Brukinsa
Brukinsa (zanubrutinib) is targeted therapy called Bruton’s tyrosine kinase (BTK) inhibitor. It’s used to treat certain blood cancers (leukemia), such as mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL). It’s convenient because it’s a capsule that you take by mouth either once or twice a day. But Brukinsa (zanubrutinib) can cause side effects such as higher blood sugar levels, infections, and muscle pain. It's best to avoid drinking alcohol if you're taking Brukinsa (zanubrutinib).
What is Brukinsa (zanubrutinib)?
What is Brukinsa (zanubrutinib) used for?
- Mantle cell lymphoma (MCL) after at least one prior therapy
- Advanced marginal zone lymphoma (MZL) for people who didn’t respond well to other anticancer medications
- Waldenström macroglobulinemia (WM)
- Chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL)
- Advanced follicular lymphoma (FL)
How Brukinsa (zanubrutinib) works
There’s a pathway inside some cells called the Bruton tyrosine kinase pathway, that sends signals that tell cells to grow and divide. This pathway is particularly active in B-cell cancers such as mantle cell lymphoma and chronic lymphocytic leukemia.
Brukinsa (zanubrutinib) is a Bruton’s tyrosine kinase (BTK) inhibitor. It blocks a specific protein in the Bruton tyrosine kinase pathway so that the cancer cells can’t grow or spread as well.
Drug facts
Side effects of Brukinsa (zanubrutinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Higher blood sugar levels (55%)
- Low blood cell counts, all (up to 50%)
- Muscle or joint pain (up to 45%)
- Cough, runny nose, and other symptoms of an upper respiratory tract infection (up to 44%)
- Bleeding (up to 42%)
- Rash (up to 36%)
- Higher creatinine levels (34%)
- Tiredness (up to 31%)
- Higher liver enzyme levels (up to 28%)
- Changes in electrolyte levels (up to 27%)
- Diarrhea (up to 25%)
- Higher potassium levels (24%)
- Bruising (up to 24%)
Less Common Side Effects
- Nausea
- Headache
- Fever
- Constipation
- Vomiting
- Itching
- Dizziness
- Swelling in the hands and feet
Note: These side effects were reported by people in clinical trials for MCL, MZL, or WM.
Brukinsa (zanubrutinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious infections: body aches, chills, fever, headache, new cough, sore throat, feeling tired, lowered blood cell counts
- Serious bleeding (general): bleeding or bruising that doesn’t stop or go away, large amount of bleeding, blood in the urine, throwing up blood, bloody or black and tarry stool
- Brain bleeds: headache, weakness, changes in vision, nausea, vomiting, trouble speaking or understanding speech, difficulty maintaining balance
- Stomach bleeds: dizziness, trouble breathing, feeling faint, stomach pain, nausea, vomiting, bright red blood in vomit, dark and tarry stool
- Heart rhythm problems: fainting, dizziness, chest pain, fast heartbeat, dizziness, difficulty breathing
The following Brukinsa (zanubrutinib) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bone, joint, or muscle pain
- Fatigue
- Skin rash
Pros and cons of Brukinsa (zanubrutinib)
Pros
- Can be taken with or without food
- Flexible dosing with option to take dose once or twice a day
- More precise in the way it targets cancer cells, compared to traditional chemotherapy
Cons
- Will need regularly blood test done to check blood cell count
- Can commonly cause muscle and joint pain, bleeds, and infections
- Must use birth control while taking, as it can harm an unborn baby
Pharmacist tips for Brukinsa (zanubrutinib)
- You can take Brukinsa (zanubrutinib) with or without food. Take the medication at the same time each day and swallow the capsule whole with a full glass of water. Don’t chew, crush, or break open the capsule.
- If you miss a dose of Brukinsa (zanubrutinib), take it as soon as you remember on the same day. Take your next dose at the normally scheduled time.
- Follow up with your provider for monthly blood tests. Brukinsa (zanubrutinib) can cause your blood cell counts to drop, so your provider will check these measurements to make sure they don't go too low. If your blood cell counts are too low, your provider might need to stop your treatment.
