Zongertinib
Zongertinib (Hernexeos) is a targeted kinase inhibitor used to treat adults with certain HER2-mutation-driven non-small cell lung cancer that cannot be surgically removed or has spread.
🧬 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 →
How we combine label and product data →
Zongertinib (Hernexeos) is a once-daily targeted tablet for adults with advanced (cannot be removed surgically or has spread) non-squamous non-small cell lung cancer carrying a specific HER2 mutation, blocking overactive HER2 and its downstream growth signals; it is a specialist drug, new in 2025 under accelerated approval. Side effects are usually manageable, with diarrhea the one most people notice, plus rash or mouth sores. The key risk is liver injury, so expect regular blood tests and report yellow skin or eyes or dark urine right away. Heart function is checked too, and new breathlessness, cough or fever needs a prompt call, since serious lung inflammation can occur.
Clinical pearls
- Swallow the tablets whole with water, with or without food, and never split, crush or chew them.
- If a dose is more than 12 hours late, skip it, and if you vomit after a dose, do not repeat it.
- Carbamazepine can make zongertinib less effective, and zongertinib can raise rosuvastatin levels, so flag both to every prescriber.
- Women who can become pregnant need a pregnancy test first, then effective contraception and no breastfeeding until two weeks after the last dose.
Patient information guide — a plain-language walkthrough of Zongertinib, written from its FDA label.
What Zongertinib is used for
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Zongertinib (brand name Hernexeos) is approved for one specific use in adults with lung cancer:
- Hernexeos is used to treat adults with unresectable (inoperable) or metastatic (spread) non-squamous non-small cell lung cancer (NSCLC) whose tumors carry HER2 (ERBB2) tyrosine kinase domain activating mutations, confirmed by an FDA-authorized test.
- This approval is based on objective response rate (how many tumors shrank) and duration of response (how long they stayed smaller). Continued approval may depend on results from ongoing confirmatory trials.
How Zongertinib works
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Zongertinib is a kinase inhibitor — it works by blocking HER2 (human epidermal growth factor receptor 2), a protein that, when mutated in certain lung cancers, sends abnormal signals telling cancer cells to grow and divide. By blocking HER2 and the downstream signals it triggers (like ERK phosphorylation), zongertinib slows or halts the growth of these cancer cells. Laboratory and animal studies confirmed it can reduce tumor activity in NSCLC models carrying these HER2 mutations.
Zongertinib dosage
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Hernexeos tablets are taken once daily by mouth, with or without food. The dose your prescriber recommends depends on your body weight. Tablets must be swallowed whole with water — never split, crushed, or chewed. Treatment continues until the cancer progresses or side effects become unacceptable.
- Missed dose: If you remember within 12 hours of your usual time, take it. If more than 12 hours have passed, skip it and take your next dose as scheduled.
- Vomited dose: Do not retake it — continue with your next dose at the regular time.
Dosing details from the FDA-approved label
From the Zongertinib 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.
- Unresectable or metastatic NSCLC with HER2 (ERBB2) tyrosine kinase domain activating mutations, patients weighing less than 90 kg
- 120 mg orally once daily with or without food until disease progression or unacceptable toxicity
- Swallow tablets whole with water; do not split, crush, or chew. If a dose is missed within 12 hours, take it; if missed by more than 12 hours, skip it. If vomited, do not take an additional dose. Dose reductions: 120 mg to 60 mg; permanently discontinue if unable to tolerate 60 mg once daily
- Unresectable or metastatic NSCLC with HER2 (ERBB2) tyrosine kinase domain activating mutations, patients weighing 90 kg or greater
- 180 mg orally once daily with or without food until disease progression or unacceptable toxicity
- Swallow tablets whole with water; do not split, crush, or chew. Dose reductions: 180 mg to 120 mg, then 60 mg; permanently discontinue if unable to tolerate 60 mg once daily
- Patients weighing less than 90 kg when concomitant strong CYP3A inducer use cannot be avoided
- Increase from 120 mg to 240 mg
- Resume the prior dose 7 to 14 days after discontinuing the CYP3A inducer
- Patients weighing 90 kg or greater when concomitant strong CYP3A inducer use cannot be avoided
- Increase from 180 mg to 360 mg
- Resume the prior dose 7 to 14 days after discontinuing the CYP3A inducer
