dasatinib, Sprycel (cont.)

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DOSING: The recommended dose range of dasatinib is 100-180 mg orally once daily. For newly diagnosed Ph+ CML treatment starts at 100 mg and is increased to 140 mg daily as needed. For advanced Ph+ CML or Ph+ ALL treatment is started at 140 mg and increased to 180 mg daily as needed.

DRUG INTERACTIONS: The blood concentration of dasatinib may be increased by several drugs that reduce its break down by liver enzymes. Increased blood concentrations of dasatinib may increase the occurrence of adverse effects. Examples include ketoconazole, itraconazole (Sporanox), clarithromycin (Biaxin), atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), telithromycin (Ketek), voriconazole (Vfend), and grapefruit juice. A dose reduction should be considered if there are no alternative medications that will not interact with dasatinib, for example a reduction in dose from 100 mg to 20 mg or 140 mg to 40 mg daily.

Certain drugs decrease the concentration of dasatinib resulting in decreased blood levels and possibly reduced effect. Examples include dexamethasone, carbamazepine, phenobarbital, rifampin, phenobarbital, and St John's Wort. A dose increase should be considered if dasatinib is combined with such drugs.

Drugs that reduce production of acid in the stomach reduce the absorption of dasatinib. Examples include proton pump inhibitors (PPIs) such as omeprazole (Prilosec) and H2 blocking drugs such as famotidine (Pepcid). Antacids used 2 hours before or after administration of dasatinib are reasonable alternatives to drugs that reduce the production of acid in the stomach.

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