Vonjo (pacritinib) is an oral kinase inhibitor approved by the U.S. FDA in 2022. It is specifically indicated for the treatment of adult patients with intermediate- or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis who have a platelet count below 50×10⁹/L.

How to Use Vonjo (Pacritinib)

Recommended Dosage and Administration Method

The standard recommended dosage is 200 mg orally, twice daily.

It can be taken with food or on an empty stomach.

Capsules must be swallowed whole; do not open, crush, or chew them.

Administration Timing and Precautions

The medication should be taken at fixed times every day to maintain consistent intervals between doses.

If the patient is receiving treatment with other kinase inhibitors, the dose of that drug must be gradually reduced or discontinued in accordance with its prescribing information before starting pacritinib.

Dosage Adjustment of Vonjo (Pacritinib)

Diarrhea Management

New-onset diarrhea: Initiate antidiarrheal medication and encourage adequate oral fluid replacement.

Grade 3 or 4 diarrhea: Withhold pacritinib until diarrhea resolves to Grade 1 or lower or returns to baseline. Resume pacritinib at the last administered dose, while intensifying the antidiarrheal regimen and fluid replacement therapy.

If diarrhea recurs: Withhold pacritinib until diarrhea resolves to Grade 1 or lower or returns to baseline. Resume pacritinib at 50% of the last administered dose.

Antidiarrheal treatment must be administered concurrently when resuming pacritinib therapy.

Thrombocytopenia Management

For clinically significant worsening of thrombocytopenia lasting more than 7 days: Withhold pacritinib and resume at 50% of the last administered dose.

If toxicity recurs: Withhold pacritinib and resume at 50% of the last administered dose.

Bleeding Event Management

Moderate bleeding: Withhold pacritinib until bleeding resolves, then resume at the last administered dose.

If bleeding recurs: Withhold pacritinib until resolution, then resume at 50% of the last administered dose.

Severe bleeding: Withhold pacritinib until bleeding resolves, then resume at 50% of the last administered dose.

If bleeding recurs: Discontinue pacritinib.

Life-threatening bleeding: Discontinue pacritinib.

Medication for Special Populations with Vonjo (Pacritinib)

Patients with Hepatic Impairment

Patients with mild or moderate hepatic impairment: No dosage adjustment is required.

Patients with severe hepatic impairment (Child-Pugh Class C): The recommended dosage is 100 mg twice daily.

If the therapeutic effect is not obvious after 12 weeks of treatment and there are no safety concerns, the dosage may be increased to 200 mg twice daily.

Patients with Renal Impairment

Avoid use of pacritinib in patients with an eGFR < 30 mL/min.

After a single 400 mg dose of pacritinib, the Cmax and AUC of pacritinib in subjects with eGFR 15–29 mL/min and those with eGFR < 15 mL/min receiving hemodialysis were increased by approximately 30% compared with subjects with normal renal function.

Pregnancy and Lactation

Pregnancy: There are currently no data on the use of pacritinib in pregnant women to evaluate the risk of drug-related major birth defects, miscarriage, or adverse maternal or fetal outcomes.

Lactation: Patients are advised not to breastfeed during pacritinib treatment and for 2 weeks after the last dose.