Generic Name: Zanubrutinib
Brand Name: Brukinsa
Drug Classification: Covalent Bruton Tyrosine Kinase (BTK) Inhibitor
INDICATIONS FOR USE
- For CLL and SLL without 17p deletion or TP53 mutation: Zanubrutinib may be taken alone as a preferred initial (first-line) treatment, or alone as a second- or third-line treatment.
- For CLL and SLL with 17p deletion or TP53 mutation: Zanubrutinib may be taken alone as a preferred initial (first-line) treatment, or alone as a second- or third-line treatment.
ADMINISTRATION ROUTE
Taken orally by mouth (in capsule form).
LENGTH OF TIME ADMINISTERED
This medication should be taken indefinitely until either the disease progresses while on the medication (which would require switching to a new medication to treat the CLL or SLL), or until certain unacceptable side effects occur requiring discontinuation of the drug.
DOSING
160 mg orally twice a day (ideally every 12 hours), or 320 mg once a day.
MISSED DOSE
If a dose is missed by more than three hours, it should be skipped. Then take the next dose at the regularly scheduled time.
Do not take an extra dose to make up for the missed dose.
HOW TO TAKE THIS MEDICATION
- Swallow the medication whole with water. Do not chew, break open, or crush.
- May be taken with or without food.
- Do not ingest any starfruit, grapefruit, bitter orange/marmalade products, Seville oranges or pomegranate. Certain citrus fruits are known to interfere with the metabolism of the medication and can potentially cause toxic levels of the drug to build up in the blood.
COMBINATION THERAPIES
Clinical trials are ongoing to investigate using zanubrutinib with various combinations of other drugs.
COMMON SIDE EFFECTS
Side effects can occur as a result of any medication, some of which may go away with time as your body adjusts to the new medication. Please notify your healthcare provider right away if any of the following side effects occur:
- Low red blood cell count, low white blood cell/neutrophil count, or low platelet count
- Respiratory infection
- Cough
- Bruising or bleeding
- Fatigue
- Rash
- Muscle, joint, or bone pain
- Constipation or diarrhea
Side effects not mentioned above may also occur. Notify your healthcare provider of any other unusual symptoms, as they may be able to tell you about ways to prevent or reduce certain side effects.
MANAGING COMMON SIDE EFFECTS
Some side effects are more common than others, many of which will go away after a short period of time after staying on the medication. It is important to talk to your healthcare provider to discuss if you might be able to manage side effects in the short term in order to stay on the therapy until your body has time to adjust to the new medication. Here are some possible ways to help manage some of the most common side effects of zanubrutinib in consultation with your healthcare provider.
Diarrhea
- Increase your fluid intake.
- Take anti-diarrheal medications (such as Imodium) per package instructions.
- Eat a bland diet (such as bananas, rice, apples/applesauce, toast, or plain pasta).
Constipation
- Increase your fluid intake.
- Consume more foods that are high in fiber (such as vegetables and whole grain bread).
- Consider over-the-counter fiber supplements (such as Fibercon, Miralax, or Metamucil).
- Move around more, as walking and other forms of light exercise can help.
- Take over-the-counter stool softeners (such as Colace) to help soften bowel movements.
Fatigue or Tiredness
- Ensure you are eating a well-rounded diet that includes a balance of lean meats, fruits, vegetables, whole grains, and limited amounts of processed foods.
- Incorporate light types of exercise (such as walking).
- If you are able, take one short twenty-minute nap during the day. Frequent or longer naps during the day can affect the amount of sleep you are getting during the night and increase fatigue/tiredness.
Muscle, Joint, or Bone Pain
- Take acetaminophen (such as Tylenol) per package instructions.
- It is important to avoid taking anti-inflammatories (such as ibuprofen) for mild pain while taking zanubrutinib due to the slightly increased risk of bleeding.
- Antihistamines (such as Allegra, Zyrtec, or Claritin) may help slightly with bone pain.
- Tonic water or magnesium supplements may help muscle cramping.
- Gentle stretching and application of heat or ice to the affected area(s) can provide temporary relief.
- If you are experiencing more severe joint pain, your healthcare provider may prescribe a short course of steroids.
REASONS TO TALK TO YOUR HEALTHCARE PROVIDER
The presence of other medical problems may affect the use of zanubrutinib. Make sure you share with your healthcare provider if you have any of the following conditions:
- Heart problems (including palpitations, fast or irregular heartbeat, dizziness, fainting, chest discomfort, or shortness of breath)
- High blood pressure (this medication may raise blood pressure)
- Diabetes (this medication may raise blood sugar)
- Liver disease (a dose reduction of 80 mg taken two times per day is available for those with severe liver dysfunction)
- Hepatitis
- Recent or current infection
- Bleeding problems or if you are on any blood thinning medication
- If you are pregnant or breastfeeding (or if you plan to become pregnant or breastfeed)
SPECIAL CONSIDERATIONS
- Zanubrutinib can have a mild blood-thinning
effect, so aspirin and other anti-inflammatory pain medications (such as ibuprofen/Advil) may need
to be avoided. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently, be careful when using sharp objects, including razors and fingernail clippers. - Serious bacterial, viral, or fungal infections can occur while taking zanubrutinib. But this can also occur in part from being immunocompromised due to having CLL or SLL. Avoid being near people who are sick and wash your hands often.
- There are several medications that interfere with the metabolism of zanubrutinib and can cause toxic levels of the drug to build up in the blood, or that increase the breakdown of zanubrutinib which can decrease the drug’s effectiveness. It is very important to tell your healthcare provider about all the medications you take, including prescription and over the counter medicines, vitamins, and herbal supplements (particularly in the case of zanubrutinib you should not be on St. John’s Wort).
- If you have had hepatitis B before or carry the virus, talk with your doctor. This drug can cause the dormant virus to become reactivated.
- Secondary cancers have been reported while taking the medication, but this is also a common finding associated with having CLL or SLL. Please be diligent about annual cancer screenings and wearing sun protection when outside in sunlight.
- You may be advised to briefly stop taking zanubrutinib for dental or surgical procedures
for several days before and after the procedure
to minimize the risk of bleeding. Please let your CLL / SLL healthcare provider know about any planned procedures. Never hold or stop taking this medication without the supervision of your healthcare provider.
