Selinexor
Selinexor is an oral cancer medicine (a nuclear export inhibitor) used with other medicines to treat adults with multiple myeloma.
🧬 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 (Xpovio) is a specialist oral cancer medicine for multiple myeloma that has been treated before, always taken with dexamethasone and sometimes bortezomib; it blocks a protein called exportin 1, trapping tumor-fighting proteins in the cell nucleus and lowering proteins that help cancer grow, and it has been on the U.S. market since about 2019. It is one of the harder myeloma drugs to tolerate, and most people notice tiredness, nausea, poor appetite and weight loss. Watch for unusual bleeding or bruising, a sign of very low platelets that can be life-threatening, and for fever, which can mean infection.
Clinical pearls
- Swallow tablets whole with water at about the same time of day, and if you vomit a dose, do not repeat it.
- Take the anti-nausea medicine you are given on schedule, and report ongoing vomiting, diarrhea or weight loss early.
- Expect frequent blood count and sodium checks, especially in the first three months, since both can drop.
- Hold off driving while dizziness or confusion lingers, and report blurry vision, since cataracts can develop or worsen.
Patient information guide A plain-language walkthrough of Selinexor, written from its FDA label.
What Selinexor is used for
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Selinexor is used to treat multiple myeloma in adults, always in combination with other medicines.
- Xpovio tablets with bortezomib and dexamethasone: adults with multiple myeloma who have had at least one prior therapy.
- Xpovio tablets with dexamethasone: adults with relapsed or refractory multiple myeloma who have had at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody.
How Selinexor works
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Selinexor blocks exportin 1 (XPO1), a protein that carries other proteins out of the cell nucleus. With XPO1 blocked, tumor-suppressing proteins build up in the nucleus and cancer-promoting proteins drop.
In lab studies, this caused cancer cells to stop dividing and die. Combining selinexor with dexamethasone or bortezomib increased the effect, including in myeloma cells resistant to proteasome inhibitors.
Selinexor dosage
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Xpovio is a tablet taken by mouth once or twice a week, depending on the combination your prescriber chooses. Your dose may be lowered or paused if side effects occur.
- Swallow tablets whole with water at about the same time of day.
- Do not break, chew, crush or divide them.
- Missed or delayed dose: take the next dose at the next regular time.
- Vomited a dose: do not repeat it. Wait for the next scheduled dose.
- Stay well hydrated and eat enough calories during treatment.
Dosing details from the FDA-approved label
From the Selinexor 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.
- Multiple Myeloma in Combination with Bortezomib and Dexamethasone (XVd)
- XPOVIO 100 mg taken orally once weekly on Day 1 of each week until disease progression or unacceptable toxicity, in combination with bortezomib 1.3 mg/m2 administered subcutaneously once weekly on Day 1 of each week for 4 weeks followed by 1 week off, and dexamethasone 20 mg taken orally twice weekly on Days 1 and 2 of each week
- Multiple Myeloma in Combination with Dexamethasone (Xd)
- XPOVIO 80 mg taken orally on Days 1 and 3 of each week until disease progression or unacceptable toxicity, in combination with dexamethasone 20 mg taken orally with each dose of XPOVIO on Days 1 and 3 of each week
- Severe hepatic impairment (total bilirubin >3x ULN with any AST) - Multiple Myeloma in Combination with Bortezomib and Dexamethasone (XVd)
- 80 mg once weekly starting dosage
- First reduction 60 mg once weekly
- Second reduction 40 mg once weekly
- Third reduction permanently discontinue
- Defined by NCI-ODWG criteria as total bilirubin >3x upper limit of normal with any level of AST
- Severe hepatic impairment (total bilirubin >3x ULN with any AST) - Multiple Myeloma in Combination with Dexamethasone (Xd)
- 100 mg once weekly starting dosage
- First reduction 80 mg once weekly
