Verzenio dosage, forms, and strengths

Verzenio is a brand-name prescription drug that treats the most common form of breast cancer (HR-positive and HER2-negative breast cancer). Healthcare professionals can use the drug at the early, advanced, or most advanced stages of the cancer’s progression. The active ingredient in Verzenio tablets is abemaciclib, a molecule that stops the growth of cancer cells which then leads to their death. The tablets are taken twice daily with or without food.

Verzenio forms and strengths

Verzenio can only be taken orally in four dosage strengths:

• Tablets: 50 mg, 100 mg, 150 mg, 200 mg

Verzenio dosage for adults

Verzenio tablets are part of a treatment regimen for the most common type of breast cancer in its early, advanced, and metastatic stages. Verzenio is not chemotherapy but rather a targeted therapy that affects how breast cancer cells grow. Its active ingredient is a CDK4 and CDK6 inhibitor. These are proteins that, while normally present in breast tissue cells, cause breast cancer cells to grow rapidly. There are no contraindications to taking this medication.

Verzenio dosage for HR+ HER2- breast cancer

The FDA has approved Verzenio as an add-on treatment for a type of breast cancer called hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), and node-positive breast cancer. This is the most common form of breast cancer and represents about 70% of breast cancer diagnoses in women.

Hormone receptor-positive cancer grows in the presence of female hormones, estrogens, and progestins. HR-positive breast cancers represent about 80% of all cases. Most breast tumors, then, grow faster in response to female hormones. 

HER2 is a protein on the surface of breast cells that regulates their growth. HER2-positive breast cancer has too many of these proteins. As a result, the cancerous cells grow quickly and aggressively. Fortunately, HER2-positive breast cancer is uncommon, representing only about 14% of all cases. HER2 negative is the most common form of breast cancer.

When any cancer, including breast cancer, spreads to the lymph nodes, it is called node-positive cancer. That means any breast cancer confined only to the breast is not a suitable candidate for Verzenio treatment.

Verzenio is only used in HR+ and HER2- breast cancer. For early breast cancer, it’s used along with tamoxifen or an aromatase inhibitor such as Arimidex (anastrozole) if there’s a high risk of recurrence. Aromatase inhibitors reduce the body’s production of estrogens. Tamoxifen blocks the effects of estrogens on cancerous cells. Because these drugs target female sex hormones, healthcare professionals call this type of treatment “endocrine therapy.” 

Verzenio is used alone or with an aromatase inhibitor or fulvestrant to treat advanced or metastatic breast cancer after endocrine therapy. Like tamoxifen, fulvestrant prevents estrogen from affecting breast cancer cells.

Tablets are taken twice daily with or without food. The daily dose will depend on whether the drug is being used with other drugs or by itself. People will start with the standard dosage and likely continue with it. However, the prescriber could reduce the dose to as low as 50 mg twice daily if there are problems. The recommended dosage is the maximum dosage. 

• Standard Verzenio dosage for breast cancer in combination with fulvestrant, tamoxifen, or an aromatase inhibitor: 150 mg twice daily

• Standard Verzenio dosage for breast cancer as monotherapy: 200 mg twice daily

Verzenio dosage for children

Verzenio is not FDA approved for use in children.

Verzenio dosage restrictions

Verzenio does not require dosage modifications for kidney disease, but people with severe liver disease (Child-Pugh Class C hepatic impairment) will be limited to one dose daily. 

However, dosage reductions are required in some situations.

For adverse reactions in general, the prescriber will gradually reduce the dose by 50 mg until adverse events are tolerable. The minimum dose is 50 mg twice daily.

For other serious problems, the drug may need to be stopped until the problem partly or completely resolves. After that, the prescriber may restart the drug at the next lower dose. To monitor for these problems, the prescriber will need regular follow-up visits and blood tests. 

Potential problems that could trigger a temporary discontinuation and then a possible lowered dose of Verzenio include:

• Blood problems including low white blood cell counts, anemia, and low platelet counts (thrombocytopenia)

• Liver problems (elevated liver enzymes)

• Diarrhea

• Blood clots (venous thromboembolic events)

• Inflammation and scarring of the lungs, including pneumonitis (interstitial lung disease)

• Other unacceptable toxicity problems or adverse events

How to take Verzenio

Verzenio is taken as a tablet twice daily.

• Follow all the instructions given by the prescriber.

• Do not change the dose or stop taking doses until talking to the prescriber or other healthcare professional.

• Please read the Patient Information that comes with this medicine. 

• Verzenio tablets can be taken with or without food.

• Take two doses each day, once in the morning and once in the evening.

• Take doses at the same time each day.

• Swallow the tablets whole with a drink of water. Do not crush, chew, or break them.

• If a tablet is broken or cracked, do not take that tablet.

• Store Verzenio tablets in a closed container at room temperature out of the reach of children and pets.

Verzenio dosage FAQs

How long does it take Verzenio to work?

Verzenio begins to work with the first dose but is not effective unless taken in the long term. Women can expect to take doses for up to two years for early breast cancer and for an indefinite period for advanced breast cancer. 

