Xpovio (Selinexor), Oral

What Is Xpovio?

Xpovio (selinexor) is an oral medication used to treat two different types of cancers: multiple myeloma and diffuse large B-cell lymphoma. This medication is in a drug class called nuclear export inhibitors.

Xpovio helps restore the balance of natural cancer-killing cells. These cells contain tumor suppressor proteins, which work to try to kill the cancer. In some cancers, the movement of the tumor suppressor proteins in and out of the cell becomes unbalanced. Xpovio blocks the protein XPO1, which keeps too many anticancer proteins from leaving these cells.

Xpovio comes in tablet form.

Drug Facts

Generic Name: Selinexor

Brand Name(s): Xpovio

Drug Availability: Prescription

Administration Route: Oral 

Therapeutic Classification: Nuclear export inhibitor

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Selinexor

Dosage Form(s): Tablet

What Is Xpovio Used For?

Xpovio is used to treat multiple myeloma and diffuse large B-cell lymphoma.

For multiple myeloma, Xpovio is typically used in two circumstances:

  • Along with Velcade (bortezomib) and Decadron (dexamethasone) to treat people who have had at least one other treatment for multiple myeloma
  • Along with dexamethasone in someone who has had at least four other treatments and has become resistant to multiple types of medications for their disease (e.g., proteasome inhibitors, immunomodulatory medications, and anti-CD38 monoclonal antibodies)

For diffuse large B-cell lymphoma, it can be used when the lymphoma has returned after trying at least two systemic therapies. 

How to Take Xpovio

Xpovio tablets come in a pre-filled blister pack. Keep the tablets in the pack until you are ready to take your dose. Swallow the tablets whole with water; do not break, chew, crush, or divide them.

Your healthcare provider may advise that you drink plenty of fluid and consume enough calories during your treatment. Nausea is a common side effect of this drug, so you may be prescribed an anti-nausea medication (an antiemetic) to help curb this. Continue taking your Xpovio as prescribed.

Storage 

Keep Xpovio blister packs in conditions at or below 86 degrees Fahrenheit and out of reach of children and pets. Do not store them in the bathroom.

How Long Does Xpovio Take to Work?

Xpovio might start working quickly to help balance the tumor suppressor proteins in the cell. However, it may take a few months of treatment before noticing improvement in your cancer.

In clinical trials, the median time to first response to treatment with Xpovio was 8.1 weeks in people with relapsed or refractory diffuse large B-cell lymphoma. In people with myeloma, the median time to first response was four weeks.

What Are the Side Effects of Xpovio?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects 

The most common side effects associated with Xpovio include:

  • Feeling tired 
  • Weight loss
  • Nausea and vomiting
  • Poor appetite
  • Diarrhea
  • Low platelet counts
  • Low white blood cell counts (leukopenia)
  • Low red blood cell counts
  • Low sodium levels
  • Upper respiratory tract infection
  • Cataracts

Severe Side Effects 

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms are life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:

  • Severely low platelet counts
  • Severely low white blood cells
  • Serious infections
  • Neurological problems (e.g., dizziness, loss of consciousness, forgetfulness, mental status changes)

Long-Term Side Effects 

Severe side effects have the potential to be long-term if left untreated.

Report Side Effects

Xpovio may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Xpovio Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For diffuse large B-cell lymphoma:
      • Adults—At first, 60 milligrams (mg) on Days 1 and 3 of each week. Your doctor may adjust your dose as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.
    • For multiple myeloma (in combination with dexamethasone):
      • Adults—At first, 80 milligrams (mg) on Days 1 and 3 of each week. Your doctor may adjust your dose as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.
    • For multiple myeloma (in combination with bortezomib and dexamethasone):
      • Adults—At first, 100 milligrams (mg) on Day 1 of each week. Your doctor may adjust your dose as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.

Modifications 

If you experience ongoing or severe side effects, your healthcare provider may modify or change the dose of your medication. It is important to notify your healthcare provider of any side effects quickly so that they can instruct you whether to hold the medication, if appropriate.

Missed Dose 

If you miss a dose of Xpovio, take your next dose at the next scheduled time. If you vomit after taking a dose, do not repeat the dose to make up for it; take the next dose on the next scheduled day. Do not double up on the missed dose.

Overdose: What Happens If I Take Too Much Xpovio?

If you take too much Xpovio, notify your healthcare provider right away. Observation of vital signs and laboratory tests may be necessary if too much Xpovio is taken.

What Happens If I Overdose on Xpovio?

If you think you or someone else may have overdosed on Xpovio, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Xpovio, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. It may also cause birth defects if the father is using it when his sexual partner becomes pregnant. If you are a woman who can bear children, your doctor may give you a pregnancy test before you start using this medicine to make sure you are not pregnant. Female patients should use effective birth control during treatment and for at least 1 week after the last dose. Male patients who have female partners should use effective birth control during treatment and for at least 1 week after the last dose. If you think you have become pregnant while using this medicine, tell your doctor right away.

