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Xpovio
selinexor
Adult Dosing .
Dosage forms: TAB (40 mg once weekly pack): 10 mg x16; TAB (40 mg once weekly pack): 40 mg x4; TAB (60 mg once weekly pack): 60 mg x4; TAB (80 mg once weekly pack): 40 mg x8; TAB (80 mg once weekly pack): 80 mg x4; TAB (100 mg once weekly pack): 50 mg x8; TAB (40 mg twice weekly pack): 40 mg x8; TAB (60 mg twice weekly pack): 20 mg x24; TAB (80 mg twice weekly pack): 20 mg x32
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, concomitant meds to mitigate toxicity, and dosing including toxicity-related dose adjustments
multiple myeloma, relapsed or refractory
- [combo with bortezomib and dexamethasone]
- Dose: 100 mg PO x1 on day 1 of 7-day cycle; Info: for patients who have received at least 1 prior tx; do not cut/crush/chew tab
- [combo with dexamethasone]
- Dose: 80 mg PO x1 on days 1, 3 of 7-day cycle; Info: for patients who have received at least 4 prior tx, including at least 2 proteasome inhibitors, at least 2 immunomodulatory agents, and an anti-CD38 agent; do not cut/crush/chew tab
diffuse large B-cell lymphoma, relapsed or refractory
- [60 mg PO x1 on days 1, 3 of 7-day cycle]
- Info: for patients who have received at least 2 lines of tx; do not cut/crush/chew tab
renal dosing
- [see below]
- CrCl >15: no adjustment; CrCl <15: not defined
- HD/PD: not defined
hepatic dosing
- [multiple myeloma in combo with bortezomib and dexamethasone]
- bilirubin >3x ULN: start 80 mg x1 on day 1 of 7-day cycle
- [multiple myeloma in combo with dexamethasone]
- bilirubin >3x ULN: start 100 mg x1 on day 1 of 7-day cycle
- [diffuse large B-cell lymphoma]
- bilirubin >3x ULN: start 40 mg x1 on days 1, 3 of 7-day cycle
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- avoid: breastfeeding during tx and x1wk after D/C
- caution: patients of childbearing potential
- caution: male patients of reproductive potential
- caution: bilirubin >3x ULN
Drug Interactions .
Overview
selinexor
nuclear export inhibitor
- CNS depression
- hypokalemia
- hyponatremia
- immunomodulatory effects
- myelosuppressive oncologic agent
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- arsenic trioxide
- butalbital
- chloramphenicol
- cladribine oral
- clonidine
- codeine
- deferiprone
- dexrazoxane
- doxylamine
- ethanol (alcoholic beverage)
- ethanol injection
- etrasimod
- fexinidazole
- ganciclovir
- haloperidol
- hydrocodone
- isocarboxazid
- kava
- kratom
- metaxalone
- metoclopramide
- midazolam
- natalizumab
- oxybate
- palifermin
- penicillamine
- phenelzine
- pimecrolimus topical
- primaquine
- promethazine
- rabies vaccine
- radium Ra 223 dichloride
- ropeginterferon alfa-2b
- scopolamine
- thalidomide
- tradipitant
- tranylcypromine
- trimethobenzamide
- valganciclovir
- zuranolone
Monitor/Modify Tx
- abiraterone acetate
- acetazolamide
- albendazole
- albuterol
- albuterol inhaled
- aldesleukin
- alemtuzumab
- alfentanil
- allopurinol
- aloe
- alprazolam
- amiloride
- amphotericin
- anthrax vaccine
- anti-thymocyte globulin
- arformoterol inhaled
- asparaginase
- atidarsagene autotemcel
- auranofin
- azathioprine
- baclofen intrathecal
- balsalazide
- baricitinib
- benznidazole
- betamethasone
- betibeglogene autotemcel
- budesonide
- bumetanide
- buprenorphine
- butorphanol
- carbamazepine
- carfilzomib
- cetuximab
- chikungunya vaccine
- chlordiazepoxide
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cidofovir
- cisplatin
- citalopram
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- colchicine
- copper histidinate
- corticotropin
- cortisone
- COVID-19 vaccine
- crizotinib
- cyclophosphamide
- dapsone
- daridorexant
- decitabine
- deferasirox
- deflazacort
- desflurane
- desipramine
- desmopressin
- desvenlafaxine
- deuruxolitinib
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- dichlorphenamide
