Lonafarnib
Lonafarnib is a prescription medicine used to reduce the risk of death in Hutchinson-Gilford Progeria Syndrome and to treat certain rare, processing-deficient progeroid laminopathies.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 2 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Lonafarnib (Zokinvy) is a specialist medicine, on the market since about 2020, that lowers the risk of death in Hutchinson-Gilford Progeria Syndrome and treats certain processing-deficient progeroid laminopathies by blocking the enzyme farnesyltransferase so faulty proteins like progerin stop building up in the cell's nucleus. Stomach trouble is very common, mainly vomiting, diarrhea and nausea, often with a smaller appetite and weight loss. Its serious risk is a lengthened QTc interval (the heart's electrical timing), so a racing or irregular heartbeat, fainting or dizziness needs a call right away. Expect regular ECGs (heart tracings), blood tests, kidney checks and eye exams, and report any trouble seeing in low light.
Clinical pearls
- Take it with the morning and evening meals, and swallow the capsules whole with water rather than chewing them.
- Skip grapefruit, Seville oranges and their juices, and avoid lovastatin, simvastatin and atorvastatin while on it.
- If diarrhea hits, check with your pharmacist before using loperamide (Imodium), because lonafarnib raises its levels.
- Zokinvy is paused 10 to 14 days before and 2 days after midazolam, so mention it before any sedated procedure.
Patient information guide A plain-language walkthrough of Lonafarnib, written from its FDA label.
What Lonafarnib is used for
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Lonafarnib, available as Zokinvy oral capsules, is used in people 12 months and older with a body surface area of at least 0.39 m².
- To reduce the risk of death in Hutchinson-Gilford Progeria Syndrome (HGPS).
- To treat processing-deficient progeroid laminopathies with a heterozygous LMNA mutation with progerin-like protein accumulation.
- To treat processing-deficient progeroid laminopathies with homozygous or compound heterozygous ZMPSTE24 mutations.
- It is not for other progeroid syndromes or processing-proficient progeroid laminopathies.
How Lonafarnib works
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Lonafarnib is a farnesyltransferase inhibitor. It blocks an enzyme that attaches a fatty chemical group to certain proteins. This prevents progerin and progerin-like proteins from building up in the inner membrane of the cell nucleus.
Lonafarnib dosage
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Zokinvy is taken by mouth twice daily with morning and evening meals. Your dose is based on body surface area. It starts lower and is raised after about 4 months, and your prescriber may lower it again if vomiting or diarrhea is a problem.
- Swallow capsules whole with enough water. Do not chew them.
- If you cannot swallow capsules, the contents can be mixed with Ora Blend SF, Ora-Plus, orange juice or applesauce. Prepare it fresh and take it within about 10 minutes.
- Never mix it with grapefruit or Seville orange juice.
- Missed dose: take it as soon as possible with food if more than 8 hours remain before the next dose. If less than 8 hours remain, skip it and take the next dose as scheduled.
Dosing details from the FDA-approved label
From the Lonafarnib prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Starting dosage for patients with BSA of 0.39 m2 and above
- 115 mg/m2 twice daily with morning and evening meals
- Round total daily dosage to the nearest 25 mg increment
- Taken with meals to reduce the risk of gastrointestinal adverse reactions; no appropriate dosage strength available for BSA less than 0.39 m2
- After 4 months of treatment
- Increase to 150 mg/m2 twice daily with morning and evening meals
- Round total daily dosage to the nearest 25 mg increment
- Table 2 lists 125 mg to 300 mg total daily dosage for BSA 0.39 to 1 m2
- Gastrointestinal adverse reactions (repeated vomiting and/or diarrhea resulting in dehydration or weight loss) in patients on 150 mg/m2 twice daily
- Dose can be reduced to the starting dose of 115 mg/m2 twice daily
- Take with morning and evening meals and with an adequate amount of water
- QTc interval greater than or equal to 500 msec
- Withhold ZOKINVY until QTc interval is less than 470 msec, then resume at same dosage
- Monitor ECGs prior to initiating, during treatment, and as clinically indicated
- Use with midazolam
- Temporarily discontinue ZOKINVY for 10 to 14 days before and 2 days after administration of midazolam