Selinexor can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

Nausea, vomiting, diarrhea, loss of appetite, or weight loss may occur with selinexor, which can be severe and cause dehydration. Your doctor may give you medicine or other treatments for these. Check with your doctor right away if you notice that you are losing weight or have a decrease in appetite.

This medicine may make you dizzy or confused. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Tell your doctor if you are using other medicine that cause dizziness or mental changes.

This medicine may cause hyponatremia (low sodium levels in the blood). Check with your doctor right away if you have loss of consciousness, confusion, seizures, decreased urine output dizziness, fast or irregular heartbeat, muscle pain or cramps, trouble breathing, swelling of the face, ankles, or hands, or unusual tiredness or weakness.

This medicine may cause serious infections. Check with your doctor right away if you have chest pain, fever or chills, confusion, cough or hoarseness, dizziness, fainting, fast heartbeat, lightheadedness, lower back or side pain, painful or difficult urination, sneezing, sore throat, tightness in the chest, or trouble breathing.

This medicine may cause brain or nerve problems. Check with your doctor right away if you have blurred or double vision, confusion as to time, place, or person, difficulty in walking, dizziness, drooping eyelids, fainting, hallucinations, headache, holding false beliefs that cannot be changed by fact, jaw pain, loss of memory, numbness or tingling in the fingers and toes, pain in the fingers and toes, pain in the testicles, problems with memory, unusual excitement, nervousness, or restlessness, or weakness.

This medicine may cause eye problems (eg, cataracts). Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

This medicine could cause infertility in some men and women. Talk with your doctor before using this medicine if you plan to have children.


What Are Reasons I Shouldn’t Take Xpovio?

People who are pregnant should not use Xpovio, as it can cause toxicity to the fetus. If you are able to become pregnant, use contraception before and up to one week after taking Xpovio. Those who have a partner who can become pregnant should use contraception during the same period mentioned above.

You should not breastfeed while using Xpovio.

What Other Medications Interact With Xpovio?

Xpovio can cause a low white blood cell count. This can increase your risk of developing an infection. Xpovio should be used cautiously with other medications that can also possibly cause immunosuppression, such as the following:

This is not a complete list of all the drugs that may interact with Xpovio. Always keep an up-to-date list of all the medicines you take and share this information with your healthcare provider and pharmacist when changes are made.

What Medications Are Similar?

Other treatments are available for multiple myeloma and diffuse large B-cell lymphoma. However, Xpovio is the only medication in the class of nuclear export inhibitors.

Besides Xpovio, other medications used to treat multiple myeloma include:

  • Immunomodulatory drugs such as Revlimid (lenalidomide), Thalomid (thalidomide), and Pomalyst (pomalidomide)
  • Proteasome inhibitors including Velcade (bortezomib), Kyprolis (carfilzomib), and Ninlaro (ixazmoib)
  • Monoclonal antibodies such as Darzalex (daratumumab), Sarclisa (isatuximab), and Blenrep (belantamab mafodotin).

Chemotherapy regimens are sometimes also used to treat diffuse large B-cell lymphoma.

Frequently Asked Questions

  • What is Xpovio used for?

    Xpovio is used to treat multiple myeloma in combination with other medications or alone (as a monotherapy), after at least four other myeloma therapies have failed. It can also be used to treat diffuse large B-cell lymphoma after it returns following chemotherapy.

  • How does Xpovio work?


    Xpovio works by balancing the amount of cancer-fighting proteins in the nucleus of a cell. When too many cells are moved in or moved out, they aren’t able to work properly. Xpovio works to balance them to fight cancer.

  • What are the side effects of Xpovio?


    Some of the side effects that can occur with Xpovio include:

    • Fatigue
    • Nausea, vomiting, or diarrhea
    • Low blood counts 
    • Decreased appetite and weight loss
  • How do I to stop taking Xpovio?

    Do not change the dose or stop taking Xpovio unless instructed by your oncologist

How Can I Stay Healthy While Taking Xpovio?

As with any medication, the list of Xpovio's possible side effects can be long. While this may be overwhelming, knowing what to expect can better equip you to manage them.

During your treatment, looking for support from your friends and family can be helpful, especially when you aren't feeling well. Additionally, support groups can provide more resources and connect you to others who are going through similar experiences.

Before starting your treatment, discuss any concerns or questions with your cancer care team. Your healthcare provider will monitor you more frequently during the first three months of treatment. It can be difficult when cancer returns or other treatments have not worked, but know you can turn to your healthcare providers for guidance and education on the next steps. Your cancer team can help you navigate your cancer treatment journey.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Xpovio label.

  2. Kasamon YL, Price LSLS, Okusanya OO, et al. FDA approval summary: selinexor for relapsed or refractory diffuse large b-cell lymphoma. The Oncologist. 2021;26(10):879-886. doi:10.1002/onco.13859

  3. Epocrates. Xpovio.

  4. Rajkumar SV. Patient education: multiple myeloma treatment (beyond the basics). UpToDate.

  5. Freedman AS, Friedberg JW. Patient education: diffuse large B cell lymphoma in adults (beyond the basics). UpToDate.

By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.