- Taking Brukinsa (zanubrutinib) can put you at higher risk for infections and raise the likelihood that you’ll get seriously sick from an infection. To lower your risk of getting sick, try to avoid being close to people who are sick. Make sure to wash your hands before you eat or use the bathroom. Also, avoid touching your eyes, nose, and mouth with unwashed hands.
- Due to the risk of bleeding with Brukinsa (zanubrutinib), let your healthcare provider know if you have had a recent surgery or plan to have surgery. You might need to stop taking Brukinsa (zanubrutinib) for a period of time before and after certain surgical procedures.
- Let your provider know if you’re taking a blood thinner medication, such as warfarin (Coumadin) or aspirin. It’s possible that taking these with Brukinsa (zanubrutinib) can put you at a higher risk for bleeding. Make sure to get help right away if you have bleeds that are difficult to stop, bruising that won't go away, stomach pain, or dark and tarry stool.
- Ask your provider or pharmacist about the best way to handle and throw away Brukinsa (zanubrutinib) safely. Anticancer medications can be very harmful to people who handle or come into contact with them.
Common questions about Brukinsa (zanubrutinib)
No, Brukinsa (zanubrutinib) isn’t a chemotherapy medication; it’s a targeted therapy. Chemotherapy works by attacking any cell that’s growing quickly, including cancer cells. On the other hand, Brukinsa (zanubrutinib) works in a more specific, targeted way. It blocks a protein called Bruton tyrosine kinase (BTK), which stops certain cancer cells from growing or spreading as well.
You should take Brukinsa (zanubrutinib) as instructed by your oncologist. How long you take Brukinsa (zanubrutinib) depends on several factors, such as how well the medication is working to treat your cancer and how well you tolerate side effects. Your oncologist can let you know how well this medication is working to treat your cancer based on your symptoms, lab results, and scan results. Don’t stop taking Brukinsa (zanubrutinib) without first discussing it with your oncology team.
The time it takes Brukinsa (zanubrutinib) to work is different for everyone. It depends on the type of cancer you have and specific Brukinsa (zanubrutinib) of your cancer. Typically, your oncologist will monitor how well Brukinsa (zanubrutinib) is working with lab tests, and sometimes scans. These are usually done every 2-3 months or so, but can be different for every person. If you’re unsure if Brukinsa (zanubrutinib) is working to treat your cancer, talk with your oncologist.
Brukinsa (zanubrutinib) is unlikely to cause hair loss. People who took Brukinsa (zanubrutinib) during clinical studies didn't report hair loss as a side effect. But there have been reports of people who did experience hair loss or skin changes that affected hair growth after taking Brukinsa (zanubrutinib). If you do notice hair thinning or loss while taking Brukinsa (zanubrutinib), talk to your oncologist. They can try to help determine whether the hair loss is caused by Brukinsa (zanubrutinib) or by other factors.
People who took Brukinsa (zanubrutinib) clinical studies didn't report weight gain as a side effect. Keep in mind that your appetite and tastes can change when you have cancer and are taking different cancer treatments. If you’re worried about weight loss or gain, talk to your oncologist. They might recommend you see a nutritionist or dietician who specializes in working with people who have cancer.
Brukinsa (zanubrutinib) isn’t recommended for use in pregnancy. Based on animal studies, this medication might cause harm to your unborn baby. If you're able to become pregnant, your oncologist might ask you to do a pregnancy test before you start taking Brukinsa (zanubrutinib). They'll also ask you to use birth control while taking Brukinsa (zanubrutinib) and for at least 1 week after the last dose. If you are a male and have a partner who's able to become pregnant, your partner should use birth control during treatment and for 1 week after your last dose of Brukinsa (zanubrutinib). Let your oncologist know right away if you become pregnant while taking this medication.
It isn’t recommended to breastfeed while taking Brukinsa (zanubrutinib). We don’t know if the medication can pass into your breast milk, but there’s a risk of serious harm to nursing infants if it does. Because of this risk, you shouldn’t breastfeed while taking Brukinsa (zanubrutinib) and for 2 weeks after your last dose. Talk with your oncologist or child's pediatrician about other ways to feed your baby during treatment.
