was resolute [4%:<500/mm 3 or platelets> <50,000/mm 3 , withhold treatment until ANC 1000/mm 3 and platelets 50,000/mm 3 ; then resume treatment at the original starting dose if recovery occurs in 7 days. If platelets> <25,000/mm 3 or recurrence of ANC> <500/mm 3 for> 7 days, withhold treatment until ANC 1000/mm 3 and platelets 50,000/mm 3 ; then resume treatment at 80 mg once daily (second episode). For third episode, further reduce dose to 50 mg once daily (for newly diagnosed patients) or discontinue (for patients resistant or intolerant to prior therapy) Accelerated or blast phase CML and Ph+ ALL (140 mg once daily starting dose): For ANC <500/mm 3 or platelets> <10,000/mm 3 , if cytopenia unrelated to leukemia, withhold treatment until ANC 1000/mm 3 and platelets 20,000/mm 3 ; then resume treatment at the original starting dose. If cytopenia recurs, withhold treatment until ANC 1000/mm 3 and platelets 20,000/mm 3 ; then resume treatment at 100 mg once daily (second episode) or 80 mg once daily (third episode). For cytopenias related to leukemia (confirm with marrow aspirate or biopsy), consider dose escalation to 180 mg once daily. Nonhematologic toxicity: Withhold treatment until toxicity improvement or resolution; if appropriate, resume treatment at a reduced dose based on the event severity and recurrence. Dermatologic toxicities : Manage rash with antihistamines or topical or systemic steroids (Khoury 2009), or treatment interruption, dose reduction, or discontinuation. Discontinue if dasatinib-related severe mucocutaneous reaction occurs. Fluid retention: Manage with diuretics, short courses of corticosteroids, and/or supportive care. Severe pleural effusions may require thoracentesis and oxygen therapy; consider dose reduction or treatment interruption. For grade 3 pleural effusion, withhold treatment until resolves to grade 1 or lower and consider corticosteroids (eg, prednisone 20 to 40 mg/day for 3 to 4 days), diuretics, thoracentesis and/or pleurodesis; may resume dasatinib at a decreased dose when effusion resolves (Khoury 2009). Pulmonary arterial hypertension: Discontinue with confirmed pulmonary arterial hypertension. Extemporaneously Prepared An oral suspension may be prepared by dissolving dasatinib tablet(s) for one dose in 30 mL chilled orange or apple juice (without preservatives). After 5 minutes, swirl the contents for 3 seconds and repeat the process every 5 minutes for a total of 20 minutes following addition of tablet(s). Minimize time between end of 20 minutes and administration since suspension will taste more bitter if allowed to stand longer. Swirl contents of container one last time, then administer immediately. To ensure the full dose is administered, rinse container with 15 mL juice and administer residue. May be administered orally (or by nasogastric tube). Discard any unused portion after 60 minutes. Sprycel data on file, Bristol-Myers Squibb Administration Administer once daily (morning or evening). May be taken without regard to food. Swallow whole; do not break, crush, or chew tablets. Take with a meal if GI upset occurs (Khoury 2009). Dietary Considerations Avoid grapefruit juice. Storage Store at 20 C to 25 C (68 F to 77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Drug Interactions Acetaminophen: May enhance the hepatotoxic effect of Dasatinib. Dasatinib may increase the serum concentration of Acetaminophen. Consider therapy modification Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): Dasatinib may enhance the anticoagulant effect of Agents with Antiplatelet Properties. Monitor therapy Antacids: May decrease the absorption of Dasatinib. Consider therapy modification Anticoagulants: Dasatinib may enhance the anticoagulant effect of Anticoagulants. Monitor therapy Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy ARIPiprazole: CYP3A4 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult full interaction monograph for specific recommendations. Monitor therapy BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination Bosentan: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy Conivaptan: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy CYP3A4 Inducers (Strong): May decrease the serum concentration of Dasatinib. Management: Avoid when possible. If such a combination cannot be avoided, consider increasing dasatinib dose and monitor clinical response and toxicity closely. Consider therapy modification CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy CYP3A4 Inhibitors (Strong): May increase the serum concentration of Dasatinib. Management: Use of this combination