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION Select patients for treatment with HERNEXEOS based on the presence of HER2 (ERBB2) tyrosine kinase domain activating mutations. ( 2.1 ) The recommended dosage of HERNEXEOS is based on body weight: ( 2.2 ) Patients weighing less than 90 kg: 120 mg ( 2.2 ) Patients weighing 90 kg or greater: 180 mg ( 2.2 ) Take HERNEXEOS orally once daily with or without food until disease progression or unacceptable toxicity. ( 2.2 ) 2.1 Patient Selection Select patients for treatment of unresectable or metastatic NSCLC based on the presence of HER2 (ERBB2) tyrosine kinase domain activating mutations in tumor or plasma specimens [see Clinical Studies (14) ] . If no mutation is detected in a plasma specimen, test tumor tissue. Information on FDA-authorized tests for HER2 (ERBB2) tyrosine kinase domain activating mutations is available at: http://www.fda.gov/CompanionDiagnostics. 2.2 Recommended Dosage and Administration The recommended dosage of HERNEXEOS is based on body weight: Patients weighing less than 90 kg: 120 mg Patients weighing 90 kg or greater: 180 mg Take HERNEXEOS orally once daily with or without food until disease progression or unacceptable toxicity. Swallow HERNEXEOS tablets whole with water. Do not split, crush, or chew tablets. Missed Dose If a dose is missed within 12 hours, take the dose. If a dose is missed by more than 12 hours, skip the missed dose and take the next scheduled dose. Vomited Dose If a dose is vomited, do not take an additional dose. Take the next dose at the regularly scheduled time. 2.3 Dosage Modifications for Adverse Reactions The recommended dose reductions for adverse reactions are presented in Table 1. Table 1 Recommended HERNEXEOS Dose Reductions for Adverse Reactions Current HERNEXEOS Dose First Reduction Second Reduction 180 mg 120 mg 60 mg 120 mg 60 mg Permanently discontinue Permanently discontinue HERNEXEOS in patients who are unable to tolerate 60 mg once daily. The recommended dosage modifications for adverse reactions are presented in Table 2.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Zongertinib side effects
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Common side effects
- Diarrhea
- Skin rash
- Fatigue or tiredness
- Nausea
- Musculoskeletal (muscle and joint) pain
- Upper respiratory tract infections (such as colds)
- Mouth sores (stomatitis)
- Nail changes
When to get medical help
- Call your doctor right away if you notice yellowing of the skin or eyes, dark urine, severe stomach pain, or unusual fatigue — these can be signs of liver problems (hepatotoxicity)
- Tell your doctor immediately if you develop new or worsening shortness of breath, cough, or fever — these may signal a serious lung condition called interstitial lung disease or pneumonitis
- Contact your doctor if you feel heart palpitations, unusual fatigue, or swelling in your legs — these could be signs of decreased heart function (left ventricular dysfunction)
- Tell your prescriber if you are pregnant or plan to become pregnant — this drug can cause serious harm to an unborn baby
The most common side effects reported in clinical trials of Hernexeos include:
- Diarrhea (very common — over half of patients)
- Skin rash
- Liver test abnormalities (hepatotoxicity)
- Fatigue
- Nausea
- Muscle and joint pain (musculoskeletal pain)
- Upper respiratory tract infections
- Mouth sores (stomatitis)
- Nail changes
- Cough
More serious reactions — including severe liver injury, decreased heart pumping function, and life-threatening lung inflammation — require prompt medical attention. Tell your doctor right away if you develop yellowing of the skin or eyes, new shortness of breath, persistent cough, fever, or any signs of heart trouble.
Zongertinib warnings and precautions
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- Liver toxicity (hepatotoxicity): Hernexeos can cause severe and life-threatening liver damage. Liver function tests are monitored at baseline, every 2 weeks for the first 12 weeks, then monthly. Watch for yellow skin or eyes, dark urine, or severe fatigue.
- Decreased heart function (left ventricular dysfunction): Drops in the heart's pumping ability (LVEF) have occurred, including serious cases. Heart function is evaluated before starting and monitored regularly during treatment. Report shortness of breath, swelling, or palpitations.
- Lung inflammation (interstitial lung disease/pneumonitis): Serious and potentially fatal lung inflammation has been reported. Seek care immediately for new or worsening shortness of breath, cough, or fever.
- Fetal harm (embryo-fetal toxicity): Hernexeos can seriously harm an unborn baby. Effective contraception is required during treatment and for 2 weeks after the last dose. Do not breastfeed during treatment and for 2 weeks afterward.
