Home Drug Guide Dasatinib

Drug Guide

Generic Name

Dasatinib

Brand Names Sprycel, Phyrago

Classification

Therapeutic: Antineoplastic Agent

Pharmacological: Tyrosine Kinase Inhibitor

FDA Approved Indications

  • Chronic Phase Philadelphia chromosome-positive (Ph+) BCR-ABL positive CML in adults
  • Accelerated Phase and Blast Crisis Ph+ CML
  • Ph+ Acute Lymphoblastic Leukemia (ALL) in adults and pediatric patients

Mechanism of Action

Dasatinib inhibits BCR-ABL kinase activity, disrupting signals required for the proliferation and survival of leukemia cells. It also inhibits other kinases such as SRC family kinases, contributing to its antileukemic effects.

Dosage and Administration

Adult: The typical dose is 100 mg once daily, taken orally with or without food. Dose adjustments may be required based on response and tolerability.

Pediatric: Dosing in pediatric patients is based on body surface area and clinical response, typically starting at 60 mg/m² daily.

Geriatric: Use with caution; start at lower doses and adjust based on tolerability and response.

Renal Impairment: No initial dose adjustment necessary, but monitor closely.

Hepatic Impairment: Use with caution; no specific dose adjustment recommendations available.

Pharmacokinetics

Absorption: Rapidly absorbed, with peak plasma concentrations achieved in approximately 0.5-4 hours.

Distribution: Extensively bound to plasma proteins (~96%).

Metabolism: Primarily metabolized in the liver via CYP3A4.

Excretion: Excreted mainly in feces (~85%); renal excretion accounts for about 4%.

Half Life: Approximately 5-6 hours.

Contraindications

  • Hypersensitivity to dasatinib or any component of the formulation.

Precautions

  • Risk of bleeding, so caution in patients with bleeding disorders or on anticoagulants.
  • Myelosuppression risk requires blood count monitoring.
  • Pregnancy category: D – risk to fetus; use effective contraception during treatment and for at least 30 days after.

Adverse Reactions - Common

  • Myelosuppression (neutropenia, anemia, thrombocytopenia) (Very common)
  • Fluid retention, pleural effusion (Common)
  • GI symptoms (nausea, diarrhea, abdominal pain) (Common)

Adverse Reactions - Serious

  • QT prolongation, cardiac arrhythmias (Uncommon but serious)
  • Bleeding complications (Uncommon)
  • Pulmonary toxicities including pulmonary arterial hypertension (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors and inducers (affect dasatinib levels)

Drug-Food Interactions

  • Grapefruit and Seville oranges may increase plasma levels of dasatinib.

Drug-Herb Interactions

  • St. John’s Wort and other CYP3A4 inducers may decrease efficacy.

Nursing Implications

Assessment: Monitor complete blood counts, liver function tests, and cardiac status regularly. Watch for signs of bleeding, infection, or pulmonary issues.

Diagnoses:

  • Risk for bleeding
  • Impaired skin integrity
  • Decreased cardiac output

Implementation: Administer as prescribed, monitor labs, manage side effects, educate patient on signs of adverse reactions.

Evaluation: Assess for hematologic response, tolerability, and adverse effects periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed, preferably at the same time daily.
  • Report symptoms such as unusual bleeding, SOB, or swelling.
  • Avoid grapefruit and Seville oranges.
  • Use effective contraception during and after treatment as advised.
  • Report any signs of infection or bleeding promptly.

Special Considerations

Black Box Warnings:

  • Potential for severe and fatal bleeding, myocardial infarction, and pulmonary hypertension.

Genetic Factors: Pharmacogenetic variations in CYP3A4 may affect drug levels.

Lab Test Interference: May cause false increases in serum amylase and lipase levels.

Overdose Management

Signs/Symptoms: Bleeding, hypotension, arrhythmias, muscle weakness.

Treatment: Supportive care, discontinue dasatinib, manage symptoms, consider gastric lavage or activated charcoal if ingestion is recent.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable until expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.