How long does Verzenio stay in your system?

Verzenio has a half-life of about 18 hours. That means it will take three or four days for the body to completely clear the last dose. 

What happens if I miss a dose of Verzenio?

If a dose is missed, skip it and take the next dose at the usual time. If vomiting occurs, consider it a missed dose, and don’t take another pill.

How long can you take Verzenio?

Verzenio is a long-term treatment for breast cancer. Women with early-stage breast cancer will take Verzenio tablets for two years. For advanced or metastatic breast cancer, women will take Verzenio for as long as it doesn’t cause problems or until the cancer progresses.

How do I stop taking Verzenio?

Do not stop taking Verzenio or reduce the dose until consulting with the prescriber. Stopping Verzenio will not cause withdrawal symptoms. However, the prescriber will need to prescribe a suitable substitute.

There are many compelling reasons to stop Verzenio treatment including adverse effects, severe diarrhea, blood clots, liver dysfunction, blood problems, lung scarring, and other serious problems. In most cases, the prescriber will discontinue treatment and wait for the issue to be partly or completely resolved. The physician will then restart treatment, sometimes at a lower dose. In some cases, treatment may need to be permanently discontinued.

The standard treatment for HR+/HER2- breast cancer after surgery and chemotherapy is endocrine therapy. Verzenio is usually used as an add-on treatment, increasing survival rate. Stopping Verzenio will not stop hormonal therapy.

The prescriber could switch to other add-on drugs such as:

• Drugs similar to Verzenio called CDK4/6 inhibitors: Kisqali (ribociclib) and Ibrance (palbociclib)

• Other targeted therapy drugs that slow down cancer cell growth or block the immune system

• Trodelvy (sacituzumab govitecan) is a drug that binds a chemotherapy drug to an antibody so that the chemotherapy drug is delivered directly to the cancer cells. 

What is the maximum dosage for Verzenio?

The recommended dose is the maximum Verzenio dose: 150 mg twice daily when used with endocrine therapy and 200 mg twice daily when used alone.

What interacts with Verzenio?

Verzenio has some drug interactions with medications, supplements, and food that either slow down or speed up the body’s breakdown of Verzenio.

Cancer doctors, pharmacists, and other healthcare providers know these drugs well. They will avoid combining Verzenio with drugs like ketoconazole that strongly interfere with the body’s metabolism of Verzenio. These drugs are called strong CYP3A inhibitors, named after the liver enzyme that breaks down Verzenio. They increase the risk and severity of side effects. Drugs that are moderate CYP3A inhibitors will require Verzenio dose reductions to prevent side effects.

Grapefruit is also a CYP3A4 inhibitor. People taking Verzenio should not consume grapefruit or grapefruit juice.

Drugs that speed up the breakdown of Verzenio called CYP3A inducers may be stopped when Verzenio treatment starts because they reduce the effectiveness of Verzenio treatment.

What happens when you mix Verzenio and alcohol?

There is no known interaction between Verenzio and alcohol. Alcohol however may increase the risk of tumor growth or metastasis, so the sound advice is to ask the healthcare provider.

Is it safe to take Verzenio during pregnancy?

Verzenio should not be taken during pregnancy. Women should take measures to prevent pregnancy during treatment and for up to three weeks after the last dose. While Verzenio has not been studied in pregnant women, it causes birth defects and low birth weight when given to pregnant animals.

Is it safe to take Verzenio while breastfeeding?

Verzenio’s drug information advises that women not breastfeed while taking Verzenio. There are no studies on whether abemaciclib is present in breast milk or affects a nursing infant. Women taking other drugs given with Verzenio—aromatase inhibitors, tamoxifen, and fulvestrant—should not breastfeed. 

What are the common side effects of Verzenio?

Side effects with Verenzio are unfortunately common. . In clinical trials, the most commonly experienced side effects were diarrhea (84%), low white blood cell counts (neutropenia and leukopenia), nausea, abdominal pain, infections, fatigue, anemia, decreased appetite, vomiting, and hair loss (alopecia).

What do I do about diarrhea?

In clinical trials, 84% of trial participants experienced diarrhea, in some cases severe. Contact the prescribing healthcare provider at the first sign of loose stools. If the diarrhea is mild (Grade 1), the doctor will continue treatment with no dose modification and possibly prescribe an antidiarrheal medication such as Imodium (loperamide). More moderate diarrhea (Grade 2) will require Verzenio to be stopped until the diarrhea is resolved. Severe diarrhea may require hospitalization. 

Sources

• Effects of alcohol on tumor growth, immune response, and survival, Alcohol Research Current Reviews

• Everyday Verzenio abemaciclib HCP, Eli Lilly

• Female breast cancer subtypes, NIH National Cancer Institute

• Inhibitors of cyclin-dependent kinases: types and their mechanism of action, International Journal of Molecular Sciences

• Targeted drug therapy for breast cancer, American Cancer Society

• Verzenio abemaciclib tablet prescribing information, DailyMed (NIH National Library of Medicine)

• Verzenio drug summary, Prescriber’s Digital Reference (PDR)