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
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
What are the side effects of Brukinsa (zanubrutinib)?
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%)
Other Side Effects
- Nausea
- Headache
- Fever
- Constipation
- Vomiting
- Itching
- Dizziness
- Swelling in the hands and feet
Serious Side Effects
- 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
Source: DailyMed
The following 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.
Frequently asked questions about Brukinsa (zanubrutinib)
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What are the 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 forms
Typical dosing 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)?
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
Chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL)
Advanced follicular lymphoma (FL)
Mantle cell lymphoma (MCL)
Chronic lymphocytic leukemia (CLL)
Small lymphocytic lymphoma (SLL)
Chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL) in adults
Waldenström's macroglobulinemia (WM) in adults
Chronic graft versus host disease (cGVHD) in adults and children 1 year and older
Brukinsa (zanubrutinib) images
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References
Best studies we foundAlu, A., et al. (2022). BTK inhibitors in the treatment of hematological malignancies and inflammatory diseases: mechanisms and clinical studies. Journal of Hematology & Oncology.
BEIGENE USA, INC. (2023). BRUKINSA- zanubrutinib capsule. DailyMed.
Burger, J. A. (2020). BTK Inhibitors: Present and future. Cancer Journal.
Cancer.Net. (2019). Safe storage and disposal of cancer medications.
Lymphoma Research Foundation. (n.d.). Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.
Lymphoma Research Foundation. (n.d.). Follicular Lymphoma.
Lymphoma Research Foundation. (n.d.). Mantle cell lymphoma.
Lymphoma Research Foundation. (n.d.). Marginal zone lymphoma.
Lymphoma Research Foundation. (n.d.). Waldenström macroglobulinemia.
MedlinePlus. (2022). Graft-versus-host disease.
National Cancer Institute. (2022). Targeted therapy to treat cancer.
National Comprehensive Cancer Network. (2023). Mantle cell lymphoma.
NCI Dictionary of Cancer Terms. (n.d.). B cell.
Rozkiewicz, R., et al. (2023). Bruton’s Tyrosine Kinase Inhibitors (BTKIs): Review of Preclinical Studies and Evaluation of Clinical Trials. Molecules.
Wang, L., et al. (2022). Case report: Zanubrutinib-induced dermatological toxicities: A single-center experience and review. Frontiers in Oncology.
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