Ponatinib

Say it: poh-NA-tih-nib · Brand names: Iclusig

Ponatinib is a strong targeted pill that blocks the abnormal protein that drives some leukemias, even when other pills stop working.

What it is

In some leukemias, an abnormal protein called BCR-ABL tells blood cells to grow out of control. Ponatinib blocks BCR-ABL, including a form called T315I that resists most other pills.

Often used for

• chronic myeloid leukemia (CML) when other pills did not work or the T315I change is present
• acute lymphoblastic leukemia with the Philadelphia chromosome

How you get it

It is a pill you take by mouth once a day, with or without food. Your team may lower the dose once the leukemia responds. Your schedule may be different.

Common side effects and what helps

• High blood pressure. Your team will check it at every visit.
• Rash or dry skin. Use gentle soap and moisturizer.
• Belly pain. Tell your team, since it can sometimes be a sign of pancreas problems.
• Headache. Ask your team what pain medicine is safe for you.
• Joint or muscle pain. Stretch gently and drink fluids.
• Feeling tired. Rest when you need to and take short walks when you can.
• Constipation. Drink fluids and eat fiber.

Call your care team right away if you have

• Chest pain, shortness of breath, or pain in your arm, back, neck, or jaw
• Numbness or weakness on one side, trouble speaking, or vision loss
• Pain, swelling, or redness in one leg or arm
• Swelling in your legs, fast weight gain, or trouble breathing when lying down
• Yellow skin or eyes, dark urine, or pain on the right side of your belly
• Bad headache, or blood pressure higher than your team told you to expect

Before you start, tell your team

• If you have had a heart attack, stroke, blood clot, or blocked blood vessels
• If you have high blood pressure, high cholesterol, diabetes, or heart failure
• If you smoke
• If you are pregnant, may become pregnant, or are breastfeeding
• All the medicines, vitamins, and herbal products you take, since some can change how this medicine works

Good to know

• This medicine has serious warnings for blocked arteries, blood clots, heart failure, and liver damage. Your team will weigh these risks with you.
• You will have blood pressure, heart, and liver checks often.
• You will have blood tests for blood counts and pancreas enzymes.
• It can slow wound healing. Tell your team about any planned surgery.

At home

• Take it at about the same time each day.
• Swallow the pills whole with water. Do not crush, chew, or split them unless your team says it is OK.
• If you miss a dose or throw up after a dose, ask your team what to do. Do not take an extra dose on your own.
• Store the pills at room temperature in their original container, away from children and pets.
• Wash your hands after touching the pills. Ask your team if others in your home should take special care.
• Do not eat grapefruit or drink grapefruit juice, since it can raise the amount of medicine in your blood.

Questions to ask

• What can I do to lower my heart and blood vessel risks?
• How long will I take this medicine?
• How often will I have blood tests to check how well it is working?
• Are any of my other medicines, foods, or supplements a problem with this medicine?
• What should I do if I miss a dose?

Side effect guides

• Fatigue (tiredness)
• Constipation
• Skin rash (including EGFR-inhibitor rash)
• Pain

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.