended.
Monitoring
- Liver tests before treatment, intensively during early treatment and periodically thereafter.
- Blood pressure early after initiation and frequently thereafter.
- Clinical assessment for heart failure; ECG, electrolytes and left-ventricular function where risk factors warrant.
- Baseline and periodic thyroid function and urinalysis for proteinuria.
- Monitor for bleeding, thrombosis, infection, pulmonary toxicity, gastrointestinal perforation, tumour lysis syndrome and impaired wound healing.
Clinical pharmacology
Pazopanib inhibits VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-alpha, PDGFR-beta and c-KIT. It is highly protein bound, metabolised mainly by CYP3A4, eliminated predominantly in faeces and has slow elimination.
Formulation and product differences
- The selected product is a pink, capsule-shaped film-coated tablet containing pazopanib as the hydrochloride salt.
- Tablets must be swallowed whole; crushing substantially increases peak concentration and overall exposure.
- Appearance and excipients may differ between authorised products, so the relevant product information should be checked.
pazopanib hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 200 mg, 400 mg
pazopanib hydrochloride interactions
Check all prescribed, non-prescription and herbal products with the oncology pharmacist or prescriber. Important examples include:
Strong CYP3A4, P-glycoprotein or BCRP inhibitors
Medicines such as clarithromycin, itraconazole, voriconazole, ritonavir or ketoconazole may increase pazopanib exposure and toxicity; alternatives are preferred.
Strong CYP3A4 inducers
Medicines such as rifampicin may reduce pazopanib exposure and should generally be avoided.
Proton-pump inhibitors, H2-receptor antagonists and antacids
Increasing stomach pH can reduce pazopanib absorption; specialist advice is needed about alternatives or administration.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.