- Second reduction 60 mg once weekly
- Third reduction permanently discontinue
- Defined by NCI-ODWG criteria as total bilirubin >3x upper limit of normal with any level of AST
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION Multiple Myeloma in Combination with Bortezomib and Dexamethasone (XVd) : Recommended dosage of XPOVIO is 100 mg taken orally once weekly in combination with bortezomib and dexamethasone ( 2.1 ). Multiple Myeloma in Combination with Dexamethasone (Xd) : Recommended dosage of XPOVIO is 80 mg taken orally on Days 1 and 3 of each week in combination with dexamethasone ( 2.1 ). See Full Prescribing Information for dosage in patients with severe hepatic impairment ( 2.5 , 8.6 ). 2.1 Recommended Dosage for Multiple Myeloma In Combination with Bortezomib and Dexamethasone (XVd) The recommended dosage of XPOVIO is 100 mg taken orally once weekly on Day 1 of each week until disease progression or unacceptable toxicity in combination with: Bortezomib 1.3 mg/m 2 administered subcutaneously once weekly on Day 1 of each week for 4 weeks followed by 1 week off. Dexamethasone 20 mg taken orally twice weekly on Days 1 and 2 of each week. Refer to Clinical Studies ( 14.1 ) and the prescribing information of bortezomib and dexamethasone for additional dosing information. In Combination with Dexamethasone (Xd) The recommended dosage of XPOVIO is 80 mg taken orally on Days 1 and 3 of each week until disease progression or unacceptable toxicity in combination with dexamethasone 20 mg taken orally with each dose of XPOVIO on Days 1 and 3 of each week. For additional information regarding the administration of dexamethasone, refer to its prescribing information. 2.2 Recommended Monitoring for Safety Monitor complete blood count (CBC) with differential, standard blood chemistries, body weight, nutritional status, and volume status at baseline and during treatment as clinically indicated. Monitor more frequently during the first three months of treatment [see Warning and Precautions (5.1, 5.2, 5.3, and 5.4)] . Assess the need for dosage modifications of XPOVIO for adverse reactions [see Dosage and Administration ( 2.4 )] . 2.3 Recommended Concomitant Treatments Advise patients to maintain adequate fluid and caloric intake throughout treatment. Consider intravenous hydration for patients at risk of dehydration [see Warnings and Precautions ( 5.3 , 5.4 )] . Provide prophylactic antiemetics. Administer a 5-HT3 receptor antagonist and other anti-nausea agents prior to and during treatment with XPOVIO [see Warnings and Precautions ( 5.3 )] .
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Selinexor side effects
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Side effects are common with selinexor, and the mix depends on the combination used.
Common side effects
- Fatigue
- Nausea and vomiting
- Decreased appetite and weight loss
- Diarrhea
- Low platelet or red blood cell counts
- Low sodium levels
- Peripheral neuropathy (nerve numbness or tingling)
- Upper respiratory tract infection
- Low platelets and anemia (low red blood cells)
When to get medical help
- Unusual bleeding or bruising, which can be a sign of very low platelets (this can be life-threatening)
- Fever, chills or other signs of infection, including pneumonia or sepsis
- Severe or ongoing nausea, vomiting, diarrhea, or weight loss, or signs of dehydration
- Confusion, dizziness or other mental status changes
- Vision changes, which may signal cataracts or other eye problems
- Any sign of low sodium, which your blood tests will track
Call your care team about bleeding, fever or infection signs, severe stomach symptoms, confusion, or vision changes.
Selinexor warnings and precautions
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- Thrombocytopenia: very low platelets can be life-threatening and cause serious bleeding.
- Neutropenia and serious infection: low white cells raise infection risk, including pneumonia and sepsis.
- Gastrointestinal toxicity: nausea, vomiting, diarrhea, appetite loss and weight loss can occur. Anti-nausea medicine is given.
- Hyponatremia: low sodium needs regular blood monitoring.
- Neurological toxicity: dizziness or mental status changes can occur. Avoid driving and hazardous activities until they resolve.
