Ponatinib (Inclusig™)

OncoLink
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 7 de julio del 2014

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In October 2013, the U.S. Food & Drug Administration asked the manufacturer of this medication to suspend sales due to the risk of life-threatening blood clots and severe narrowing of blood vessels.

 

Pronounced: poe na' ti nib
Classification: Tyrosine Kinase Inhibitor

About Ponatinib

Ponatinib is a tyrosine kinase inhibitor. It works by blocking proteins that cause the rapid growth of certain types of leukemia cells. This helps the bone marrow to start making normal blood cells again.

How to Take Ponatinib

Ponatinib comes as a tablet to take by mouth. It is usually taken once a day, with or without food. Take ponatinib at around the same time every day. Swallow the tablets whole, do not crush or break ponatinib tablets. If you miss a dose, take the next dose at the regular time and do not take 2 doses to make up for the missed dose.

Ponatinib is broken down in the body by an enzyme called CYP3A4, which is affected by certain foods and medications. These foods and medications should be avoided while taking bosutinib and include: grapefruit, grapefruit juice, dexamethasone, ketoconazole, rifampin, phenytoin, St. John's wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.

Over the counter heartburn medications called proton pump inhibitors (Prilosec, Prevacid, Nexium) can also interfere with bosutinib and should not be taken.

Possible Side Effects of Ponatinib

There are a number of things you can do to manage the side effects of Ponatinib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bath daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your doctor or nurse before scheduling dental appointments or procedures.
  • Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nosebleeds, bleeding gums or blood in your urine or stool. If your platelet count becomes too low, you may receive a transfusion of platelets.

  • Do not use a razor to shave (an electric razor is fine).
  • Avoid contact sports and activities that can result in injury or bleeding.
  • Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
  • Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Read the thrombocytopenia tip sheet for more information.

Heart Concerns

This medication can cause high blood pressure. Your oncology provider will check your blood pressure regularly while on this therapy. Notify your provider if you develop headaches, dizziness, chest pain or shortness of breath.

Ponatinib can cause heart failure, irregular heartbeats and heart attack. If you develop chest pain, dizziness or lightheadedness, palpitations, feel short of breath or feel your heart beating irregularly, you should seek medical assistance right away.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Muscle or Joint Pain/Aches and Headache

Your doctor or nurse can recommend medication and other strategies to relieve pain. Also view OncoLink's page on pain management.

Fluid Retention

Ponatinib has been reported to cause fluid retention. This may result in generalized swelling, bloating of the abdomen (ascites), fluid development in the lungs (pleural effusion), or heart failure. Notify your healthcare team if you develop swelling in your arms, legs, feet or abdomen, unexpected weight gain, shortness of breath or difficulty breathing, or if you develop a dry cough.

Sexual and Reproductive Changes

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected. Some patients have been able to stop therapy in order to have children. Discuss these options with your oncology team. See OncoLink's section on sexuality & fertility for helpful tips for dealing with these side effects.

Other Side Effects

Ponatinib can cause liver toxicity. Your oncology team will monitor your liver function with blood tests. Report any yellowing of the skin or whites of the eyes (jaundice), as this can be a sign of liver damage.

Studies did not evaluate wound healing with ponatinib, but other medications in the same category do affect wound healing. Therefore, the manufacturer recommends stopping the medication at least 1 week before any surgical procedure and possibly not restart until there is adequate wound healing.

This medication can affect your pancreas and your oncology provider will monitor for this problem with blood tests. Let your provider know if you have a history of pancreatitis or excessive alcohol use or if you develop abdominal pain or nausea and vomiting.

Emergent Side Effects

In studies, patients experienced blood clots, stroke and heart attack. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes.

Some patients experienced a tear in the intestinal wall - called a "perforation." Signs of this include: severe pain in the abdomen, swelling of the abdomen or a high fever. If you experience any of the symptoms mentioned above, contact your healthcare provider immediately or go to the emergency room

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