Pazopanib
Clinical data | |
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Pronunciation | /pæˈzoʊpənɪb/ paz-OH-pə-nib |
Trade names | Votrient |
AHFS/Drugs.com | Monograph |
MedlinePlus | a610013 |
License data | |
Pregnancy category |
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Routes of administration | By mouth (tablets) |
ATC code | |
Legal status | |
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Pharmacokinetic data | |
Bioavailability | 21% (14–39%)[1] |
Protein binding | >99.5%[1][2] |
Metabolism | Liver: CYP3A4 (major), 1A2 and 2C8 (minor)[2] |
Elimination half-life | 30.9±4 hours[1] |
Excretion | Faeces (primary), urine (<4%)[2] |
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Pazopanib, sold under the brand name Votrient, is an
Medical uses
It is approved by numerous regulatory administrations worldwide, including the US
- The medication is used to treat clear cell renal cell carcinoma, the most common histological subtype.
- The treatment phase is continuing treatment beyond 3 months.
- The patient has been issued an authority prescription for pazopanib.
- The patient must have stable or responding disease according to the Response Evaluation Criteria In Solid Tumours (RECIST).
- This treatment must be the sole tyrosine kinase inhibitor subsidised for this condition.
Pazopanib has also demonstrated initial therapeutic properties in patients with ovarian and non-small cell lung cancer,[9][unreliable medical source?] though plans to apply to the EMA for a variation to include advanced ovarian cancer have been withdrawn and a license will not be sought in any country.[10][11]
Contraindications
The only contraindication is hypersensitivity to pazopanib or any of its excipients.[5] Cautions include:[2]
- Hypertension, including hypertensive crises have been reported.
- QT interval prolongation and torsades de pointes have been reported.
- Thrombotic microangiopathy has been reported.
- Thrombotic thrombocytopenic purpura has been reported.
- Haemolytic uremic syndromehas been reported.
- Haematologic parameter alterations have been reported in 31–37% of patients.
- Events of cardiac dysfunction (decreased left ventricular ejection fraction and congestive heart failure) have been observed.
- Fatal haemorrhage, arterial and venous thrombotic events and perforations in the gastrointestinal tract have been observed in randomized clinical trials.
It has one black box warning by the US FDA, namely severe hepatotoxicity including fatalities.[2][3]
Adverse effects
The most common side effects of pazopanib are nausea, vomiting, diarrhoea (occurs in about half of patients), changes in hair colour, hypertension (which usually occurs during the first few weeks of treatment), appetite loss,
Overdose
The treatment for overdose is purely supportive and the symptoms include grade 3 hypertension and fatigue.[5]
Interactions
Drug interactions include:[2]
- Co-administration with strong inhibitors of the liver enzyme CYP3A4 (e.g. ketoconazole, ritonavir, clarithromycin, grapefruit juice) may increase pazopanib serum levels as it is a CYP3A4 substrate.
- CYP3A4 inducers (e.g. rifampin, carbamazepine) decrease pazopanib serum levels.
- It is a p-glycoprotein (PGP) substrate and hence PGP inhibitors such as quinidine may interact with pazopanib.
- Pazopanib is not a substrate for either of the liver enzymes OATP1B3.[13]
- Pazopanib has inhibitory potency towards OATP1B1 but not for OATP1B3.[14]
Pharmacology
Mechanism of action
Pazopanib is a multiple kinase inhibitor that limits tumor growth by
Pharmacokinetics
After oral intake of a single tablet, pazopanib has a bioavailability of 21% with a range of 14–39% between people. It reaches highest concentrations in the blood plasma after median 3.5 hours; the range in studies was 1.0 to 11.9 hours. When taken regularly, the area under the curve (AUC) increases 1.23- to 4-fold as compared to a single dose. Taking the drug together with food approximately doubles the AUC as well as the highest plasma concentrations (Cmax); and crushing the tablet increases the AUC 1.46-fold, as well doubling the Cmax.[1][4]
When in the bloodstream, more than 99.5% of the substance are bound to
Pazopanib is eliminated with a biological half-life of 30.9±4 hours on average (range 21–51 hours) mainly via the faeces. Less than 4% are eliminated via the urine.[1][4]
References
- ^ a b c d e f "CHMP Assessment Report: Votrient (pazopanib)" (PDF). European Medicines Agency. Retrieved 8 October 2016.
- ^ a b c d e f g h "Votrient (pazopanib) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 27 January 2014.
- ^ a b c "Votrient- pazopanib hydrochloride tablet, film coated". DailyMed. 17 August 2020. Retrieved 9 November 2020.
- ^ a b c d e "Votrient : EPAR - Product Information" (PDF). European Medicines Agency. Glaxo Group Ltd. 23 January 2014. Retrieved 27 January 2014.
- ^ a b c d "Votrient 200 mg and 400 mg film coated tablets - Summary of Product Characteristics (SPC)". electronic Medicines Compendium. GlaxoSmithKline UK. 20 December 2013. Retrieved 27 January 2014.
- ^ a b "Product Information Votrient Tablets" (PDF). TGA eBusiness Services. GlaxoSmithKline Australia Pty Ltd. 25 March 2013. Retrieved 27 January 2014.
- ^ "Pharmaceutical Benefits Scheme (PBS) - Pazopanib". Pharmaceutical Benefits Scheme. Australian Government. Retrieved 27 January 2014.
- ^ "Pazopanib - Online Pharmaceutical Schedule". Pharmaceutical Management Agency. Retrieved 9 June 2015.
- ^ "Pazopanib shows encouraging activity in several tumour types, including soft tissue sarcoma and ovarian cancer". FierceBiotech. 2008-09-15. Retrieved 2010-08-10.
- ^ "GSK pulls bid to extend use of kidney drug to ovarian cancer". Reuters. 31 March 2014. Retrieved 7 April 2014.
- ^ "Regulatory update: Votrient (pazopanib) as maintenance therapy for advanced ovarian cancer in the EU". GlaxoSmithKline. 31 March 2014. Archived from the original on 8 April 2014. Retrieved 7 April 2014.
- ^ S2CID 2178331.
- PMID 24643910.
- PMID 24807167.
- S2CID 5063031.
- S2CID 1738165.
- PMID 22341567.
- ^ Rimel BJ (April 2015). "Antiangiogenesis agents in ovarian cancer". Contemporary Oncology. 7 (2): 16–19.
External links
- "Pazopanib". Drug Information Portal. U.S. National Library of Medicine.
- "Pazopanib hydrochloride". Drug Information Portal. U.S. National Library of Medicine.