Zongertinib interactions
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Zongertinib is broken down mainly by liver enzymes (CYP3A4/3A5), and it can affect how certain other drugs are processed. Key interactions to know about:
- Strong CYP3A inducers (e.g., carbamazepine): These drugs significantly lower zongertinib blood levels, potentially making Hernexeos less effective. Avoid combining if possible; if unavoidable, the Hernexeos dose will need to be increased under medical supervision.
- BCRP substrate drugs (e.g., rosuvastatin): Zongertinib raises blood levels of these drugs, which can increase their side effects. Some combinations should be avoided; others require close monitoring and possible dose adjustment of the other drug.
- Strong CYP3A inhibitors, P-gp inhibitors, and proton pump inhibitors: No clinically significant effect on zongertinib levels was found with these drug classes in studies.
Interactions listed in the FDA-approved label
From the Zongertinib prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- Strong CYP3A inducers: Zongertinib is a CYP3A substrate; strong CYP3A inducers decrease zongertinib exposure, which may reduce effectiveness of HERNEXEOS. Avoid concomitant use. If it cannot be avoided, increase the HERNEXEOS dose based on body weight.
- BCRP substrates: Zongertinib is a BCRP inhibitor; HERNEXEOS increases exposure of BCRP substrates, which may increase the risk of adverse reactions related to these substrates. Avoid concomitant use with certain BCRP substrates where minimal concentration changes may lead to serious adverse reactions. If it cannot be avoided, monitor for increased adverse reactions and follow the substrate's approved labeling. For other BCRP substrates, monitor for increased adverse reactions and adjust dosages as clinically appropriate.
Read the label’s full interactions text
7 DRUG INTERACTIONS Strong CYP3A Inducers : Avoid concomitant use with strong CYP3A inducers. If concomitant use cannot be avoided, increase HERNEXEOS dose. ( 7.1 ) BCRP Substrates : Avoid concomitant use with certain BCRP substrates where minimal concentration increase may lead to serious adverse reactions and consider alternative therapies. If concomitant use cannot be avoided, monitor patients closely for adverse reactions and follow recommendations provided in the BCRP substrate approved product labeling. For other BCRP substrates, monitor for increased adverse reactions and adjust the dosages of those substrates as clinically appropriate. ( 7.2 ) 7.1 Effects of Other Drugs on HERNEXEOS Avoid concomitant use of HERNEXEOS with strong CYP3A inducers. If concomitant use cannot be avoided, increase HERNEXEOS dose as recommended [see Dosage and Administration (2.4) ]. Zongertinib is a CYP3A substrate. Strong CYP3A inducers decrease zongertinib exposure [see Clinical Pharmacology (12.3) ] , which may reduce effectiveness of HERNEXEOS. 7.2 Effects of HERNEXEOS on Other Drugs BCRP Substrates Avoid concomitant use of HERNEXEOS with certain BCRP substrates where minimal concentration changes may lead to serious adverse reactions. If coadministration cannot be avoided, monitor for increased adverse reactions and follow recommendations provided in the approved product labeling for the BCRP substrate. For other BCRP substrates, monitor for increased adverse reactions and adjust the dosages of those substrates as clinically appropriate. Zongertinib is a BCRP inhibitor. HERNEXEOS increases exposure of BCRP substrates [see Clinical Pharmacology (12.3) ] , which may increase the risk of adverse reactions related to these substrates.
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 Zongertinib
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- Pregnancy: Hernexeos can cause serious birth defects and harm to a developing baby. A pregnancy test is required before starting. Use effective contraception during treatment and for 2 weeks after the last dose.
- Breastfeeding: Do not breastfeed during treatment or for 2 weeks after the last dose, due to the risk of serious harm to the infant.
- Fertility: Animal studies suggest Hernexeos may affect fertility in both males and females. Talk to your doctor if this is a concern.
- Heart disease history: Hernexeos has not been studied in patients with significant cardiac disease or reduced heart pumping function at baseline — inform your doctor of any heart history.
- Liver or kidney problems: Mild liver impairment does not appear to meaningfully affect drug levels, but more severe liver or kidney impairment has not been fully studied. Tell your doctor about any organ function issues.
- Children and adolescents: Safety and effectiveness have not been established in pediatric patients.
- Older adults (65+): Approximately half of clinical trial participants were 65 or older; no major differences in safety or effectiveness were observed compared to younger patients.
- All medications and supplements: Tell your prescriber about every drug, supplement, or herbal product you take, especially carbamazepine or cholesterol-lowering statins.
