ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
PARP Inhibitor Pregnancy: Contraindicated in pregnancy — genotoxic; contraception mandatory during and for 1 month after treatment

Olaparib

Brand names: Lynparza

Adult dose

Dose: 300 mg twice daily
Route: Oral
Frequency: Twice daily (approximately 12 hours apart)
Max: 600 mg/day
For mCRPC with BRCA1/2 or ATM mutations who have progressed on prior enzalutamide or abiraterone. Swallow tablets whole — do not crush

Paediatric dose

Dose: Not applicable N/A/kg
Route: Oral
Frequency: Not applicable
Max: Not applicable
Not applicable

Dose adjustments

Renal

Reduce to 200 mg twice daily if eGFR 31-50; avoid if eGFR under 31

Hepatic

Avoid in moderate-severe hepatic impairment

Paediatric weight-based calculator

Not applicable

Clinical pearls

  • PROfound trial: olaparib doubled radiographic progression-free survival in BRCA1/2-mutated mCRPC vs enzalutamide or abiraterone — NICE approved (TA672)
  • Biomarker selection is mandatory — test for BRCA1/2 and other HRR gene mutations (via tumour or ctDNA) before prescribing
  • Monitor FBC regularly — anaemia requiring transfusion occurs in approximately 20%; withhold and reduce dose for haematological toxicity
  • Pneumonitis is rare but potentially fatal — if new respiratory symptoms develop, interrupt and investigate urgently
  • MDS/AML risk is a class effect of PARP inhibitors — counsel patients; report unexplained cytopenias promptly

Contraindications

  • No BRCA/HRR mutation (outside clinical trial)
  • Myelodysplastic syndrome or acute myeloid leukaemia

Side effects

  • Nausea (very common)
  • Fatigue
  • Anaemia
  • Vomiting
  • Diarrhoea
  • Myelodysplastic syndrome / acute myeloid leukaemia (rare but serious)
  • Pneumonitis (rare)

Interactions

  • Strong CYP3A4 inhibitors (clarithromycin, itraconazole — reduce olaparib dose to 100 mg twice daily)
  • Strong CYP3A4 inducers (rifampicin — avoid combination)
  • Warfarin (increased INR — monitor)

Monitoring

  • FBC (monthly for first year, then periodically)
  • Renal function
  • LFTs
  • Signs of MDS (cytopenias)
  • Respiratory symptoms (pneumonitis)

Reference: BNFc; BNF 90; NICE TA672 (Olaparib for mCRPC); PROfound Trial; EAU Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways