Ponatinib (Iclusig®)

Printable PDF Version

About This Drug

Ponatinib is used to treat cancer. It is given orally (by mouth).

Possible Side Effects

  • Fever
  • Headache
  • Tiredness
  • Nausea and throwing up (vomiting)
  • Pain in your abdomen
  • Loose bowel movements (diarrhea)
  • Constipation (unable to move bowels)
  • High blood pressure
  • Joint and muscle pain
  • Pain in your extremities (arms and/or legs)
  • Effects on the nerves are called peripheral neuropathy. You may feel numbness, tingling, or pain inyour hands and feet. It may be hard for you to button your clothes, open jars, or walk as usual. The effect on the nerves may get worse with more doses of the drug. These effects get better in some people after the drug is stopped but it does not get better in all people.
  • Swelling of your legs, ankles and/or feet
  • Rash
  • Dry skin
  • Changes in your liver function
  • Changes in your pancreas function
  • Changes in your kidney function
  • Electrolyte changes
  • Blood sugar levels may change. If you have diabetes, changes may need to be made to your diabetes medication.
  • Blood clots and events such as stroke and heart attack
  • Decrease in platelets, this could raise your risk of bleeding
  • Decrease in white blood cells, this could raise your risk of infection

Note: Each of the side effects above was reported in 20% or greater of patients treated with ponatinib. Not all possible side effects are included above.

Warnings and Precautions

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding
  • Blurred vision or other changes in eyesight including loss of vision
  • Changes in the tissue of the heart, which can be life-threatening. Some changes may happen that can cause your heart to have less ability to pump blood or cause heart attack. You may have abnormal heartbeats.
  • Abnormal bleeding – symptoms may be coughing up blood, throwing up blood (may look like coffee grounds), red or black tarry bowel movements, abnormally heavy menstrual flow, nosebleeds or any other unusual bleeding.
  • Blood clots and events such as stroke and heart attack which can be life-threatening.A blood clot in your leg may cause your leg to swell, appear red and warm, and/or cause pain. A blood clot in your lungs may cause trouble breathing, pain when breathing, and/or chest pain.
  • Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel extreme tiredness, agitation, confusion, hallucinations (see or hear things that are not there), have trouble understanding or speaking, loss of control of your bowels or bladder, eyesight changes, numbness or lack of strength to your arms, legs, face, or body, seizures or coma. If you start to have any of these symptoms let your doctor know right away.
  • Severe high blood pressure
  • Inflammation of your pancreas
  • Severe changes in your liver function, which can cause liver failure and be life-threatening
  • Tumor lysis syndrome: This drug may act on the cancer cells very quickly. This may affect how your kidneys work.
  • Swelling of your legs, ankles and/or feet. You may have trouble breathing because of fluid build-up around your lungs and/or your heart.
  • Severe peripheral neuropathy
  • Slow wound healing and perforation, which is a hole in your stomach, intestine, esophagus, or other organ, which may be life-threatening.

Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team.

Important Information

  • Ponatinib may cause slow wound healing. It should not be given within 7 days of surgery. If you must have emergency surgery or have an accident that results in a wound, tell the doctor that you are on ponatinib.

How to Take Your Medication

  • Swallow the medicine whole with or without food. Do not crush or dissolve the tablets.
  • Missed dose: If you vomit or miss a dose, take your next dose at the regular time, and contact your physician.  Do not take 2 doses at the same time and do not double up on the next dose.
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time.
  • Storage: Store this medicine in the original container at room temperature. Discuss with your nurse or your doctor how to dispose of unused medicine.

Treating Side Effects

  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help or stop lessen these symptoms.
  • If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping.
  • Ask your nurse or doctor about medicine that can lessen or stop your diarrhea and/or constipation.
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
  • If you have numbness and tingling in your hands and feet, be careful when cooking, walking, and handling sharp objects and hot liquids.
  • If you have diabetes, keep good control of your blood sugar level. Tell your nurse or your doctor if your glucose levels are higher or lower than normal.
  • Manage tiredness by pacing your activities for the day.
  • Be sure to include periods of rest between energy-draining activities.
  • To decrease infection, wash your hands regularly.
  • Avoid close contact with people who have a cold, the flu, or other infections.
  • Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.
  • To help decrease bleeding, use a soft toothbrush. Check with your nurse before using dental floss.
  • Be very careful when using knives or tools.
  • Use an electric shaver instead of a razor.

Food and Drug Interactions

  • Do not eat grapefruit or drink grapefruit juice while taking this medicine. Grapefruit and grapefruit juice may raise the levels of ponatinib in your body. This could make side effects worse.
  • Check with your doctor or pharmacist about all other prescription medicines and dietary supplements you are taking before starting this medicine, as there are known drug interactions with ponatinib. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplement to make sure that there are no interactions.
  • Avoid the use of St. John’s Wort while taking ponatinib as this may lower the levels of the drug in your body, which can make it less effective.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Feeling dizzy or lightheaded
  • Easy bleeding or bruising
  • Confusion and/or agitation
  • Seizures
  • Hallucinations
  • Trouble understanding or speaking
  • Blurry vision or changes in your eyesight
  • Numbness or lack of strength to your arms, legs, face, or body
  • Pain in your chest
  • Dry cough
  • Coughing up blood
  • Wheezing and/or trouble breathing
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Fatigue that interferes with your daily activities
  • Your leg or arm is swollen, red, warm and/or painful
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause. If you have any of these symptoms for 2 minutes, call 911.
  • Blood in your urine, vomit (bright red or coffee-ground) and/or stools ( bright red, or black/tarry)
  • Abnormal blood sugar
  • Unusual thirst, passing urine often, headache, sweating, shakiness, irritability
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Fatigue that interferes with your daily activities
  • Pain in your abdomen that does not go away
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Loose bowel movements (diarrhea) 4 times a day or loose bowel movements with lack of strength or a feeling of being dizzy
  • Signs of possible liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
  • Decreased urine, or very dark urine
  • Signs of tumor lysis: Confusion or agitation, decreased urine, nausea/vomiting, diarrhea, muscle cramping, numbness and/or tingling, seizures.
  • Swelling of legs, ankles, or feet
  • Weight gain of 5 pounds in one week (fluid retention)
  • Pain that does not go away, or is not relieved by prescribed medicines
  • New rash and/or itching
  • Rash that is not relieved by prescribed medicines
  • Numbness, tingling, or pain your hands and feet
  • If you think you may be pregnant

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 3 weeks after treatment. Let your doctor know right away if you think you may be pregnant
  • Breastfeeding warning: Women should not breast feed during treatment and for 6 days after treatment because this drug could enter the breast milk and cause harm to a breast feeding baby.
  • Fertility warning: In women, this drug may affect your ability to have children in the future. Talk with your doctor or nurse if you plan to have children.Ask for information on egg banking.

Revised February 2018

This information is intended to provide helpful health information to the general public and is not to be used in place of any medical, health, psychological, or any other kind of personal professional services. The information herein does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned, nor is the information intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular medication. The dose, method of administration and contraindications for any administered medication should be confirmed before use. UPMC specifically disclaims all responsibility for any liability, loss or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any medication mentioned herein.