should be avoided; consider reducing dasatinib dose if a strong CYP3A4 inhibitor must be used. If using dasatinib 100 mg/day, consider reduction to 20 mg/day; if using dasatinib 140 mg/day, consider reduction to 40 mg/day. Consider therapy modification CYP3A4 Substrates (High risk with Inhibitors): Dasatinib may increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Consider therapy modification Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy Dexamethasone (Systemic): May decrease the serum concentration of Dasatinib. Management: Avoid when possible. If such a combination cannot be avoided, consider increasing dasatinib dose and monitoring clinical response and toxicity closely. Consider therapy modification Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification Flibanserin: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Flibanserin. Monitor therapy Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination Histamine H2 Receptor Antagonists: May decrease the absorption of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of H2-antagonists if some acid-reducing therapy is needed. Avoid combination HYDROcodone: CYP3A4 Inhibitors (Weak) may increase the serum concentration of HYDROcodone. Monitor therapy Idelalisib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification Lomitapide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Lomitapide. Management: Patients on lomitapide 5 mg/day may continue that dose. Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half. The lomitapide dose may then be titrated up to a max adult dose of 30 mg/day. Consider therapy modification MiFEPRIStone: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. Consider therapy modification MiFEPRIStone: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying). Management: Though the drugs listed here have uncertain QT-prolonging effects, they all have some possible association with QT prolongation and should generally be avoided when possible. Consider therapy modification Mitotane: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Consider therapy modification Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination Netupitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy NiMODipine: CYP3A4 Inhibitors (Weak) may increase the serum concentration of NiMODipine. Monitor therapy Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modification Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Monitor therapy Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Pidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Monitor therapy Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination Pimozide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Pimozide. Avoid combination Pitolisant: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant. Consider therapy modification Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapy Propacetamol: Dasatinib may enhance the hepatotoxic effect of Propacetamol. Dasatinib may increase serum concentrations of the active metabolite(s) of Propacetamol. Specifically, acetaminophen concentrations may increase. Consider therapy modification Proton Pump Inhibitors: May decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of the proton pump inhibitor if some acid-reducing therapy is needed. Avoid combination QTc-Prolonging Agents (Highest Risk): QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying) may enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Management: Avoid such combinations when possible. Use should be accompanied by close monitoring for evidence of QT prolongation or other alterations of cardiac rhythm. Consider therapy modification QTc-Prolonging Agents (Moderate Risk): QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying) may enhance the QTc-prolonging effect of QTc-Prolonging Agents (Moderate Risk). Monitor therapy Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification Sarilumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Simeprevir: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy St John's Wort: May decrease the serum concentration of Dasatinib. Avoid combination Stiripentol: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Monitor therapy Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Consider therapy modification Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination Voriconazole: May enhance the QTc-prolonging effect of Dasatinib. Voriconazole may increase the serum concentration of Dasatinib. Management: This combination should be avoided; consider reducing dasatinib dose if voriconazole must be used. If using dasatinib 100 