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Care During Chemotherapy and Beyond

Niraparib

(nye RAP a rib)

Trade Name(s): ZejulaTM

Niraparib is the generic name for the trade name drug ZejulaTM. In some cases, health care professionals may use the trade name ZejulaTM when referring to the generic drug name niraparib.

Drug Type: Niraparib is an anti-cancer ("antineoplastic" or "cytotoxic") targeted therapy. This medication is classified as a PARP (poly ADP ribose polymerase) inhibitor. (For more detail, see "How Niraparib Works" below)

What Niraparib Is Used For:

  • Niraparib is indicated as a maintenance treatment for recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients who are in a complete or partial response to platinum based chemotherapy. It is usually started within 8 weeks following the most recent platinum containing regimen.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Niraparib Is Given:

  • Niraparib is a capsule, taken by mouth daily.
  • Consider taking at bedtime to decrease the risk for nausea or vomiting.
  • It may be taken with or without food.
  • Swallow niraparib capsules whole. Do not open, crush or dissolve the capsules.
  • Do not change your dose or stop niraparib unless your health care provider tells you to.
  • If you miss a dose, take your next dose at your usually scheduled time. Do not take an extra dose to make up for a missed dose.
  • If you take too much niraparib, call your health care provider right away and go to the emergency room.
  • Do not repeat a vomited dose.
  • Let your doctor know if you are starting any new medications as some medications interact with niraparib.

The amount of niraparib that you will receive depends on many factors, your general health or other health problems, and the type of side effects that you may have. Your doctor will determine you exact dosage and schedule.

Side Effects:

Important things to remember about the side effects of niraparib:

  • Most people will not experience all of the niraparib side effects listed.
  • Side effects are often predictable in terms of their onset, duration, and severity.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking niraparib:

These are less common side effects (occurring in 10-29%) for patients receiving niraparib:

Note all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here.

Always inform your health care provider if you experience any unusual symptoms.

When to Contact Your Health Care Provider:

Contact your health care provider immediately, day or night, and go to the emergency room, if you should experience any of the following symptoms:

  • Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
  • Signs of an allergic reaction, like rash, hives, itching, red, swollen, blistered or peeling skin with or without fever, wheezing, tightness in the chest or throat, trouble breathing or talking, shortness of breath, a cough that is new or worse, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Blood in urine
  • Pain or burning with urination
  • Mouth sores that prevent you from eating or drinking
  • Extreme fatigue (unable to carry on self-care activities)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting niraparib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
  • Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking niraparib.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Niraparib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.).
  • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking niraparib. Barrier methods of contraception, such as condoms, are recommended for up to 6 months after last dose of niraparib.
  • Do not breast feed while taking niraparib.

Self-Care Tips:

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Try taking niraparib at bedtime.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Niraparib:

You will be checked regularly by your doctor while you are taking niraparib to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC).

How Niraparib Works:

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Niraparib is a targeted therapy. Niraparib is a poly ADP-ribose polymerase (PARP) enzyme inhibitor, which is highly selective for PARP1 and PARP2. PARP1 and PARP2 are involved in detecting DNA damage and promote repair. Inhibiting PARP1 and PARP2 enzymatic activity results in DNA damage, apoptosis, and cell death. Niraparib induces cytotoxicity in tumor cell lines with and without BRCA1/2 deficiencies.

Research continues to identify which cancer may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Reference:

Niraparib. Lexicomp Online® [updated 2017 May 1; cited 2017 May 1]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; May 1, 2017.

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