- digoxin
- dihydrocodeine
- dinutuximab
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- droperidol
- duloxetine
- ebola vaccine, live
- efbemalenograstim alfa
- eflapegrastim (G-CSF)
- elivaldogene autotemcel
- emapalumab
- epinephrine
- escitalopram
- esketamine
- eslicarbazepine acetate
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- etomidate
- etuvetidigene autotemcel
- everolimus
- exagamglogene autotemcel
- fentanyl
- filgrastim (G-CSF)
- flucytosine
- fludrocortisone
- fluoxetine
- fluphenazine
- flurazepam
- fluvoxamine
- formoterol inhaled
- foscarnet
- fosfomycin injection
- fostamatinib
- furosemide
- gabapentin
- gabapentin enacarbil
- givinostat
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- hydrochlorothiazide
- hydrocortisone
- hydromorphone
- hydroxychloroquine
- hydroxyurea
- hydroxyzine
- ifosfamide
- indapamide
- influenza H5N1 vaccine
- influenza vaccine
- insulin
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- isoflurane
- isoproterenol
- Japanese encephalitis vaccine
- ketamine
- leflunomide
- lemborexant
- lenalidomide
- levalbuterol inhaled
- levomilnacipran
- levorphanol
- licorice
- linezolid
- lonafarnib
- lorazepam
- lovotibeglogene autotemcel
- lymphocyte immune globulin, anti-thymocyte globulin
- magnesium citrate
- mannitol
- meningococcal vaccine
- meperidine
- mercaptopurine
- mesalamine
- mesalamine rectal
- methadone
- methazolamide
- methohexital
- methotrexate
- methylprednisolone
- metolazone
- mifepristone
- milnacipran
- mirtazapine
- morphine
- motixafortide
- mycophenolate mofetil
- mycophenolic acid
- nalbuphine
- necitumumab
- nelarabine
- nilotinib
- olanzapine
- oliceridine
- olodaterol inhaled
- olsalazine
- opicapone
- opium
- osilodrostat
- oxazepam
- oxcarbazepine
- oxybutynin
- oxycodone
- oxymorphone
- oxytocin
- pamidronate
- panitumumab
- paroxetine
- pegfilgrastim (G-CSF)
- peginterferon alfa 2a
- peginterferon beta 1a
- pentamidine
- pentazocine
- pentobarbital
- perphenazine
- phenobarbital
- pneumococcal vaccine
- poliovirus vaccine
- polyethylene glycol
- polyethylene glycol/electrolytes
- posaconazole
- prednisolone
- prednisone
- pregabalin
- primidone
- proguanil
- propofol
- pyrimethamine
- quazepam
- ramucirumab
- remifentanil
- remimazolam
- respiratory syncytial virus vaccine
- ribavirin
- rifabutin
- rituximab
- romidepsin
- ruxolitinib topical
- sacituzumab govitecan
- salmeterol inhaled
- sargramostim (GM-CSF)
- sarilumab
- satralizumab
- sertraline
- sevoflurane
- sipuleucel-T
- sirolimus
- sirolimus albumin-bound
- smallpox/mpox vaccine, live
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- spironolactone
- stiripentol
- succimer
- sufentanil
- sulfasalazine
- sulfate bowel prep
- suvorexant
- tafasitamab
- tapentadol
- temazepam
- teplizumab
- terbutaline
- teriflunomide
- thioridazine
- thiothixene
- tick-borne encephalitis vaccine
- tocilizumab
- tofacitinib
- topiramate
- torsemide
- tramadol
- trazodone
- triamcinolone
- triamterene
- triazolam
- trimethoprim
- typhoid vaccine
- upadacitinib
- valproic acid
- vamorolone
- vancomycin
- vasopressin
- venlafaxine
- vilanterol inhaled
- vilazodone
- vortioxetine
- zaleplon
- ziconotide
- zidovudine
- zolpidem
- zonisamide
Caution Advised
- 5-HTP
- abatacept
- abrocitinib
- acalabrutinib
- adalimumab
- afamitresgene autoleucel
- almotriptan
- amantadine
- amitriptyline
- amoxapine
- anakinra
- anifrolumab
- apomorphine
- apraclonidine ophthalmic
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- avacopan
- axicabtagene ciloleucel
- azacitidine
- baclofen
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexpiprazole
- brexucabtagene autoleucel
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- brodalumab
- bromocriptine
- brompheniramine
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- buspirone
- busulfan
- cabazitaxel
- canakinumab
- cannabidiol
- cannabis
- carbinoxamine
- carboplatin
- cariprazine
- carisoprodol
- carmustine
- cenobamate
- certolizumab pegol
- cetirizine
- chamomile, German
- chlophedianol
- chlorambucil
- chlorcyclizine
- chlorpheniramine
- chlorzoxazone
- ciltacabtagene autoleucel
- cladribine injection
- clemastine
- clobetasol ophthalmic
- clofarabine
- coccidioides immitis skin test antigen
- copanlisib
- crovalimab
- cyclobenzaprine
- cyclosporine
- cyproheptadine
- cytarabine
- dacarbazine
- dactinomycin
- danicopan
- dantrolene
- daratumumab
- darifenacin
- daunorubicin
- delgocitinib topical
- deucravacitinib
- deutetrabenazine
- dexamethasone ophthalmic
- dexbrompheniramine
- dexchlorpheniramine
- difelikefalin
- difenoxin
- difluprednate ophthalmic
- dimenhydrinate
- dimethyl fumarate
- diphenhydramine
- diphenoxylate
- diroximel fumarate
- docetaxel
- domperidone
- doxepin
- doxepin topical
- doxorubicin
- dronabinol
- dupilumab
- duvelisib
- eculizumab
- efavirenz
- efgartigimod alfa
- eletriptan
- elinzanetant
- elotuzumab
- elranatamab
- entacapone
- entrectinib
- epcoritamab
- epirubicin
- eribulin
- etanercept
- ethosuximide
- etoposide
- felbamate
- fenfluramine
- fesoterodine
- fingolimod
- flibanserin
- floxuridine
- fludarabine
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- foslevodopa
- fosphenytoin
- frovatriptan
- fruquintinib
- ganaxolone
- gemtuzumab ozogamicin
- glofitamab
- glycopyrrolate
- golimumab
- guanfacine
- guselkumab
- hydrocortisone ophthalmic
- hyoscyamine
- ibritumomab tiuxetan
- ibrutinib
- icotrokinra
- idarubicin
- idecabtagene vicleucel
- idelalisib
- iloperidone
- imipramine
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lacosamide
- lamotrigine
- lebrikizumab
- levetiracetam
- levocetirizine
- levodopa
- lifileucel
- linvoseltamab
- lisocabtagene maraleucel
- lofexidine
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- loxapine
- lumateperone
- lurasidone
- meclizine
- melatonin
- melphalan
- meprobamate
- methocarbamol
- methsuximide
- methyldopa
- metyrapone
- metyrosine
- milsaperidone
- mirikizumab
- mitomycin
- mitotane
- mitoxantrone
- mogamulizumab
- molindone
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- nadofaragene firadenovec intravesical
- naltrexone
- naratriptan
- narsoplimab
- nefazodone
- nipocalimab
- nortriptyline
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- orphenadrine
- oxaliplatin
- ozanimod
- paclitaxel
- pacritinib
- paliperidone
- passion flower
- pegcetacoplan
- pentostatin
- perampanel
- pheniramine
- phenytoin
- pimozide
- pirtobrutinib
- polatuzumab vedotin
- ponesimod
- pozelimab
- pramipexole
- prednisolone ophthalmic
- procarbazine
- prochlorperazine
- protriptyline
- pyrilamine
- quetiapine
- ramelteon
- rasagiline
- ravulizumab
- regorafenib
- repotrectinib
- rilonacept
- rilzabrutinib
- risankizumab
- risperidone
- ritlecitinib
- rizatriptan
- ropinirole
- rotigotine transdermal
- rozanolixizumab
- rufinamide
- ruxolitinib
- safinamide
- secukinumab
- selegiline
- selegiline transdermal
- sibeprenlimab
- siltuximab
- siponimod
- solifenacin
- spesolimab
- sumatriptan
- sutimlimab
- tacrolimus
- talquetamab
- tarlatamab
- tasimelteon
- teclistamab
- temozolomide
- temsirolimus
- tetrabenazine
- tezepelumab
- thioguanine
- thiotepa
- tiagabine
- tildrakizumab
- tisagenlecleucel
- tizanidine
- tolcapone
- tolterodine
- topotecan
- trabectedin
- tralokinumab
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- trospium
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- valbenazine
- valerian
- vedolizumab
- venetoclax
- vigabatrin
- vilobelimab
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zanubrutinib
- zilucoplan
- ziprasidone
- zolmitriptan
Adverse Reactions .
