Olaparib (Lynparza)

Olaparib at a glance

Olaparib, known by the verified brand name Lynparza, is a PARP inhibitor. It interferes with a cell's ability to repair damaged DNA. Certain weaknesses in a cancer's repair machinery can make it more vulnerable to this treatment.

The usual tablet dose is 300 mg twice daily, commonly two 150 mg tablets in the morning and two in the evening. Lower doses may be prescribed for side effects, kidney impairment or a medicine interaction. Tablets may be taken with or without food. Your dispensing label takes priority over a general dose example.

Nausea, fatigue and anaemia are important everyday concerns. Less frequent but serious problems include lung inflammation, blood clots, liver injury and bone-marrow disorders. A targeted treatment can still cause substantial side effects, so blood tests and prompt symptom reporting remain essential.

What olaparib is and how it works

DNA carries the instructions cells use to grow and function. Damage to DNA occurs continually, and cells have several repair systems. PARP proteins help with part of that repair. Olaparib blocks their activity and can trap PARP on damaged DNA, making repair more difficult. Cancer cells that already have another repair weakness may be less able to survive this additional damage.

BRCA1 and BRCA2 are genes involved in DNA repair. A harmful change, often called a mutation, can affect how that repair works. Homologous recombination repair, or HRR, refers to a repair pathway involving BRCA and other genes. Homologous recombination deficiency, or HRD, describes impaired function in that pathway; it is not simply another name for every BRCA result.

The treatment goal depends on your situation. Olaparib may help maintain a response to previous treatment, lower the risk of recurrence within a defined treatment plan, or help control existing cancer. Ask which aim applies to you; benefit is not guaranteed.

How the team decides whether it is suitable

The specialist considers your diagnosis, relevant tumour or inherited-gene tests, previous treatment and response, current health and applicable prescribing information. BRCA, HRR or HRD findings may be important. Other tumour tests can matter in a particular combination plan. The required test is not identical for every patient or every region.

A tumour mutation does not automatically mean that it was inherited. A germline result refers to an inherited change that may have implications for relatives. Genetic counselling can help explain whether further testing is appropriate. Ask how your report supports the proposed treatment.

Existing anaemia, persistent low counts after chemotherapy, lung disease, previous blood clots, liver disease and kidney impairment influence the safety assessment. Moderate kidney impairment usually requires a lower dose. Evidence is limited in severe kidney impairment, dialysis or severe liver impairment. European information does not recommend use in severe liver impairment; severe kidney impairment requires exceptional specialist benefit–risk assessment. Known allergy to olaparib or its ingredients is a European contraindication. Safety and effectiveness in children have not been established.

Before treatment starts

A full blood count measures red cells, white cells and platelets. Red cells carry oxygen, white cells help fight infection and platelets help stop bleeding. Blood-count effects from previous chemotherapy should have recovered sufficiently before olaparib begins.

The team checks kidney function and liver tests, including liver enzymes and bilirubin, a substance processed by the liver. Tell them about any existing cough or breathlessness so that new changes can be recognised. Report previous clots, unusual bleeding, transfusions, hepatitis or other liver problems, allergies and all other health conditions.

Bring a complete medicine list, including antibiotics, antifungals, epilepsy treatment, heart medicines, hormonal contraception, vitamins and herbal products. Discuss contraception, pregnancy testing and fertility concerns before the first dose.

Have your hospital's urgent contact arrangements and temperature advice available at home. Confirm arrangements for blood tests and repeat prescriptions. Arrange supportive medicines, such as anti-sickness treatment, so you know how to use them from the start.

How treatment is taken

Tablets, timing and food

Take the prescribed dose twice daily, usually about 12 hours apart. The reviewed Lynparza tablets contain 100 mg or 150 mg; a 300 mg dose means two 150 mg tablets, not one tablet.

Swallow tablets whole with water. Do not split, chew, crush or dissolve them. They may be taken with or without food, to suit your routine. If swallowing is difficult or you use a feeding tube, contact the oncology pharmacist; the reviewed labels do not provide a home dispersion or tube-administration method.

