Pazopanib with Famotidine Interaction Details
Brand Names Associated with Pazopanib
- Pazopanib
- Votrient®
Brand Names Associated with Famotidine
- Duexis® (as a combination product containing Famotidine, Ibuprofen)
- Famotidine
- Fluxid®
- Pepcid®
- Pepcid® AC
- Pepcid® Complete (as a combination product containing Calcium Carbonate, Famotidine, Magnesium Hydroxide)
- Pepcid® RPD
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 20, 2023
Interaction Effect
An increased risk of QT-interval prolongation; decreased pazopanib bioavailability
Interaction Summary
Use caution with concomitant use of pazopanib and QT-prolonging drugs (eg, famotidine) as additive effects on the QT interval and increased risk of torsade de pointes may occur. Monitor ECG at baseline and periodically and normalize electrolytes. Drugs that raise gastric pH (eg, famotidine) may decrease exposure of pazopanib in some patients, and should be avoided . There were no significant effects on PFS or OS when coadministered in patients with metastatic renal cell carcinoma in 1 study . If concomitant use is necessary, consider use of short-acting antacids and separate administration by several hours , or consider alternative dosing regimens (eg, give pazopanib when gastric pH is expected to be low) .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Due to the potential for additive effects on the QT interval and increased risk of torsade de pointes, coadministration of pazopanib with drugs that prolong the QT interval, such as famotidine, should be done cautiously. Baseline and periodic monitoring of ECG and electrolyte maintenance (eg, calcium, magnesium, potassium) within the normal range is recommended. Additionally, concomitant use of pazopanib and drugs that raise gastric pH, such as famotidine, reduces the absorption and solubility of pazopanib, which may cause subtherapeutic exposure of pazopanib in some patients, and should be avoided . If a concomitant gastric acid-reducing agent is required, consider using short-acting antacids instead of famotidine and allow several hours between dosing of pazopanib and the antacid . Or consider alternative dosing regimens that do not increase gastric pH at the time of pazopanib dosing or administer pazopanib at a time when gastric pH is expected to be low, such as late evening .
Mechanism Of Interaction
Additive effects on QT-interval prolongation; decreased solubility and absorption of pazopanib due to increased gastric pH
Literature Reports
A) In a retrospective cohort study in patients with metastatic renal cell carcinoma, concomitant use (n=66) of pazopanib and a proton pump inhibitor (esomeprazole, lansoprazole, omeprazole, pantoprazole) or a histamine-2 receptor antagonist (famotidine, ranitidine) compared with pazopanib alone (n=24) did not significantly reduce progression-free survival (PFS; 9 vs 11 months) or overall survival (OS; 28 vs 30.1 months). There was also no significant difference in patients receiving a proton pump inhibitor (n=57) compared with a histamine-2 receptor antagonist (n=9) on median PFS (11 vs 8 months) or median OS (27 vs 31 months) .
Pazopanib Overview
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Pazopanib is used to treat advanced renal cell carcinoma (RCC, a type of cancer that begins in the cells of the kidneys) in adults. Pazopanib is in a class of medications called kinase inhibitors. It works by slowing or stopping the spread of cancer cells.
Famotidine Overview
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Prescription famotidine is used to treat ulcers (sores on the lining of the stomach or small intestine); gastroesophageal reflux disease (GERD, a condition in which backward flow of acid from the stomach causes heartburn and injury of the esophagus [tube that connects the mouth and stomach]); and conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome (tumors in the pancreas or small intestine that cause increased production of stomach acid). Over-the-counter famotidine is used to prevent and treat heartburn due to acid indigestion and sour stomach caused by eating or drinking certain foods or drinks. Famotidine is in a class of medications called H2 blockers. It works by decreasing the amount of acid made in the stomach.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.