mg/day, consider reduction to 20 mg/day; if using dasatinib 140 mg/day, consider reduction to 40 mg/day. Monitor ECG closely. Consider therapy modification Adverse Reactions 10%: Cardiovascular: Facial edema, peripheral edema Central nervous system: Headache (12% to 33%), fatigue (8% to 26%), pain (11%) Dermatologic: Skin rash (11% to 21%; includes drug eruption, erythema, erythema multiforme, erythematous rash, erythrosis, exfoliative rash, follicular rash, heat rash, macular rash, maculopapular rash, milia, papular rash, pruritic rash, pustular rash, skin exfoliation, skin irritation, urticaria vesiculosa, vesicular rash), pruritus (12%) Endocrine & metabolic: Fluid retention (19% to 48%; grades 3/4: 1% to 8%; cardiac-related: 9%) Gastrointestinal: Diarrhea (17% to 31%), nausea (8% to 24%), vomiting (5% to 16%), abdominal pain (7% to 12%) Hematologic & oncologic: Thrombocytopenia (grades 3/4: 22% to 85%), neutropenia (grades 3/4: 29% to 79%), anemia (grades 3/4: 13% to 74%), hemorrhage (8% to 26%; grades 3/4: 1% to 9%), febrile neutropenia (4% to 12%; grades 3/4: 4% to 12%) Infection: Infection (9% to 14%; includes bacterial, fungal, viral) Local: Localized edema (3% to 22%; grades 3/4: 1%; superficial) Neuromuscular & skeletal: Musculoskeletal pain (> <22%), myalgia (7% to 13%), arthralgia ( 13%) Respiratory: Pleural effusion (5% to 28%; grades 3/4: 7%), dyspnea (3% to 24%) Miscellaneous: Fever (6% to 18%) 1% to> <10%: Cardiovascular: Cardiac conduction disturbance (7%), ischemic heart disease (4%), cardiac disease ( 4%; includes cardiac failure, cardiomyopathy, diastolic dysfunction, ejection fraction decreased, left ventricular dysfunction, ventricular failure), edema ( 4%; generalized), pericardial effusion ( 4%; grades 3/4: 1%), prolonged Q-T interval on ECG ( 1%), cardiac arrhythmia, chest pain, flushing, hypertension, palpitations, tachycardia Central nervous system: Intracranial hemorrhage ( 3%; grades 3/4: 3%), chills, depression, dizziness, drowsiness, insomnia, myasthenia, neuropathy, peripheral neuropathy Dermatologic: Acne vulgaris, alopecia, dermatitis, eczema, hyperhidrosis, urticaria, xeroderma Endocrine & metabolic: Hyperuricemia, weight gain, weight loss Gastrointestinal: Constipation (10%), gastrointestinal hemorrhage (2% to 9%; grades 3/4: 1% to 7%), abdominal distention, change in appetite, colitis (including neutropenic colitis), dysgeusia, dyspepsia, enterocolitis, gastritis, mucositis, stomatitis Hematologic & oncologic: Bruise Hepatic: Increased serum bilirubin (grades 3/4: 6%), increased serum ALT (grades 3/4: 5%), increased serum AST (grades 3/4: 4%), ascites ( 1%) Infection: Herpes virus infection, sepsis Neuromuscular & skeletal: Muscle spasm (5%), stiffness, weakness Ophthalmic: Blurred vision, decreased visual acuity, dry eye syndrome, visual disturbance Otic: Tinnitus Renal: Increased serum creatinine (grades 3/4: 8%) Respiratory: Pulmonary hypertension ( 5%; grades 3/4: 1%), pulmonary edema ( 4%; grades 3/4: 3%), cough, pneumonia (bacterial, viral, or fungal), pneumonitis, pulmonary infiltrates, upper respiratory tract infection Miscellaneous: Soft tissue injury (oral)> <1% (Limited to important or life-threatening): Abnormal gait, abnormal platelet aggregation, abnormal T waves on ECG, acute coronary syndrome, acute pancreatitis, acute respiratory distress, amnesia, anal fissure, angina pectoris, anxiety, arthritis, asthma, ataxia, atrial fibrillation, atrial flutter, bronchospasm, bullous skin disease, cardiomegaly, cerebrovascular accident, cholecystitis, cholestasis, confusion, conjunctivitis, coronary artery disease, cor pulmonale, cranial nerve palsy (facial), decreased libido, deep vein thrombosis, dehydration, dementia, dermal ulcer, diabetes mellitus, dyschromia, dysphagia, embolism, emotional lability, epistaxis, equilibrium disturbance, erythema nodosum, esophagitis, fibrosis (dermal), fistula (anal), gastroesophageal reflux disease, gastrointestinal disease (protein wasting), gingival hemorrhage, gynecomastia, hearing loss, hematoma, hematuria, hemoptysis, hemorrhage (ocular), hepatitis, hypercholesterolemia, hypersensitivity reaction, hypersensitivity angiitis, hyperthyroidism, hypoalbuminemia, hypotension, hypothyroidism, increased creatine phosphokinase, increased gamma-glutamyl transferase, increased lacrimation, increased pulmonary artery pressure, increased troponin, inflammation (panniculitis), interstitial pulmonary disease, intestinal obstruction, livedo reticularis, lymphadenopathy, lymphocytopenia, malaise, menstrual disease, myocarditis, nail disease, nephrotic syndrome, optic