Older information may refer to 50 mg capsules and a different dose. Capsules and tablets are not interchangeable milligram for milligram because they are absorbed differently. This guide uses the current reviewed tablet instructions. Do not use an old capsule prescription to calculate your tablet dose.

Dose changes and treatment length

For side effects, the team may pause treatment or reduce the tablet dose from 300 mg twice daily to 250 mg twice daily, then to 200 mg twice daily if needed. A 250 mg dose uses one 150 mg and one 100 mg tablet. Moderate kidney impairment generally requires 200 mg twice daily; certain interactions need a different reduction. These decisions must be prescribed.

Some plans have a defined course, such as one year or up to two years in an appropriate setting. Other plans continue while treatment remains useful and tolerable. A two-year stopping point is not a universal rule, and continuing beyond it is not automatically appropriate. Ask for your intended duration and the reasons it might change.

Missed doses and vomiting

If you miss a dose, skip it and take the next normal dose at its scheduled time. Do not take extra tablets or double the next dose. If you vomit after taking olaparib, do not repeat the dose; take the next one at the usual time. Contact the team if vomiting persists or you cannot keep fluids down.

If you take too much, obtain urgent advice or attend an emergency department. Tell staff the strength, number of tablets and time taken, and take the pack with you.

Other treatments in the same plan

Olaparib may be accompanied by another cancer medicine. Keep a written schedule showing which instructions belong to which drug. A tablet taken with food does not make its partner's fasting requirement disappear.

When prescribed with abiraterone for a specialist metastatic prostate-cancer plan, the corticosteroid prednisone or prednisolone is part of treatment; do not stop it abruptly. Hormone-suppression treatment usually continues unless the relevant surgery has already been performed. Standard Zytiga abiraterone tablets require no food for two hours before and one hour after the dose, whereas olaparib itself allows food. Confirm the exact abiraterone product.

Abiraterone adds monitoring for potassium, blood pressure, fluid retention and liver problems. If your partner is bevacizumab, endocrine therapy or durvalumab, obtain its separate information too. The European olaparib information includes special blood-cell disorders with durvalumab that are described below. These partners are not interchangeable and do not all have the same safety plan.

Storage and handling

Keep tablets in their original packaging to protect them from moisture and out of children's reach. Follow your pack's storage temperature: US information specifies 20–25°C (68–77°F), while European tablets have no special temperature-storage requirement. Avoid leaving medicine in a hot car. Return unused tablets through your pharmacy's disposal arrangements.

Monitoring and checking whether treatment is working

Blood counts are checked before treatment and regularly afterwards. US information specifies monthly monitoring throughout treatment. European information specifies monthly checks for the first 12 months and periodic checks thereafter, with additional tests when needed. A treatment pause for low counts can require weekly tests until recovery.

If abnormal counts persist after about four weeks of interruption, the team may arrange specialist blood assessment, including a bone-marrow examination and chromosome tests. This is an investigation into the cause, not an automatic diagnosis of a second cancer.

Liver enzymes and bilirubin should be checked before treatment and throughout treatment under US instructions. Abnormal tests or symptoms need closer checks. European information emphasises prompt liver assessment when symptoms or signs suggest injury. Follow the actual schedule provided, including extra tests required by a partner drug.

Kidney function affects the prescribed dose. Olaparib can also increase the blood test called creatinine; the team interprets this alongside other results and symptoms. A rise should not automatically be dismissed as harmless or taken as proof of permanent kidney damage. Report reduced urine, dehydration or new swelling.

Scans, examination, symptoms and, when helpful, tumour-marker trends are used to assess benefit. Side-effect severity does not show how well the cancer is responding. Record missed doses and symptoms to discuss at clinic.

Common side effects and practical management

Nausea, vomiting and appetite changes

Use anti-sickness medicines as prescribed. Smaller meals, regular snacks and frequent small drinks may be easier than large meals. Since olaparib tablets allow food, taking them with a tolerable snack may fit your routine. Check the schedule if another medicine requires fasting.

Tell the team if nausea continues despite treatment or appetite loss is causing weight loss. Repeated vomiting, dizziness, little urine or inability to drink needs prompt assessment for dehydration.

