Pazopanib

Pazopanib comes as tablets you take at home. During treatment, you usually see a:

• cancer doctor
• cancer nurse or specialist nurse
• specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

While you are taking pazopanib, a nurse or person trained to take blood (phlebotomist) will take blood samples from you. These samples may be used to check:

• the level of your blood cells 
• how well your liver, kidneys and thyroid gland are working. 

You may also have a urine test before and possibly during treatment to check your kidneys.

Your doctor, nurse or pharmacist will discuss your treatment plan with you. They will give you the tablets to take home with you.

You will usually carry on taking pazopanib for as long as it is working for you. Do not stop taking pazopanib without talking to your doctor first.

If you have certain side effects, or changes in your blood test results, your doctor may tell you to stop taking pazopanib for a short time or to reduce the dose you take.

Always take your tablets exactly as explained. This is important to make sure they work as well as possible for you.

You take pazopanib once a day. Try to take it at the same time each day.

There are some important things to remember when taking your tablets:

• Take pazopanib at least 2 hours after a meal or 1 hour before a meal. This is because food can affect how pazopanib is absorbed. 
• Take the tablets with a glass of water, one after the other.
• Swallow the tablets whole. Do not chew, break or crush the tablets before you take them. 
• Do not eat grapefruit or drink grapefruit juice during your treatment. This can increase the chance of side effects.
• If you forget to take your tablets or are sick after taking them, just take your next dose at the usual time – do not take a double dose.
• Keep the tablets in the original package and at room temperature, away from moisture, heat and direct sunlight.
• Keep the tablets safe, somewhere children cannot see or reach them.
• Get a new prescription before you run out of tablets and make sure you have plenty for the holidays.
• If your treatment is stopped, return any unused tablets to the pharmacist.

Pazopanib can cause high blood pressure in some people. Tell your doctor, nurse or pharmacist if you already have high blood pressure before starting this treatment.

Your blood pressure will be checked regularly when you are taking pazopanib. If your blood pressure goes up, it is most likely to happen in the first few weeks of taking the drug. If you develop high blood pressure, you will be prescribed medicines to help control it.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

Your doctor can give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get an infection in your mouth or throat. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help
• try to drink plenty of fluids
• avoid alcohol, tobacco and foods that irritate your mouth and throat.

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.

Pazopanib may affect how well you sleep. If you feel sleepy, do not drive, or operate machinery.

Your hair may lose colour and it may become thinner while you are taking pazopanib. Changes to your hair are usually temporary and get better if you stop treatment. But for some people, hair changes can be permanent.

Pazopanib can affect the skin and nails. You may develop a rash and your skin may feel dry and itchy or peel. Some people notice their skin loses some of its colour. Tell your doctor or specialist nurse if you notice any skin changes. They can advise you about creams or lotions to help with dryness and can prescribe medicines to relieve itching.

In some people, pazopanib can cause skin to be more sensitive to sunlight. If you are out in the sun, use a sun cream with a high sun protection factor (at least SPF 30) to protect your skin.

You may get sore and red palms of hands and soles of feet. You may also notice numbness or tingling in them. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends. 

Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:

• keep your hands and feet cool
• moisturise your hands and feet regularly
• avoid tight-fitting socks, shoes and gloves.

Your doctor may tell you to reduce the dose of pazopanib or to stop taking the tablets to let this side effect improve.

Some people have indigestion or pain or discomfort in their tummy when taking pazopanib. Tell your doctor, nurse or pharmacist if this happens to you.

Very rarely, pazopanib can cause a hole (perforation) in the small bowel. Contact the hospital immediately if you have severe pain in the tummy and sickness and vomiting. It is also very important to let them know if you:

• are bleeding from the back passage
• have black stools (poo)
• are vomiting up blood 
• have vomit that looks like coffee grounds.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C  
• a temperature below 36°C 
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough 
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

Pazopanib can increase your risk of bleeding. Rarely, this can be serious. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo) 
• coughing up blood
• tiny red or purple spots on your skin that may look like a rash.

Contact the hospital straight away if you have any bleeding that does not stop.

You may get pain in your muscles or joints, or in the area where your cancer is. 

If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help. 

You may gain weight. Or your face, ankles and legs may swell. This improves slowly after your treatment has finished. Your doctor may give you drugs to help reduce the swelling.

This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop: 

• a cough that does not go away
• wheezing
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Wounds may take longer to heal while you are having treatment with pazopanib. If you need an operation, your doctor will tell you to stop taking pazopanib before it, and for a few weeks afterwards. 

You may also need to stop taking pazopanib for a few days if you are having dental treatment or to allow a wound to heal. Talk to your doctor, nurse or pharmacist if you need to have surgery or dental treatment.

Less commonly, pazopanib can cause a fistula from the bowel to the skin. A fistula is an opening between areas of the body that are not usually connected.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or semen. If you have sex during this treatment, your cancer team will usually advise using condoms or a dental dam to protect your partner.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.