- Embryo-fetal harm: can harm an unborn baby.
- Cataract: may develop or worsen and often needs surgery.
Selinexor interactions
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The label describes few specific interaction concerns.
- Clarithromycin (a strong CYP3A4 inhibitor) did not meaningfully change selinexor levels in studies.
- Carbamazepine (a strong CYP3A4 inducer) did not meaningfully change selinexor levels.
- Acetaminophen did not meaningfully change selinexor levels.
- A high-fat meal did not meaningfully affect how the body handles selinexor.
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 Selinexor
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- There are no listed contraindications.
- Pregnancy: can cause fetal harm. Confirm pregnancy status before starting and use effective contraception during treatment and for 1 week after.
- Breastfeeding: do not breastfeed during treatment and for 1 week after the last dose.
- Fertility: may be impaired in females and males.
- Children: safety and effectiveness have not been established.
- Older adults: more likely to stop treatment or have serious side effects.
- Severe liver impairment: lower starting dose. No change for mild or moderate impairment.
What Selinexor does in the body
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Higher selinexor exposure was linked to a greater chance of dose changes and some side effects. At the approved dose, it did not have a large effect on the heart's QTc interval (an electrical timing measure).
How your body processes Selinexor
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After a dose by mouth, selinexor peaks in the blood within about 4 hours. A high-fat meal did not meaningfully change this. About 95% of it is bound to proteins in the blood.
It is broken down by CYP3A4 and other enzymes (UGTs and GSTs). The average half-life is 6 to 8 hours. Age, sex, weight, and mild to severe kidney impairment did not meaningfully change its levels. Severe liver impairment raised exposure by about 32%.
How to store Selinexor
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Store at or below 30°C (86°F).
Written from the FDA-approved label with AI and reviewed by our pharmacy team. 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.
Selinexor: pharmacist answers to common questions
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 is selinexor used for?
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How do I take it?
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What side effects should I expect?
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When should I call my doctor right away?
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Is it safe in pregnancy or while breastfeeding?
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Should I be careful about driving?
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Is Selinexor available over the counter?
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When was Selinexor 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 Selinexor on HelloPharmacist
Selinexor forms and strengths (how it 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.
Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Selinexor inactive ingredients by manufacturer.
Tablet
How this form is used
- Xpovio is used with bortezomib and dexamethasone for adults with multiple myeloma who have had at least one prior therapy.
- Xpovio is used with dexamethasone for adults with relapsed or refractory multiple myeloma after at least four prior therapies.
- Xpovio tablets are swallowed whole with water at about the same time of day.
- Do not break, chew, crush or divide Xpovio tablets.
- If an Xpovio dose is missed, take the next dose at the next regular time.
- If you vomit an Xpovio dose, do not repeat it.
Selinexor on the U.S. market: products, makers and brands
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.
1 company lists 6 Selinexor product records with the FDA, mostly as tablet; the earliest marketing or approval year on record is 2019. Brand names on the directory include Xpovio; the rest are generics.
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.
How widely Selinexor is used (Medicaid data)
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 1,601 medications we measure, Selinexor ranks #1,575 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 | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 20 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 40 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 50 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 60 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
| 80 mg | Oral | Karyopharm Therapeutics Inc. | NDA | View NDC → |
Showing 6 of 6 products — FDA National Drug Code Directory. See every product, package size and price: browse all 6 Selinexor NDCs →
Selinexor 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 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.
Selinexor FDA approval history
How Selinexor went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Selinexor 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 Selinexor recalls since July 2021.
✅No Selinexor 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 2178390 1 dose form · 6 strengths
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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.
Selinexor supply and 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.
Selinexor brand names
Selinexor is sold under one brand name in the FDA directory — Xpovio. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Selinexor: manufacturers and labelers
One company lists Selinexor products with the FDA. By number of product records, the largest are Karyopharm Therapeutics Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Selinexor drug class (RxNorm)
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.
Sources for this Selinexor 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. Karyopharm 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 →