Zongertinib overdose
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In one reported case, a person who accidentally took 5 times the recommended daily dose experienced nausea and vomiting. If you think you or someone else has taken too much Hernexeos, contact a Poison Control Center or seek emergency medical attention right away.
What Zongertinib does in the body
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At concentrations well above the recommended therapeutic level (about 2.6 times the peak drug level from the standard dose), zongertinib did not cause a meaningful change in the QTc interval — the part of the heart's electrical cycle measured to assess irregular heart rhythm risk. The full relationship between zongertinib blood levels and its anti-cancer effects has not yet been completely mapped out.
How your body processes Zongertinib
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After taking Hernexeos by mouth, zongertinib reaches peak blood levels in about 2 hours and has an oral bioavailability of 76% — meaning most of the dose gets into circulation. It is extensively bound to blood proteins (over 99%) and has an effective half-life of about 12 hours, with steady blood levels reached within about 2.5 days of daily dosing. Food does not meaningfully affect how much drug is absorbed, so it can be taken with or without a meal.
Zongertinib is broken down mainly in the liver, primarily by CYP3A4/3A5 enzymes, and is eliminated mostly through the feces (about 93% of a dose), with very little excreted in urine. Age, sex, race, and mild kidney or liver impairment do not appear to significantly change how the body handles the drug.
How to store Zongertinib
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Store at 20°C to 25°C (68°F to 77°F), excursions permitted to 15°C to 30°C (59°F to 86°F) . Store in the original container to protect from moisture.
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Zongertinib: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Zongertinib — the kind of thing our pharmacy team would talk through with you at the counter.
What exactly is Hernexeos being used to treat in my case?
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Can I take this pill with food, or does it need to be on an empty stomach?
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What side effects are most likely, and which ones should make me call my doctor right away?
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Are there any medications I should avoid while on Hernexeos?
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Is it safe to get pregnant or breastfeed while taking this medication?
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How will my doctor know if the drug is affecting my liver or heart?
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Is Zongertinib available over the counter?
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When was Zongertinib 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 Zongertinib on HelloPharmacist
Zongertinib forms and strengths (how it comes)
Zongertinib 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
- Hernexeos tablets are used to treat adults with unresectable or metastatic non-squamous non-small cell lung cancer (NSCLC) whose tumors test positive for HER2 (ERBB2) tyrosine kinase domain activating mutations
- Hernexeos tablets are taken once daily by mouth, with or without food
- Swallow Hernexeos tablets whole with water — do not split, crush, or chew them
- If you miss a dose by 12 hours or less, take it; if more than 12 hours have passed, skip it and take the next dose at the regular time
- If you vomit after taking Hernexeos, do not take an extra dose — resume your next scheduled dose as normal
Zongertinib on the U.S. market: products, makers and brands
How Zongertinib 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 1 Zongertinib product record with the FDA, mostly as tablet; the earliest marketing or approval year on record is 2025. Brand names on the directory include Hernexeos; the rest are generics.
Also listed with the FDA, not a patient dose form: Powder (4) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Compare Zongertinib products
A representative set of FDA-listed product records for Zongertinib — 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 | ||||
| 60 mg | Oral | Boehringer Ingelheim Pharmaceuticals, Inc. | NDA | View NDC → |
Showing 1 of 1 products — FDA National Drug Code Directory. See every product, package size and price: browse all 1 Zongertinib NDCs →
Zongertinib 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 Zongertinib — 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 Zongertinib 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.
Zongertinib FDA approval history
How Zongertinib went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Zongertinib 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 Zongertinib recalls since July 2021.
✅No Zongertinib 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 2721604 1 dose form · 1 strength
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Dose form (SCDF) Oral Tablet RxCUI 2721608In current FDA listingsClinical drug / strength (SCD) 60 MGRxCUI 2721609
Look up RxCUI 2721604 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.
Zongertinib supply and shortage status
Whether Zongertinib 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.
Zongertinib brand names
Zongertinib is sold under one brand name in the FDA directory — Hernexeos. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Zongertinib: manufacturers and labelers
One company lists Zongertinib products with the FDA. By number of product records, the largest are Boehringer Ingelheim Pharmaceuticals, Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Zongertinib drug class (RxNorm)
Zongertinib belongs to the Human epidermal growth factor receptor 2 (HER2) tyrosine kinase inhibitors 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 Zongertinib 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. Boehringer Ingelheim Pharmaceuticals, 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 →