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION Start at 115 mg/m 2 twice daily with morning and evening meals. ( 2.1 ) After 4 months, increase to 150 mg/m 2 twice daily. ( 2.1 ) Round all total daily doses to nearest 25 mg increment. ( 2.1 ) See full prescribing information for dosage modifications due to adverse reactions. ( 2.2 ) See full prescribing information for preparation and administration instructions. ( 2.4 ) 2.1 Recommended Dosage The starting dosage of ZOKINVY for patients with a BSA of 0.39 m 2 and above is 115 mg/m 2 twice daily with morning and evening meals (see Table 1 ) to reduce the risk of gastrointestinal adverse reactions [see Adverse Reactions ( 6.1 )] . An appropriate dosage strength of ZOKINVY is not available for patients with a BSA of less than 0.39 m 2 [see Indications and Usage ( 1 )] . After 4 months of treatment, increase the dosage to 150 mg/m 2 twice daily with morning and evening meals (see Table 2 ). Round all total daily dosages to the nearest 25 mg increment (see Table 1 and Table 2 ). If a dose is missed, take the dose as soon as possible with food, up to 8 hours prior to the next scheduled dose. If less than 8 hours remain before the next scheduled dose, skip the missed dose, and resume taking ZOKINVY at the next scheduled dose. Table 1 provides the BSA-based dosage recommendations for the starting dosage of 115 mg/m 2 twice daily. Table 1: Recommended Dosage and Administration for 115 mg/m 2 Body Surface Area-Based Dosing BSA (m 2 ) Total Daily Dosage Rounded to Nearest 25 mg Morning Dosing Number of Capsule(s) Evening Dosing Number of Capsule(s) ZOKINVY 50 mg ZOKINVY 75 mg ZOKINVY 50 mg ZOKINVY 75 mg 0.39 - 0.48 100 1 1 0.49 - 0.59 125 1 1 0.6 - 0.7 150 1 1 0.71 - 0.81 175 2 1 0.82 - 0.92 200 2 2 0.93 – 1 225 1 1 2 Table 2 provides the BSA-based dosage recommendations for the dosage of 150 mg/m 2 twice daily.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Lonafarnib side effects
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Stomach and infection-related effects are the most common.
Common side effects
- Vomiting
- Diarrhea
- Nausea
- Infections, including upper respiratory infections
- Decreased appetite and weight loss
- Fatigue
- Stomach pain
- Headache
- Headache and muscle or joint pain
- Cough
- High blood pressure
When to get medical help
- Call your doctor right away if you have a racing, pounding or irregular heartbeat, fainting or dizziness, which could be signs of a heart rhythm problem.
- Tell your doctor if vomiting or diarrhea is repeated or leads to dehydration or weight loss.
- Report any new vision changes, especially trouble seeing in low light.
- Tell your doctor if you become pregnant or think you might be.
- Your doctor will check heart tracings (ECGs), blood tests, kidney function and eyes during treatment.
Also possible are electrolyte changes, low blood cell counts and raised liver enzymes. Call your doctor about heart rhythm symptoms, dehydration, vision changes or severe vomiting or diarrhea.
Lonafarnib warnings and precautions
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- QTc prolongation: it can cause serious heart rhythm problems and sudden death. Avoid it with a history of arrhythmias, a slow heartbeat with symptoms, or low potassium or magnesium. ECGs are checked before and during treatment.
- Drug interactions: many medicines can raise or lower its levels or be affected by it.
- Lab changes: electrolytes, blood counts and liver enzymes are monitored.
- Kidneys and eyes: animal studies showed kidney and retinal toxicity, so kidney function and eye exams are done regularly.
- Fertility and pregnancy: it may reduce fertility and can harm a fetus.
Lonafarnib interactions
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Many medicines and foods can interact with lonafarnib.
- Strong CYP3A inhibitors: contraindicated because they can raise lonafarnib levels and the risk of heart rhythm problems.
- Strong or moderate CYP3A inducers: contraindicated because they can make it less effective.
- Midazolam: contraindicated because of the risk of extreme sedation or breathing problems.
- Lovastatin, simvastatin, atorvastatin: contraindicated because of the risk of muscle damage.
- Grapefruit and Seville oranges: avoid.
- Other QTc-prolonging drugs: avoid, or use ECG monitoring if unavoidable.
- Loperamide, CYP2C19 substrates, digoxin and dabigatran: levels may rise, so dose changes or monitoring may be needed.
Interactions listed in the FDA-approved label
From the Lonafarnib prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- Strong CYP3A inhibitors: May increase lonafarnib AUC and Cmax, increasing the incidence and severity of adverse reactions including QTc interval prolongation. Use is contraindicated. Avoid consumption of grapefruit or Seville oranges.
- Moderate CYP3A inhibitors: When ZOKINVY is initiated in a patient already on a moderate CYP3A inhibitor, the patient may be at increased risk of adverse reactions. No dosage adjustment when added to steady-state ZOKINVY. When initiating, monitor closely for at least the first 7 days and consider an alternative therapy if adverse reactions occur.
- Strong or moderate CYP3A inducers: Strong CYP3A inducer decreases lonafarnib Cmax and AUC, which may reduce ZOKINVY efficacy. Use is contraindicated.
- Weak CYP3A inducers: No interaction requiring dosage change is stated. No ZOKINVY dosage adjustment is recommended.
- QTc prolonging drugs: ZOKINVY causes QTc interval prolongation; concomitant use may result in a greater increase and adverse reactions including Torsade de pointes, other serious arrhythmias, and sudden death. Avoid concomitant use. If unavoidable, obtain ECGs when initiating, during concomitant use, and as clinically indicated.
- Lovastatin, simvastatin, or atorvastatin (statins): Increased CYP3A substrate exposure may increase the risk of myopathy or rhabdomyolysis. Coadministration is contraindicated.
- Midazolam: Increased midazolam exposure may increase the risk of extreme sedation or respiratory depression. Coadministration is contraindicated. Temporarily discontinue ZOKINVY for 10-14 days before and 2 days after midazolam.
- Other sensitive CYP3A substrates: ZOKINVY increases the AUC and Cmax of CYP3A substrates, which may increase their adverse reactions. Avoid coadministration. If unavoidable, monitor for adverse reactions and reduce the substrate dosage per its approved labeling.
- Loperamide: ZOKINVY increases the AUC and Cmax of loperamide, which may increase the risk of loperamide's adverse reactions. Loperamide is contraindicated in patients less than 2 years of age. Do not exceed loperamide 1 mg once daily when first coadministered; increase slowly with caution per its labeling.
- CYP2C19 substrates: ZOKINVY, a moderate CYP2C19 inhibitor, increases the AUC and Cmax of CYP2C19 substrates, which may increase their adverse reactions. Avoid coadministration. If unavoidable, monitor for adverse reactions and reduce the substrate dosage per its approved labeling.
Read the label’s full interactions text
7 DRUG INTERACTIONS QTc Interval Prolongation Drugs: Avoid concomitant use with ZOKINVY. ( 2.2 , 5.2 , 7.1 , 12.3 ) See full prescribing information for additional clinically significant drug interactions with ZOKINVY and recommended dosage modifications for drug interactions. ( 2.2 , 7 ) 7.1 Effect of Other Drugs on ZOKINVY Table 5 presents clinically significant drug interactions involving drugs that affect ZOKINVY. Table 5: Clinically Significant Drug Interactions (Drugs that Affect ZOKINVY) CYP3A Inhibitors Clinical Impact Lonafarnib is metabolized by CYP3A. Concomitant use of ZOKINVY with a strong CYP3A inhibitor may increase lonafarnib area under curve (AUC) and maximum concentration (C max ) [see Clinical Pharmacology ( 12.3 )] , which may increase the incidence and severity of adverse reactions, including QTc interval prolongation. Prolongation of the QTc interval increases the risk of Torsade de pointes, other serious arrhythmias, and sudden death [see Warnings and Precautions ( 5.1 )] . Prevention or Management Strong CYP3A inhibitors Use of ZOKINVY with strong CYP3A inhibitors is contraindicated [see Contraindications ( 4 )] . Avoid consumption of grapefruit or Seville oranges. Moderate CYP3A inhibitors No dosage adjustment for ZOKINVY is recommended when moderate CYP3A inhibitors are added to steady-state ZOKINVY [see Dosage and Administration ( 2.2 )] . When initiating ZOKINVY in a patient who is currently on a moderate CYP3A inhibitor, the patient may be at increased risk of adverse reactions [see Dosage and Administration ( 2.2 )] . CYP3A Inducers Clinical Impact Coadministration of ZOKINVY with a strong CYP3A inducer decreases lonafarnib C max and AUC [see Clinical Pharmacology ( 12.3 )] , which may reduce ZOKINVY efficacy. Prevention or Management Strong or moderate CYP3A inducers Use of ZOKINVY with strong or moderate CYP3A inducers is contraindicated [see Contraindications ( 4 )] . Weak CYP3A inducers No ZOKINVY dosage adjustment is recommended.
Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Lonafarnib
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- Do not take it with the contraindicated medicines listed above.
- Tell your doctor about any heart rhythm history or low potassium or magnesium.
- Pregnancy: it can cause fetal harm. Use effective contraception if you could become pregnant.
- Fertility may be reduced, based on animal findings.
- Breastfeeding: no human data exist, so discuss it with your doctor.
- Children: it is used from 12 months of age with a body surface area of at least 0.39 m².
- Adults: safety and effectiveness have been established for the labeled uses.
What Lonafarnib does in the body
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Lonafarnib lengthens the QTc interval, a measure of the heart’s electrical recovery time. In a study of healthy volunteers, the largest average increase was 19 msec, seen 48 hours after a dose. This is why ECG monitoring is part of treatment.
How your body processes Lonafarnib
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Taking lonafarnib with food lowers how much is absorbed, which is why the label pairs dosing with meals to reduce stomach side effects. It is highly bound to proteins in the blood and has a half-life of about 4 to 6 hours in healthy people. It is broken down mainly by the CYP3A enzyme. About 62% of a radiolabeled dose was found in feces.
How to store Lonafarnib
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Store at 20°C-25°C (68°F-77°F), excursions permitted to 15°C-30ºC (59°F-86ºF) .
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Lonafarnib
160 supplements and herbal products have documented interactions with Lonafarnib in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 5
- Moderate · 115
- Minor · 40
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Lonafarnib: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Lonafarnib — the kind of thing our pharmacy team would talk through with you at the counter.
What is lonafarnib for?
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How should I take it?
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What if I miss a dose?
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What side effects should I expect?
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Can I take it with my other medicines or juices?
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Is it safe during pregnancy?
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Is Lonafarnib available over the counter?
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When was Lonafarnib first available?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Lonafarnib on HelloPharmacist
Lonafarnib forms and strengths (how it comes)
Lonafarnib is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Lonafarnib inactive ingredients by manufacturer.
Capsule
How this form is used
- Zokinvy is used to reduce the risk of death in Hutchinson-Gilford Progeria Syndrome.
- Zokinvy is used to treat processing-deficient progeroid laminopathies with a heterozygous LMNA mutation with progerin-like protein accumulation, or homozygous or compound heterozygous ZMPSTE24 mutations.
- Zokinvy is taken by mouth with the morning and evening meals.
- Zokinvy capsules are swallowed whole with enough water and are not chewed.
- If swallowing capsules is not possible, Zokinvy capsule contents can be mixed with Ora Blend SF, Ora-Plus, orange juice or applesauce and taken within about 10 minutes.
- Do not mix Zokinvy with grapefruit or Seville orange juice.
Lonafarnib on the U.S. market: products, makers and brands
How Lonafarnib appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
1 company lists 2 Lonafarnib product records with the FDA, mostly as capsule; the earliest marketing or approval year on record is 2020. Brand names on the directory include Zokinvy; the rest are generics.
Also listed with the FDA, not a patient dose form: Powder (2) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Compare Lonafarnib products
A representative set of FDA-listed product records for Lonafarnib — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Capsule | ||||
| 50 mg | Oral | Sentynl Therapeutics, Inc. | NDA | View NDC → |
| 75 mg | Oral | Sentynl Therapeutics, Inc. | NDA | View NDC → |
Showing 2 of 2 products — FDA National Drug Code Directory. See every product, package size and price: browse all 2 Lonafarnib NDCs →
Lonafarnib side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Lonafarnib — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Lonafarnib in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Lonafarnib FDA approval history
How Lonafarnib went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Lonafarnib recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Lonafarnib recalls since July 2021.
✅No Lonafarnib recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 2467553 1 dose form · 2 strengths
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Dose form (SCDF) Oral Capsule RxCUI 2467581In current FDA listings
Look up RxCUI 2467553 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Lonafarnib supply and shortage status
Whether Lonafarnib is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
Lonafarnib brand names
Lonafarnib is sold under one brand name in the FDA directory — Zokinvy. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Lonafarnib: manufacturers and labelers
One company lists Lonafarnib products with the FDA. By number of product records, the largest are Sentynl Therapeutics, Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Lonafarnib drug class (RxNorm)
Lonafarnib belongs to the Farnesyltransferase Inhibitor class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Lonafarnib page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Sentynl Therapeutics, Inc. is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →