Medical Oncologist
Pazopanib (Votrient)
Pazopanib Side Effects: — What to Expect and When to Call
Pazopanib most commonly causes high blood pressure, fatigue, and diarrhoea. Liver toxicity is less common but can be serious. It usually has no early symptoms, which is why scheduled blood tests matter as much as how you feel.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- Blood pressure rises early — High blood pressure is very common and can develop within the first few weeks. Home monitoring from day one is standard.
- Liver monitoring is non-optional — Liver toxicity often has no symptoms. Scheduled blood tests in the first few months are the only way to detect it early.
- Most side effects are manageable — Dose adjustment, supportive medicines, and skin care keep most people on treatment without stopping.
- Hair colour change is expected — Gradual whitening or greying of hair is very common and usually reverses after treatment ends.
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Pazopanib most commonly causes high blood pressure, fatigue, diarrhoea, and changes to hair colour. Liver toxicity can also occur and needs regular blood test monitoring, particularly in the first few months. Most side effects can be managed with dose adjustment or supportive medicines without stopping treatment.
When do pazopanib side effects start and do they need a call?
| Side effect | Typically starts | Whether to contact your team |
|---|---|---|
| High blood pressure (very common) | Within the first few weeks | At your next appointment if mildly raised; same day if very high, or if you have a severe headache or vision changes |
| Fatigue (very common) | Gradual, from the first weeks | At your next appointment; dose adjustment may help |
| Diarrhoea (very common) | Within the first weeks | Same day if not settling or if there is blood; go to emergency if you cannot keep fluids down |
| Changes to hair and skin colour (very common) | Within the first month | Not urgent — expected and usually reverses after treatment ends |
| Nausea (common) | Early weeks; often settles | At your next appointment if it is affecting what you eat |
| Hand and foot redness or soreness (common) | Weeks to months | At your next appointment — early reporting helps prevent worsening |
| Liver enzyme rise (common; can be severe) | Early treatment; no symptoms — detected on blood tests | Your team schedules blood tests specifically for this — attend every one |
| Low thyroid function (common) | Months into treatment; detected on blood tests | Managed with medicine once detected — attend scheduled tests |
| Typically starts | Most effects appear within the first few weeks. Thyroid and some skin effects develop over months. | Attend every scheduled blood test, even when you feel completely well. |
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
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Radiation Oncologist
Radiation Oncologist
Hematologist
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Dr. Mohammed Imran
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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What should I do in my first week on pazopanib?
- Get a home blood pressure monitor and check your reading every day from day one.
- Note your usual energy level and bowel pattern before effects begin — so you can spot any change.
- Write down every medicine and supplement you take and show the list to your team before starting.
- Tell your team about any unhealed wounds or upcoming surgery — pazopanib affects healing.
- Save your treatment team's out-of-hours contact number before you take your first dose.
- Keep every scheduled blood test appointment, especially in the first two months.
Why does pazopanib affect so many different parts of the body?
Pazopanib works by blocking proteins that help cancer cells build new blood vessels. Those same proteins are active in normal body processes, which is why a drug targeted at cancer can still affect your blood pressure, liver, thyroid, and skin.
High blood pressure is one of the most common effects because pazopanib disrupts the signalling that keeps blood vessel walls relaxed. This is usually manageable with an added blood pressure medicine, but it needs to be identified and treated rather than ignored.
Serious effects are less common, but most give warning signs — either through symptoms you can feel or through changes in blood tests. This is why the monitoring schedule in the first few months is more frequent than it will be later in treatment.
Questions patients and families ask most
Can I take my usual medicines and supplements with pazopanib?
Drug interactions are a significant concern with pazopanib because it is processed by the same liver pathway as many common medicines. Some medicines raise the level of pazopanib in your blood, increasing side effects; others lower it, reducing how well it works. St John's Wort, certain antibiotics, antifungals, and some seizure medicines can all be affected. Tell your oncology team everything you take — including vitamins, herbal remedies, and medicines bought without a prescription — before your first dose and before adding anything new.
Will the changes to my hair and skin colour be permanent?
