Selinexor
Selinexor is a targeted cancer medicine used to treat multiple myeloma in adults who have already tried other therapies.
🧬 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 1 clinical label set 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 →
📖 Selinexor: Patient Information Guide
A plain-language walkthrough of Selinexor — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.
🎯What it's used for▾
Selinexor is a nuclear export inhibitor approved for adults with multiple myeloma. The specific use depends on which regimen is prescribed:
- Xpovio in combination with bortezomib and dexamethasone (XVd): for adults with multiple myeloma who have received at least one prior therapy
- Xpovio in combination with dexamethasone alone (Xd): for adults with relapsed or refractory multiple myeloma who have had at least four prior therapies and whose disease is no longer responding to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody
⚙️How it works▾
Selinexor targets a protein called exportin 1 (XPO1) that cancer cells rely on to push tumor-suppressor proteins out of the cell's control center (the nucleus). By blocking XPO1, selinexor traps those protective proteins inside the nucleus, where they can do their job of slowing cancer growth. At the same time, it reduces levels of proteins that drive cancer cell growth — such as c-myc and cyclin D1 — causing cancer cells to stop dividing and die.
When combined with dexamethasone or bortezomib, selinexor shows synergistic (greater-than-additive) cell-killing effects in multiple myeloma, including in cancer that has become resistant to proteasome inhibitors.
💊How it's taken▾
Xpovio tablets are taken by mouth, swallowed whole with water, at approximately the same time each dosing day. The frequency depends on which treatment combination your oncologist prescribes — either once weekly or on two specific days per week. Food does not significantly affect how the drug is absorbed, so it can be taken with or without a meal.
- If you miss a dose, take it at the next regularly scheduled time — do not take two doses to make up for a missed one
- If you vomit after taking a dose, do not retake it — wait for your next scheduled dose
- Your doctor may adjust, pause, or reduce your dose based on side effects; this is common and expected with this type of therapy
🤒Side effects — in detail▾
Side effects with selinexor are common and vary depending on which combination regimen you are receiving. The most frequently reported ones include:
- Fatigue and weakness
- Nausea and vomiting
- Decreased appetite and weight loss
- Diarrhea
- Low platelet counts (thrombocytopenia)
- Low red blood cell counts (anemia)
- Low white blood cell counts (neutropenia and leukopenia)
- Upper respiratory tract infections
- Peripheral neuropathy (tingling, numbness, or weakness in hands or feet)
- Cataracts (clouding of the eye lens)
- Low blood sodium (hyponatremia)
Thrombocytopenia (low platelets) is the most serious and common reason for dose changes. Severe infections, bleeding, and neurological symptoms also require prompt medical attention. Your care team will monitor your blood regularly to catch these problems early.
⚠️Warnings & precautions▾
- Thrombocytopenia (low platelets): This is the leading reason doses need to be adjusted. It can cause life-threatening bleeding. Watch for unusual bruising, tiny red spots on the skin, or prolonged bleeding from cuts.
- Neutropenia (low white blood cells): Raises risk of serious and potentially fatal infections. Report fever, chills, or any sign of infection immediately.
- Gastrointestinal toxicity: Nausea, vomiting, diarrhea, appetite loss, and weight loss are common. Anti-nausea medicines are usually given before each dose as a precaution. Severe symptoms require dose interruption.
- Hyponatremia (low blood sodium): Can cause confusion, dizziness, or in severe cases, seizures. Blood sodium is monitored throughout treatment.
- Neurological toxicity: Dizziness and mental status changes can occur. Avoid driving or operating heavy machinery until symptoms resolve.
- Embryo-fetal toxicity: Selinexor can cause serious harm to an unborn baby. Effective contraception is required for both men and women during treatment and for one week after the last dose.
- Cataracts: Can develop or worsen during treatment. Surgical removal may ultimately be needed.
🔀What it interacts with▾
Selinexor has a relatively limited drug interaction profile based on clinical data, but you should always tell your full care team about every medication, supplement, or over-the-counter product you take.
- OATP1B3 transporter substrates: Selinexor inhibits this transporter, which could affect how certain other drugs move through the body — your oncologist and pharmacist should review your full medication list
- Acetaminophen (Tylenol): No clinically significant interaction was found in studies, but inform your care team of all over-the-counter use
- Strong CYP3A4 inhibitors (e.g., clarithromycin) and inducers (e.g., carbamazepine): Clinical studies did not show a meaningful change in selinexor levels with these drugs, but always disclose all medications to your team
This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.
📋Before taking it▾
- Pregnancy: Selinexor can cause serious harm to a fetus. A pregnancy test is required before starting treatment. Do not use if pregnant unless discussed thoroughly with your oncologist.
- Contraception: Women of childbearing age must use effective birth control during treatment and for one week after the last dose. Men with female partners who could become pregnant must also use contraception during this time.
- Breastfeeding: Do not breastfeed while taking Xpovio or for one week after stopping — potential harm to the nursing infant is unknown.
- Fertility: Based on animal studies, selinexor may affect fertility in both women and men — discuss this with your doctor before starting treatment if this is a concern.
- Children: Xpovio has not been studied in pediatric patients and is not approved for use in children.
- Older adults: Adults 65 and older — especially those 75 and older — may have a higher rate of serious side effects and may be more likely to need treatment stopped. Closer monitoring is important.
- Severe liver disease (hepatic impairment): A lower starting dose is recommended for patients with severe hepatic impairment. Mild to moderate liver disease does not require a dose change.
- Kidney disease (renal impairment): No dose adjustment is needed for mild to severe kidney disease, but the effect of end-stage kidney disease has not been fully studied.
📡Pharmacodynamics — effects in the body▾
Higher blood levels of selinexor are associated with a greater likelihood of needing dose adjustments and experiencing certain side effects — so the drug is carefully dosed to balance effectiveness and tolerability. At therapeutic doses, Xpovio does not cause a clinically meaningful effect on heart rhythm (specifically the QTc interval), meaning it is not expected to cause the type of dangerous arrhythmia sometimes seen with other cancer drugs.
🔬Pharmacokinetics — how your body processes it▾
After taking an Xpovio tablet, selinexor reaches its peak blood level within about 4 hours. It is highly protein-bound (about 95%) and is broken down mainly by liver enzymes (CYP3A4, UGTs, and GSTs). The drug's half-life — the time for half of it to leave the body — is 6 to 8 hours after a single dose, and it does not build up significantly with repeated dosing. Food, including a high-fat meal, does not meaningfully change how much of the drug is absorbed, so it can be taken with or without food. In patients with severe liver disease, drug exposure increases by about 32%, which is why a lower starting dose is used in that group.
📦How to store it▾
Store at or below 30°C (86°F).
📄 Written from Selinexor’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →
Supplements & herbs that interact with Selinexor
138 supplements and herbal products have documented interactions with Selinexor in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 3
- Moderate · 94
- Minor · 41
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.
🩺 Pharmacist Counseling Corner
Quick, plain-English answers to the questions patients ask most about Selinexor — the kind of thing our pharmacy team would talk through with you at the counter.
What exactly is Xpovio and why has my doctor prescribed it for my multiple myeloma? ▾
When and how should I take my Xpovio tablets? ▾
What side effects should I watch out for, and when should I call my doctor? ▾
Will I need blood tests while I'm on this treatment? ▾
Can I become pregnant or father a child while taking Xpovio? ▾
My dose got reduced — does that mean the treatment isn't working anymore? ▾
Is Selinexor available over the counter? ▾
When was Selinexor first available? ▾
Who makes Selinexor? ▾
💬 Answers drafted from Selinexor’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →
🧰 Keep exploring
💊 How Selinexor comes
Selinexor 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.
Tablet
How this form is used
- Xpovio tablets are used in combination with bortezomib and dexamethasone to treat adults with multiple myeloma who have had at least one prior therapy
- Xpovio tablets are used in combination with dexamethasone alone for adults with relapsed or refractory multiple myeloma who have had at least four prior therapies and whose disease no longer responds to several standard treatments
- Xpovio tablets should be swallowed whole with water — do not break, chew, crush, or divide them
- Xpovio tablets should be taken at approximately the same time of day with each scheduled dose, and can be taken with or without food
- If a Xpovio dose is missed or delayed, take the next dose at the next regularly scheduled time — do not double up
- If you vomit after taking a Xpovio tablet, do not take another dose that day — wait until your next scheduled dose
📊 Selinexor across the U.S. market
How Selinexor 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.
Also listed with the FDA, not a patient dose form: Powder (1) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
📈 How widely Selinexor is used
A general measure of how commonly Selinexor is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Selinexor is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Selinexor prescribed? Of the 1,594 medications we measure, Selinexor ranks #1,569 by Medicaid prescriptions — more than 2% of them.
Utilization by Selinexor product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
Other Selinexor products — combination packs and listings not yet matched to a specific clinical product (kept visible so every prescription is accounted for)
Summed across the 2 of 19 listed NDC products with Medicaid activity.
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Selinexor, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 2 of 19 listed Selinexor NDCs with Medicaid activity.
🔍 Compare Selinexor products
A representative set of FDA-listed product records for Selinexor — 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 |
|---|---|---|---|---|
| 💊Tablet | ||||
| 10 mg | — | Catalent Pharma Solutions, LLC | DRUG FOR FURTHER PROCESSING | View NDC → |
| 20 mg | — | Catalent Pharma Solutions, LLC | DRUG FOR FURTHER PROCESSING | View NDC → |
| 80 mg | — | Catalent Pharma Solutions, LLC | DRUG FOR FURTHER PROCESSING | View NDC → |
| 10 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 20 mg | Oral | Karyopharm Therapeutics Inc. × 2 listings | NDA | View NDC → |
| 40 mg | Oral | Karyopharm Therapeutics Inc. × 2 listings | NDA | View NDC → |
| 50 mg | Oral | Karyopharm Therapeutics Inc. × 2 listings | NDA | View NDC → |
| 60 mg | Oral | Karyopharm Therapeutics Inc. × 2 listings | NDA | View NDC → |
| 80 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 💊Bulk drug substance | ||||
| 1 kg/kg | — | Finorga | BULK INGREDIENT | View NDC → |
Showing 14 of 14 products — FDA National Drug Code Directory. See every product, package size and price: browse all 14 Selinexor NDCs →
📈 What people report — real-world data (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 Selinexor — 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 Selinexor 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.
🏛️ The road to your pharmacy
How Selinexor went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
🚨 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.
Source: openFDA drug enforcement (recall) reports.
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 2178390 1 dose form · 6 strengths
-
Dose form (SCDF) Oral Tablet RxCUI 2178394In current FDA listings
Look up RxCUI 2178390 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.
📦 Supply & shortage status
Whether Selinexor 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.
🏷️ Sold under these brand names
🏭 Manufacturers & labelers
RxNorm drug class
Selinexor belongs to the Nuclear Export 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.
🔬 Where this comes from
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 we combine label and product data
HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 1 FDA-filed SPL label set within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.
For canonical ingredient pages, bounded product-attributed indication and administration excerpts may be added to the AI evidence, and the generator is instructed to preserve available product, brand, route, and form qualifiers instead of treating one label as universal. Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. Karyopharm Therapeutics Inc. is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.
This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.