These highlights do not include all the information needed to use XPOVIO safely and effectively. See full prescribing information for XPOVIO. XPOVIO® (selinexor) tablets, for oral useInitial U.S. Approval: 2019

This Medication Guide has been approved by the U.S. Food and Drug Administration.		Revised: 4/2026
MEDICATION GUIDE XPOVIO® (x-PO-Vee-O) (selinexor) tablets
What is the most important information I should know about XPOVIO? XPOVIO can cause serious side effects, including: Low platelet counts and low white blood cell counts are common with XPOVIO and can sometimes be severe or life-threatening. Low platelet counts. Low platelet counts can lead to bleeding which can sometimes cause death. Your healthcare provider may prescribe platelet transfusions or other treatments for your low platelet counts. Tell your healthcare provider right away if you have any bleeding or easy bruising during treatment with XPOVIO. Low white blood cell counts. You may have an increased risk of infection during treatment with XPOVIO. Tell your healthcare provider if you have any signs or symptoms of infection, including fever, chills, cough, shortness of breath, pain during urination, or feeling generally unwell. Your healthcare provider may prescribe antibiotics, or certain medicines to help increase your white blood cell count, if needed.
Your healthcare provider will do blood tests before you start taking XPOVIO and often during the first 3 months of treatment and then as needed during treatment to monitor your blood cell counts. See “What are the possible side effects of XPOVIO?” for more information about side effects.
What is XPOVIO? XPOVIO is a prescription medicine used: in combination with the medicines bortezomib and dexamethasone to treat adults with multiple myeloma (MM) who have received at least one prior treatment for their disease. in combination with dexamethasone to treat adults with multiple myeloma (MM) that has come back (relapsed) or that did not respond to previous treatment (refractory), and who have received at least 4 prior therapies, and whose disease did not respond to (refractory) to at least 2 proteasome inhibitor medicines, at least 2 immunomodulatory agents, and an anti-CD38 monoclonal antibody medicine.
It is not known if XPOVIO is safe and effective in children.
Before taking XPOVIO, tell your healthcare provider about all of your medical conditions, including if you: have or have had a recent or active infection have or have had bleeding problems have or have had liver problems have cataracts are pregnant or plan to become pregnant. XPOVIO can harm your unborn baby. Females who are able to become pregnant: Your healthcare provider will check to see if you are pregnant before you start taking XPOVIO. You should use effective birth control (contraception) during treatment with XPOVIO and for 1 week after your last dose. Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment with XPOVIO. Males with female partners who are able to become pregnant: You should use effective birth control (contraception) during treatment with XPOVIO and for 1 week after your last dose. are breastfeeding or plan to breastfeed. It is not known if XPOVIO passes into your breast milk. Do not breastfeed during treatment with XPOVIO and for 1 week after your last dose of XPOVIO.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Talk with your healthcare provider before taking any new medicines.
How should I take XPOVIO? Take XPOVIO exactly as prescribed by your healthcare provider. Do not change your dose or stop taking XPOVIO without talking to your healthcare provider first. If you have multiple myeloma, your healthcare provider will prescribe dexamethasone with your XPOVIO treatment. Take dexamethasone exactly as prescribed. Swallow XPOVIO tablets whole with water. Do not break, chew, crush, or divide the tablets. Take any medicines your healthcare provider prescribes before and during treatment with XPOVIO to help prevent nausea and vomiting. Tell your healthcare provider if the prescribed medicine does not help your nausea and vomiting. It is important for you to drink enough fluids to help prevent dehydration and to eat enough calories to help prevent weight loss during treatment with XPOVIO. Talk to your healthcare provider if this is a problem for you. See “What are the possible side effects of XPOVIO?” If you miss a dose of XPOVIO, take your next dose at your next regularly scheduled day and time. If you vomit after taking a dose of XPOVIO, do not take an extra dose. Take your next dose at your next regularly scheduled day and time.
What should I avoid while taking XPOVIO? XPOVIO can cause neurologic side effects. See “What are the possible side effects of XPOVIO?” below. If you have any neurologic side effects with XPOVIO, do not drive or operate heavy or dangerous machinery until your neurologic side effects go away. Avoid falling. Use care as needed to avoid falling due to neurologic side effects.