For most people, the change is not permanent. Pazopanib commonly causes the hair to lose pigment, which can look like greying or whitening, and sometimes affects skin and eyebrow colour too. The change typically reverses over some months after treatment ends, though the speed varies from person to person. Some people also notice mild thinning, but the complete hair loss associated with chemotherapy does not typically happen with pazopanib. The colour change does not reflect how well the treatment is working.
What does liver toxicity mean and how would I know if it was happening?
Liver toxicity means liver cells are under stress, which shows on blood tests as elevated enzyme levels. In mild cases there are no symptoms at all — you would not know without the test. In more serious cases you might notice yellowing of the skin or whites of the eyes, dark-coloured urine, pain in the upper right abdomen, or unusual tiredness. If any of these appear, contact your team the same day. Do not wait for your next scheduled visit. Attending every blood test is essential because it is the only way to detect a problem before it becomes serious.
Will the side effects get worse over time or will they settle?
It depends on the specific effect. Blood pressure, nausea, and some skin changes often stabilise after the first few weeks as your body adapts and medicines are adjusted. Fatigue tends to persist and sometimes needs a dose change to manage. Hair and skin colour changes progress slowly over the first few months and then usually plateau. Liver enzyme abnormalities are most common early in treatment and, when caught on blood tests, usually settle with dose adjustment. Your team will review your side effect profile regularly and adjust the plan as needed.
Is it safe to eat grapefruit while taking pazopanib?
No. Grapefruit and grapefruit juice should be avoided on pazopanib. Grapefruit contains compounds that block the enzyme your body uses to break down pazopanib, which can cause unpredictable rises in the drug level in your blood. A higher level means more side effects without any added benefit to treatment. Pomelo and Seville orange carry the same risk. Your prescriber may give you a list of foods and drinks to avoid — ask for one at your first appointment if you have not received it.
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Drug Deep Dive: Sunitinib (Sutent)
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- Fertility, Pregnancy and Contraception on Sunitinib
- Hand-Foot Skin Reaction on Sunitinib: Prevention From Day One
- How Does Sunitinib Work? The Multi-Kinase Angiogenesis Inhibitor Explained
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- Sunitinib Price in India: Brand, Generic and Monthly Cost
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- Tests and Monitoring While You Are on Sunitinib
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- Thyroid Failure and Fatigue on Sunitinib: The Test to Repeat Every Cycle
- When Sunitinib Stops Working: Resistance and What Comes Next
- Who Is Eligible for Sunitinib? Kidney Cancer, GIST and Pancreatic Neuroendocrine Tumours
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Common questions
Frequently asked questions
How soon after starting pazopanib can I expect to feel side effects?
Side effects can begin within days for some people, particularly blood pressure changes. Fatigue and diarrhoea often appear within the first couple of weeks. Hair and skin colour changes develop more gradually over the first month or two. Thyroid problems are a later development and are found on blood tests rather than felt as a symptom. Your team will tell you what to watch for and when your first blood tests are scheduled.
Will I lose my hair on pazopanib?
Complete hair loss of the kind caused by chemotherapy does not typically happen on pazopanib. What is much more common is a gradual change in colour — often a whitening or greying — and sometimes mild thinning. The change is cosmetic and does not indicate how well the treatment is working. For most people the colour reverses gradually over some months after treatment ends.
What should I do if I notice my blood pressure is high?
Tell your team at your next appointment if readings are only mildly raised. Call the same day if readings are consistently very high, or if you have a severe headache, vision changes, or chest pain — those need urgent assessment. Do not stop pazopanib without speaking to your team, but do report raised blood pressure promptly. It is usually manageable with an added or adjusted blood pressure medicine.
How will my team know if my liver is being affected?
Liver toxicity from pazopanib often has no symptoms in the early stages — it shows on blood tests before you feel anything. This is why blood tests are scheduled more frequently at the start of treatment than later on. Attending every test, even when you feel well, is essential. If liver enzyme levels rise significantly, your dose may be adjusted or treatment paused until they settle.
Can I keep taking pazopanib if I develop side effects?
For most side effects, yes. Dose adjustment, blood pressure medicines, and skin care for hand-foot changes are all standard ways to manage side effects without stopping the drug. Serious complications — such as significant liver toxicity or severe bleeding — may need a dose pause or treatment change, but that depends on severity and your individual response. Reporting side effects early gives your team the most options for keeping you on treatment.