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Risks and warnings for Brukinsa (zanubrutinib)
Brukinsa (zanubrutinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious infections
Some people taking Brukinsa (zanubrutinib) have developed serious infections, including pneumonia and hepatitis B virus (HBV) infection reactivation. Some people have also developed opportunistic infections, which are infections that happen in people with immune systems that aren’t working as well, such as people with cancer. Your oncologist might recommend you take medications, such as antivirals or antibiotics, to help prevent infections. If you have any symptoms of infection such as fever, chills, or weakness, contact your oncologist.
Serious bleeds
- Risk factors: Taking other medications that raise your risk for bleeds| Recent surgery
Brukinsa (zanubrutinib) can put you at risk for bleeds. Most of the time, these bleeds show up as rash-life bruises or purple pin-points on your skin. But in some cases, people have experienced more serious bleeds (e.g., in the brain or stomach) that were life-threatening. You’re at a higher risk of bleeding if you're also taking a blood thinner medication. Let your oncologist know if you experience any symptoms of bleeding, such as unusual bruising or bleeding, bleeding that takes longer to stop, bleeding from the nose or gums, or blood in the stool or urine.
If you’re getting surgery or any medical procedures, let your care team know you’re taking Brukinsa (zanubrutinib). They might ask you to temporarily stop this medication for a few days before and after your procedure to lower your risk for bleeds.
Low blood cell counts
Brukinsa (zanubrutinib) can cause the levels of your red blood cells, white blood cells, and platelets to drop. When these cell counts are lower than normal, you have a higher risk of anemia, bleeding, bruising, and infections. Your oncologist will check your blood cell counts regularly while you’re taking Brukinsa (zanubrutinib). Let your oncologist know right away if you experience fevers, chills, or bleeding and bruising that doesn’t stop or go away because they might need to lower your dose of Brukinsa (zanubrutinib) or stop this medication.
Possible risk of cancers
Although rare, Brukinsa (zanubrutinib) can cause new cancers to develop, including skin cancer and cancers in other areas of the body. To lower your risk of skin cancers, you should use sun protection, like sunscreen and long-sleeved clothing. When you’re outside. Talk to your oncologist if you notice any changes in your skin so they can check your skin for skin cancer.
Heart rhythm problems
- Risk factors: High blood pressure | History of irregular heartbeat | Infections
Taking Brukinsa (zanubrutinib) can cause changes in your heart’s rhythm (arrhythmias). You might be at a higher risk for heart rhythm problems if you have high blood pressure, an active infection, or a history of irregular heartbeats. Let your oncologist know if you experience dizziness, an unusually fast or slow heartbeat, or chest pain. These can be symptoms of a change in your heart rhythm.
Liver problems
Brukinsa (zanubrutinib) can cause serious liver problems that can be dangerous. You will likely need to have regular blood tests to monitor your liver labs and make sure they stay within a healthy range. Let your oncologist know if you have stomach pain, clay or light-colored stool, dark-colored urine, or yellowing of the skin or whites of the eyes.
Harm to an unborn baby
Brukinsa (zanubrutinib) hasn’t been studied in human pregnancies, but animal studies show that it can harm an unborn baby. Because of these risks, people who can become pregnant should use birth control during Brukinsa (zanubrutinib) treatment and for at least 1 week after the last dose. Males who have partners who are able to become pregnant should use effective birth control during treatment and for 1 week after the last dose. Let your oncologist know right away if you become pregnant during this time.
Brukinsa (zanubrutinib) dosage
Typical dosage for Brukinsa (zanubrutinib)
- Adults: The typical dose is 160 mg by mouth twice daily or 320 mg by mouth once daily.
Your oncologist might also prescribe Gazyva (obinutuzumab) in addition to Brukinsa (zanubrutinib), depending on what type of cancer you have.
Your dose of Brukinsa (zanubrutinib) might be different if you experience certain side effects or you’re also taking other medications that can interact with Brukinsa (zanubrutinib).
What are alternatives to Brukinsa (zanubrutinib)?
Brukinsa (zanubrutinib) images