What are the possible side effects of XPOVIO? XPOVIO can cause serious side effects, including: See “What is the most important information I should know about XPOVIO?” Stomach and intestinal (gastrointestinal) problems are common with XPOVIO and can sometimes be severe. Nausea and vomiting. Nausea and vomiting may affect your ability to eat and drink well. You can lose too much body fluid and body salts (electrolytes) and may be at risk for becoming dehydrated. You may need to receive intravenous (IV) fluids or other treatments to help prevent dehydration. Your healthcare provider will prescribe anti-nausea medicines for you to take before you start and during treatment with XPOVIO. See “How should I take XPOVIO?” Diarrhea. You can lose too much body fluid and body salts (electrolytes) and may be at risk for becoming dehydrated. You may need to receive IV fluids or other treatments to help prevent dehydration. Your healthcare provider will prescribe anti-diarrhea medicine for you as needed. Loss of appetite and weight loss. Tell your healthcare provider if you have a decrease or loss of appetite and if you notice that you are losing weight at any time during treatment. Your healthcare provider may prescribe medicines that can help increase your appetite or prescribe other kinds of nutritional support. Your healthcare provider will monitor your appetite and weight before you start XPOVIO and often during the first 3 months, then as needed during treatment. Decreased sodium levels in your blood. Decreased sodium levels in your blood is common with XPOVIO but can also sometimes be severe or life-threatening. Low sodium levels in your blood can happen if you have nausea, vomiting, or diarrhea, you become dehydrated, or if you have loss of appetite with XPOVIO. You may not have any symptoms of a low sodium level. Your healthcare provider may talk with you about your diet and prescribe IV fluids for you based on the sodium levels in your blood. Your healthcare provider will do blood tests before you start taking XPOVIO, and often during the first 2 months of treatment, and then as needed during treatment to monitor the sodium levels in your blood. Serious infections. XPOVIO can cause infections that can sometimes cause death, including upper or lower respiratory tract infections, such as pneumonia, and an infection throughout your body (sepsis). Tell your healthcare provider right away if you have any signs or symptoms of an infection such as cough, chills or fever, during treatment with XPOVIO. Neurologic side effects. XPOVIO can cause neurologic side effects that can sometimes be severe and life- threatening. XPOVIO can cause dizziness, fainting, decreased alertness, and changes in your mental status including confusion and decreased awareness of things around you (delirium). In some people, XPOVIO may also cause problems with thinking (cognitive problems), seeing or hearing things that are not really there (hallucinations), and may become very sleepy or drowsy. Taking other medicines that can cause dizziness or mental status changes during treatment with XPOVIO may increase your risk of neurologic side effects. Talk to your healthcare provider about all of your medicines. Tell your healthcare provider right away if you get any of these signs or symptoms. New or worsening cataract, a cloudy or loss of transparency of the lens in the eye. New or worsening cataract are common with XPOVIO. If a cataract forms, your vision may decrease, and you may need eye surgery to remove the cataract and restore your vision. Tell your healthcare provider right away if you have symptoms of a cataract such as double vision, blurred vision, sensitivity to light or glare.
Your healthcare provider may change your dose of XPOVIO, stop your treatment for a period of time, or completely stop your treatment if you have certain side effects during treatment with XPOVIO.
The most common side effects of XPOVIO in adults with multiple myeloma in combination with bortezomib and dexamethasone include:
tiredness numbness, tingling, or burning in your hands or feet (peripheral neuropathy)	upper respiratory tract infection low phosphate levels in your blood low red blood cell count (anemia). Symptoms may include tiredness and shortness of breath.
The most common side effects of XPOVIO in adults with multiple myeloma in combination with dexamethasone include:
tiredness low red blood cell count (anemia). Symptoms may include tiredness and shortness of breath.	constipation shortness of breath upper respiratory tract infection
XPOVIO may cause fertility problems in males and females, which may affect your ability to have children. Talk to your healthcare provider if you have concerns about fertility. These are not all the possible side effects of XPOVIO. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store XPOVIO? Store XPOVIO at or below 86°F (30°C). XPOVIO comes in a child-resistant blister pack.
Keep XPOVIO and all medicines out of the reach of children.
General information about the safe and effective use of XPOVIO. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use XPOVIO for a condition for which it was not prescribed. Do not give XPOVIO to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about XPOVIO that is written for health professionals.
What are the ingredients in XPOVIO? Active ingredient: selinexor Inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, Opadry 200 clear, Opadry II blue, povidone K30, and sodium lauryl sulfate. Manufactured for and marketed by: Karyopharm Therapeutics Inc., 85 Wells Avenue, Newton, MA, 02459 XPOVIO is a registered trademark of Karyopharm Therapeutics Inc. All other trademarks are the property of their respective owners. ©2026 Karyopharm Therapeutics Inc. For more information, call 1-888-209-9326 or go to www.XPOVIO.com

Revised: 5/2026

Document Id: 5e9b366c-3fc4-4178-bb80-687e21f9beff

Set id: f6dd2682-75a6-4863-90a8-a3197f6f78a8

Version: 18

Effective Time: 20260512

Karyopharm Therapeutics Inc.