Serious Reactions
- thrombocytopenia
- hemorrhage
- neutropenia
- febrile neutropenia
- infection, serious
- sepsis
- pneumonia
- anemia
- lymphopenia
- nausea, severe
- vomiting, severe
- diarrhea, severe
- anorexia
- dehydration
- hyponatremia
- syncope
- amnesia
- mental status alterations
- delirium
- hallucinations
- cardiac failure
- cataracts
Common Reactions
- fatigue
- nausea
- anorexia
- diarrhea
- weight loss
- constipation
- vomiting
- fever
- cough
- edema
- URI
- dizziness
- musculoskeletal pain
- dysgeusia
- hypotension
- mental status changes
- blurred vision
- abdominal pain
- dyspnea
- hemorrhage
- peripheral neuropathy
- pneumonia
- UTI
- dehydration
- sepsis
- headache
- cataracts
- cardiac failure
- febrile neutropenia
- HSV infection
- syncope
- thrombocytopenia
- anemia
- lymphopenia
- hyponatremia
- neutropenia
- glucose incr.
- Cr incr.
- phosphate decr.
- calcium decr.
- magnesium decr.
- ALT or AST incr.
- potassium incr.
- albumin decr.
- potassium decr.
- CK incr.
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; CBC with diff, blood chemistries, wt, nutritional and volume status at baseline, then as clinically indicated with more frequent monitoring during first 3mo of tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; risk of teratogenicity, skeletal abnormalities, decr. fetal wt, based on animal data at 0.08x or greater systemic exposure and drug's mechanism of action
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and x1wk after D/C in patients of childbearing potential and male patients
Lactation
Clinical Summary
avoid breastfeeding during tx and x1wk after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: for selinexor: unknown; CYP450: 3A4 substrate; UGT: substrate (enzymes not defined)
Excretion: for selinexor: unknown; Half-life: 6-8h
Subclass: Nuclear Export Inhibitors
Mechanism of Action
for selinexor: blocks exportin 1 (XPO1), reversibly inhibiting nuclear export of tumor suppressor proteins (TSPs), growth regulators, and oncogenic protein mRNAs, resulting in cell cycle arrest and apoptosis
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Karyopharm Therapeutics Inc.
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral tablet:
- 20 mg (1 carton, 4 blister packs of 5 tablets): $23,549.00
oral tablet:
- 20 mg (1 carton, 4 blister packs of 2 tablets): $23,549.00
- 40 mg (1 carton, 4 blister packs of 2 tablets): $23,549.00
- 50 mg (1 carton, 4 blister packs of 2 tablets): $23,549.00
oral tablet:
- 20 mg (1 carton, 4 blister packs of 6 tablets): $23,549.00
oral tablet:
- 40 mg (1 carton, 4 blister packs of 1 tablet): $23,549.00
- 60 mg (1 carton, 4 blister packs of 1 tablet): $23,549.00
oral tablet:
- 20 mg (1 carton, 4 blister packs of 3 tablets): $23,549.00
oral tablet:
- 20 mg (1 carton, 4 blister packs of 4 tablets): $23,549.00
oral tablet:
- 20 mg (1 carton, 4 blister packs of 8 tablets): $23,549.00
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