Diarrhoea, indigestion and abdominal discomfort

Report a clear increase in loose stools or stoma output. Drink enough to replace losses within any fluid limit set for heart or kidney problems. Use only the diarrhoea medicine agreed with your team. Fever, blood in the stool, severe pain or weakness requires urgent advice.

Indigestion and upper abdominal discomfort can occur. A pharmacist can check suitable treatment and interactions. Persistent or worsening pain should be assessed rather than repeatedly covered with painkillers.

Fatigue, headache and dizziness

Balance rest with gentle activity, such as short walks, when you are able. Plan demanding tasks for times when energy is best. New severe fatigue can reflect anaemia or another treatable problem, so do not assume you must simply tolerate it.

Headache and dizziness should be reported if persistent or troublesome. Ask which painkiller is appropriate, especially if platelets are low or you take an anticoagulant. Avoid driving when dizzy, weak or unusually tired. Sudden severe neurological symptoms need emergency assessment.

Taste, mouth and skin changes

Taste changes can make familiar food unappealing. Trying different textures or cooler foods may help. Keep up gentle mouth care with a soft toothbrush and report ulcers, white patches or pain that limits drinking.

An itchy rash can often be managed with advice and prescribed skin treatment. Contact the team for a new or spreading rash. Facial or throat swelling, wheezing or breathing difficulty may indicate an allergic reaction and needs emergency care.

Important serious side effects

Low blood counts and serious infection

Anaemia can cause pallor, breathlessness, a fast heartbeat and marked tiredness. The team may pause treatment, change the dose or arrange supportive care such as a blood transfusion. Do not start iron simply because haemoglobin is low; the cause needs assessment.

Low white cells can increase infection risk. Contact the hospital immediately for fever, chills, a new cough with illness, painful urination or sudden deterioration. Serious illness may need urgent treatment even without a high temperature.

Low platelets can cause bruising, bleeding gums, nosebleeds or small red or purple skin spots. Report these promptly. Uncontrolled bleeding, vomiting blood, black stools or collapse requires emergency care.

Pneumonitis: lung inflammation

Olaparib can cause pneumonitis, including severe or fatal cases. Symptoms may include a new or worsening cough, breathlessness and fever. Infection, anaemia or a clot can cause similar symptoms, so a new breathing problem needs assessment rather than guessing its cause.

The team will interrupt olaparib while suspected pneumonitis is investigated. If confirmed, treatment is discontinued and the lung condition treated. Seek emergency care for severe or sudden breathlessness or chest pain.

Blood clots

A clot in a deep vein may cause pain, swelling or warmth in one leg or arm. A clot reaching the lungs, called a pulmonary embolism, can cause sudden breathlessness, chest pain, coughing up blood, dizziness or collapse. A painful swollen limb needs urgent assessment; severe chest or breathing symptoms require emergency care.

Risk varies by treatment setting and is particularly important in metastatic prostate-cancer studies. A percentage from those studies should not be applied to every person taking olaparib. Tell the team about previous clots. Preventive or treatment anticoagulation is an individual decision; do not start aspirin or a blood thinner yourself.

Liver injury

Olaparib can cause drug-induced liver injury, sometimes severe or potentially fatal. Warning signs include yellowing of the eyes or skin, dark urine, pain on the right side of the abdomen, unusual tiredness, loss of appetite, nausea or vomiting. Contact your hospital promptly rather than waiting for the next routine blood test.

The team should withhold treatment while suspected drug-induced injury is assessed. US instructions require discontinuation when it is confirmed; European instructions describe considering discontinuation for severe injury according to the clinical situation. Do not restart tablets on your own after a suspected liver problem.

MDS, AML and other serious blood disorders

Myelodysplastic syndrome, or MDS, affects the bone marrow's production of healthy blood cells. Acute myeloid leukaemia, or AML, is a blood cancer. These have occurred during or after olaparib treatment, sometimes with fatal outcomes. Previous platinum chemotherapy, radiotherapy and other DNA-damaging treatments can also contribute to risk.

Persistent low counts, repeated infections, unusual bruising, worsening fatigue or breathlessness need investigation. Risk estimates differ between patient groups and follow-up periods. Ordinary treatment-related anaemia does not itself mean MDS or AML. Confirmed MDS or AML requires stopping olaparib and specialist management.

When olaparib is combined with durvalumab, European information also describes pure red cell aplasia, where production of red cells is severely reduced, and autoimmune haemolytic anaemia, where the immune system destroys red cells. Severe fatigue, breathlessness, pallor or jaundice requires prompt assessment. Confirmed cases require stopping both medicines under specialist care.

Other medicines, supplements and vaccinations

An enzyme called CYP3A helps clear olaparib from the body. Some medicines inhibit this enzyme and raise olaparib exposure, increasing side effects. Others induce it and can reduce treatment exposure. These interactions are not reliably solved by taking tablets a few hours apart.

Important examples include certain antifungals, clarithromycin, ritonavir-containing treatments, diltiazem, verapamil, rifampicin, carbamazepine and phenytoin. Avoid St John's wort. Strong or moderate inhibitors and inducers should generally be avoided; if an inhibitor is essential, the oncologist may prescribe a lower olaparib dose. Do not make the change yourself.

Avoid grapefruit and its juice, and Seville oranges and their juice, because they can increase exposure. Check ingredients in mixed drinks and foods containing these fruits. A restriction on these fruits does not mean every fruit must be avoided.

Olaparib can also affect other medicines, including some statins, anticoagulants, transplant medicines and diabetes treatments. Have every new prescription checked, including treatment started by another clinic. Review the list again when an interacting medicine stops, because any temporary olaparib dose reduction may need to be reversed on a planned timetable.

Discuss vaccines with the cancer team. Non-live vaccines may be appropriate, although protection can be reduced. Live vaccines need particular caution when immune function is impaired. Timing depends on blood counts and the whole treatment history; do not apply a fixed waiting period without individual advice.

Everyday life during treatment

Many patients manage treatment at home, but fatigue and monitoring can affect work and family responsibilities. Consider shorter workdays, help with transport or household tasks, and planned rest. Arrange repeat prescriptions early to avoid supply gaps.

For travel, carry original labelled packs, a medicine list and urgent contact information. Plan around tests and ensure suitable medical care is available at your destination. Tell the team before long journeys, especially with a previous clot. Do not add a preventive medicine without advice.

Tell your dentist and other clinicians about olaparib before procedures. Low counts may affect timing, while a partner medicine may have its own surgery precautions. The reviewed olaparib labels do not supply a universal stop-before-surgery interval for everyone.

Discuss worries about recurrence, sexual activity, intimacy or treatment burden. Hair changes from previous or accompanying treatments can also affect confidence; ask the team what to expect from your complete plan.

Fertility, contraception, pregnancy and breastfeeding

Olaparib can harm an unborn baby. A pregnancy test is required before treatment when pregnancy is possible. European information also describes ongoing pregnancy testing; its patient leaflet includes testing six months after the final dose. Confirm the schedule with your team.

Patients who could become pregnant need effective contraception during treatment and for six months afterwards. European information recommends two highly effective, complementary methods and warns that hormonal contraception may be less effective; an additional non-hormonal method should be considered. For hormone-dependent cancer, non-hormonal options require particular discussion.

Male patients with a pregnant partner or a partner who could become pregnant need precautions during treatment and for three months afterwards. European instructions specify condoms, with highly effective contraception also used by a partner who could become pregnant. Do not donate sperm during treatment or for three months afterwards.

Do not breastfeed during treatment or for one month after the last olaparib dose. A partner medicine may require a longer interval, which must also be followed. Effects on human fertility are not fully known; discuss preservation options before starting if future pregnancy or parenthood matters to you. Report a pregnancy promptly.

After treatment finishes

Continue follow-up and blood tests as arranged, particularly if treatment stopped because of low counts, lung symptoms or liver injury. New persistent cough, breathlessness, infections, bruising or worsening fatigue still needs assessment after tablets have stopped.

Complete the full contraception, sperm-donation and breastfeeding precaution periods. Review other medicines when olaparib or an interacting treatment stops. Do not restart leftover tablets on your own; the dose, test results and reason for stopping need review. Return unused medicine safely through the pharmacy.

Frequently asked questions