neuritis, osteonecrosis, ototoxicity (hemorrhage), palmar-plantar erythrodysesthesia, pancreatitis, pericarditis, petechia, photophobia, pleuropericarditis, prolongation P-R interval on ECG, proteinuria, pulmonary embolism, pure red cell aplasia, reactivation of HBV, renal failure, renal insufficiency, rhabdomyolysis, seizure, skin photosensitivity, Stevens-Johnson syndrome, Sweet syndrome, syncope, tendonitis, thrombophlebitis, thrombosis, thyroiditis, transient ischemic attacks, tremor, tumor lysis syndrome, upper gastrointestinal tract ulcer, urinary frequency, uterine hemorrhage, vaginal hemorrhage, ventricular arrhythmia, ventricular tachycardia, vertigo, voice disorder Warnings/Precautions Concerns related to adverse effects: Bone marrow suppression: Severe dose-related bone marrow suppression (thrombocytopenia, neutropenia, anemia) is associated with treatment (usually reversible); dosage adjustment and/or temporary interruption may be required for severe myelosuppression; the incidence of myelosuppression is higher in patients with advanced chronic myeloid leukemia (CML) and Ph+ acute lymphoblastic leukemia (ALL). Monitor blood counts every 2 weeks for 12 weeks and then every 3 months thereafter or as clinically indicated (for chronic phase CML) or weekly for the first 2 months, then monthly thereafter or as clinically necessary (for accelerated or blast phase CML or for ALL). Cardiovascular adverse events: Cardiac ischemic events, cardiac fluid retention-related events, and conduction abnormalities (arrhythmia and palpitations) have been reported. Monitor for signs and symptoms of cardiac dysfunction. Dermatologic toxicity: Cases of severe mucocutaneous dermatologic reactions (including Stevens-Johnson syndrome and erythema multiforme) have been reported with dasatinib. Discontinue dasatinib if severe mucocutaneous reaction occurs and other etiologies have been ruled out. Fluid retention: Dasatinib may cause fluid retention, including pleural and pericardial effusions, pulmonary hypertension, and generalized or superficial edema. A prompt chest x-ray (or other appropriate diagnostic imaging) is recommended for symptoms suggestive of effusion (new or worsening dyspnea on exertion or at rest, pleuritic chest pain, or dry cough). Fluid retention may be managed with supportive care (diuretics or corticosteroids); thoracentesis and oxygen therapy may be necessary for severe fluid retention; consider dose reduction or treatment interruption. Utilizing once-daily dosing is associated with a decreased frequency of fluid retention. The risk for pleural effusion is increased in patients with hypertension, prior cardiac history and a twice a day administration schedule; interrupt treatment for grade 2 effusion; may consider reinitiating at a reduced dose after resolution (Quintás-Cardama 2007). Use with caution in patients where fluid accumulation may be poorly tolerated, such as in cardiovascular disease (HF or hypertension) and pulmonary disease. Hemorrhage: Fatal intracranial and GI hemorrhage have been reported in association with dasatinib use; severe hemorrhage (including CNS, GI) may occur due to thrombocytopenia. In addition to thrombocytopenia, dasatinib may also cause platelet dysfunction. Concomitant medications that inhibit platelet function or anticoagulants may increase the risk of bleeding. Pulmonary arterial hypertension: Dasatinib may increase the risk for pulmonary arterial hypertension (PAH). PAH may occur at any time after starting treatment, including after> 12 months of therapy. Evaluate for underlying cardiopulmonary disease prior to therapy initiation and during therapy; evaluate and rule out alternative etiologies in patients with symptoms suggestive of PAH (eg, dyspnea, fatigue, hypoxia, fluid retention) and interrupt therapy if symptoms are severe. Discontinue permanently with confirmed PAH diagnosis (may be reversible upon discontinuation). QT prolongation: May prolong QT interval; there are reports of patients with QTcF >500 msec. Use caution in patients at risk for QT prolongation, including patients with long QT syndrome, patients taking antiarrhythmic medications or other medications that lead to QT prolongation or potassium-wasting diuretics, patients with cumulative high-dose anthracycline therapy, and conditions which cause hypokalemia or hypomagnesemia. Correct hypokalemia and hypomagnesemia prior to and during dasatinib therapy. Tumor lysis syndrome: Tumor lysis syndrome (TLS) has been reported in patients with resistance to imatinib therapy, usually in patients with advanced phase disease. Risk for TLS is higher in patients with advanced stage disease and/or a high tumor burden; monitor patients at risk more frequently. Maintain adequate hydration and correct uric acid levels prior to treatment; monitor electrolyte levels. Disease-related concerns: Hepatic impairment: Use with caution in patients with hepatic impairment due to extensive hepatic metabolism. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Use with caution in patients taking anticoagulants or medications interfering with platelet function; not studied in clinical trials. Avoid concomitant use with CYP3A4 inducers and inhibitors; if concomitant use cannot be avoided, consider dasatinib dosage adjustments. Drugs that affect gastric pH: Elevated gastric pH may reduce dasatinib bioavailability; avoid concomitant use with proton pump inhibitors and H 2 blockers. If needed, may consider antacid administration at least 2 hours before or 2 hours after the dasatinib dose. Special populations: Elderly: Patients 65 years of age and older are more likely to experience toxicity (compared with younger patients). Monitoring Parameters CBC with differential every 2 weeks for 12 weeks and then every 3 months thereafter or as clinically indicated (for chronic phase chronic myeloid leukemia [CML]) or weekly for 2 months, then monthly or as clinically necessary (for accelerated or blast phase CML or for acute lymphoblastic leukemia [ALL]); bone marrow biopsy; liver function tests, electrolytes including calcium, phosphorus, magnesium; monitor for fluid retention; monitor for signs/symptoms of cardiac dysfunction; ECG monitoring if at risk for QT c prolongation; chest x-ray is recommended for symptoms suggestive of pleural effusion (eg, cough, dyspnea); signs/symptoms of tumor lysis syndrome and dermatologic reactions. Thyroid function testing recommendations (Hamnvik 2011): Preexisting levothyroxine therapy: Obtain baseline TSH levels, then monitor every 4 weeks until levels and levothyroxine dose are stable, then monitor every 2 months Without preexisting thyroid hormone replacement: TSH at baseline, then monthly for 4 months, then every 2 to 3 months Pregnancy Considerations Dasatinib crosses the placenta, with fetal plasma and amniotic concentrations comparable to maternal concentrations. Adverse effects, including hydrops fetalis and fetal leukopenia and thrombocytopenia have been reported following maternal exposure to dasatinib. Women of reproductive potential should use effective contraception during and for 30 days after the final dose to avoid becoming pregnant. Pregnant women are advised to avoid contact with crushed or broken tablets. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience muscle pain, joint pain, constipation or headache. Have patient report immediately to prescriber signs of infection, signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding); shortness of breath; excessive weight gain; swelling of arms or legs; cough; angina; tachycardia; passing out; abnormal heartbeat; severe dizziness; severe abdominal pain; severe nausea; vomiting; severe diarrhea; severe loss of strength and energy; signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes); or signs of tumor lysis syndrome (tachycardia or abnormal heartbeat; any passing out; urinary retention; muscle weakness or cramps; nausea, vomiting, diarrhea or lack of appetite; or feeling sluggish) (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about dasatinib Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 17 Reviews Add your own review/rating Drug class: BCR-ABL tyrosine kinase inhibitors Consumer resources Dasatinib Dasatinib (Advanced Reading) Professional resources Dasatinib (AHFS Monograph) Other brands: Sprycel Related treatment guides Acute Lymphoblastic Leukemia Chronic Myelogenous Leukemia Leukemia ]} Drug Status Rx Availability Prescription only D Pregnancy Category Positive evidence of risk N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Dasatinib Rating 17 User Reviews 8.6 /10 17 User Reviews 8.6 Rate it! Drug Class BCR-ABL tyrosine kinase inhibitors Related Drugs BCR-ABL tyrosine kinase inhibitors Gleevec , imatinib , Sprycel , Tasigna , nilotinib , bosutinib Chronic Myelogenous Leukemia hydroxyurea , Hydrea , Gleevec , cyclophosphamide , imatinib , Sprycel , Tasigna , cytarabine , More... Acute Lymphoblastic Leukemia methotrexate , Gleevec , mercaptopurine , imatinib , Adriamycin , doxorubicin , Sprycel , More... Leukemia prednisone , triamcinolone , dexamethasone , Decadron , Deltasone , Sprycel , Kenalog-40 , More...} } traditional
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