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Phyrago
dasatinib
Adult Dosing .
Dosage forms: TAB: 20 mg, 50 mg, 70 mg, 80 mg, 100 mg, 140 mg
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments
Ph-positive CML
- [chronic phase, newly diagnosed]
- Dose: 100 mg PO qd; Info: may incr. dose to 140 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
- [chronic phase, resistant or intolerant dz]
- Dose: 100 mg PO qd; Info: may incr. dose to 140 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
- [accelerated phase or blast phase, resistant or intolerant dz]
- Dose: 140 mg PO qd; Info: may incr. dose to 180 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
Ph-positive ALL, relapsed or refractory
- [140 mg PO qd]
- Info: may incr. dose to 180 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 20 mg, 50 mg, 70 mg, 80 mg, 100 mg, 140 mg
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments; recalculate dose q3mo based on changes in wt
Ph-positive CML, chronic phase
- [1 yo and older, 10-19 kg]
- Dose: 40 mg PO qd; Info: may incr. dose to 50 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
- [1 yo and older, 20-29 kg]
- Dose: 60 mg PO qd; Info: may incr. dose to 70 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
- [1 yo and older, 30-44 kg]
- Dose: 70 mg PO qd; Info: may incr. dose to 90 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
- [1 yo and older, >45 kg]
- Dose: 100 mg PO qd; Info: may incr. dose to 120 mg PO qd if hematologic or cytogenetic response not achieved; do not cut/crush/chew tab
Ph-positive ALL, newly diagnosed
- [1 yo and older, 10-19 kg]
- Dose: 40 mg PO qd x2y; Start: on or before day 15 of induction chemo; Info: do not cut/crush/chew tab; part of multi-drug chemo regimen
- [1 yo and older, 20-29 kg]
- Dose: 60 mg PO qd x2y; Start: on or before day 15 of induction chemo; Info: do not cut/crush/chew tab; part of multi-drug chemo regimen
- [1 yo and older, 30-44 kg]
- Dose: 70 mg PO qd x2y; Start: on or before day 15 of induction chemo; Info: do not cut/crush/chew tab; part of multi-drug chemo regimen
- [1 yo and older, >45 kg]
- Dose: 100 mg PO qd x2y; Start: on or before day 15 of induction chemo; Info: do not cut/crush/chew tab; part of multi-drug chemo regimen
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pulmonary HTN
- electrolyte abnormalities, uncorrected
- avoid: breastfeeding during tx and x2wk after D/C
- caution: patients of childbearing potential
- caution: male patients of reproductive potential
- caution: elderly patients
- caution: hepatic impairment
- caution: myelosuppression
- caution: thrombocytopenia
- caution: fluid retention
- caution: cardiopulmonary dz
- caution: long QT syndrome, congenital
- caution: QT prolongation
- caution: QT prolongation family history
- caution: torsades de pointes history
- caution: ventricular arrhythmia
- caution: bradycardia
- caution: MI, recent
- caution: CHF
- caution: anthracycline use at high cumulative dose
- caution: tumor burden, high
Drug Interactions .
Overview
dasatinib
kinase inhibitor
- CYP3A4 substrate
- antiplatelet effects
- gastric pH sensitive
- hyperuricemic effects
- immunosuppressive oncologic agent
- myelosuppressive oncologic agent
- prolongs QT interval (conditional)
Contraindicated
- chikungunya vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- adagrasib
- ceritinib
- cimetidine
- cisapride
- cladribine oral
- clarithromycin
- cobicistat
- crizotinib
- deferiprone
- dexlansoprazole
- dexrazoxane
- domperidone
- dronedarone
- encorafenib
- enoxaparin
- enzalutamide
- ephedra
- esomeprazole
- famotidine
- fexinidazole
- fondaparinux
- fosphenytoin
- ganciclovir
- grapefruit
- hydroxychloroquine
- idelalisib
- nelfinavir
- nizatidine
- omeprazole
- pacritinib
- palifermin
- pantoprazole
- penicillamine
- primaquine
- primidone
- rifabutin
- rifampin
- ritonavir
- ropeginterferon alfa-2b
- sotalol
- St. John's wort
- tipranavir
- toremifene
- tucatinib
- valganciclovir
- vandetanib
- vonoprazan
- voriconazole
- ziprasidone
Monitor/Modify Tx
- abrocitinib
- acalabrutinib
- ado-trastuzumab emtansine
- afatinib
- albendazole
- alemtuzumab
- allopurinol
- alteplase
- aluminum hydroxide
- amiodarone
- anacaulase topical
- anagrelide
- anthrax vaccine
- anti-thymocyte globulin
- antithrombin
- apixaban
- apomorphine
- aprepitant
- artemether/lumefantrine
- asenapine
- asparaginase
- aspirin
- atidarsagene autotemcel
- auranofin
- avacopan
- avapritinib
- axitinib
- azathioprine
- azithromycin
- balsalazide
- baricitinib
- benznidazole
- berotralstat
- betibeglogene autotemcel
- bevacizumab
- binimetinib
- bivalirudin
- brentuximab vedotin
- bromelain
- bromfenac ophthalmic
- cabazitaxel
- cabozantinib
- calaspargase
- calcium carbonate
- cangrelor
- caplacizumab
- carfilzomib
- celecoxib
- chikungunya vaccine
- chloroquine
- cidofovir
- cilostazol
- ciprofloxacin
- citalopram
- clofazimine
- clopidogrel
- clozapine
- colchicine
- collagenase clostridium histolyticum
- conivaptan
- COVID-19 vaccine
- cyclophosphamide
- cyclosporine
- cysteamine
- dabigatran
- dalteparin
- danazol
- danshen
- dapsone
- darunavir
- deferasirox
- defibrotide
- degarelix
- desflurane
- desipramine
- desvenlafaxine
- deuruxolitinib
- dexmedetomidine
- dexmedetomidine injection
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- diflunisal
- diltiazem
- dimethyl fumarate
- diosmin
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- dipyridamole
- diroximel fumarate
- disopyramide
- dofetilide
- donepezil
- dordaviprone
- droperidol
- duloxetine
- duvelisib
- ebola vaccine, live
- edoxaban
- efbemalenograstim alfa
- eflapegrastim (G-CSF)
- elivaldogene autotemcel
- epirubicin
- epoprostenol
- eptifibatide
- eribulin
- erlotinib
- erythromycin
- escitalopram
- ethanol
- etodolac
- evening primrose oil
- everolimus
- exagamglogene autotemcel
- febuxostat
- fedratinib
- fenoprofen
- fenugreek
- filgrastim (G-CSF)
- flecainide
- fluconazole
- flucytosine
- fluorouracil
- fluoxetine
- fluphenazine
- flurbiprofen
- flurbiprofen ophthalmic
- fluvoxamine
- fosamprenavir
- foscarnet
- fostamatinib
- fruquintinib
- garlic
- gefitinib
- gemtuzumab ozogamicin
- gilteritinib
- ginkgo
- givinostat
- glasdegib
- goserelin
- Haemophilus b vaccine
- haloperidol
- heparin
- hepatitis A vaccine
- hepatitis B vaccine
- histrelin
- human papillomavirus vaccine
- hydrocortisone
- hydroxyurea
- hydroxyzine
- ibrutinib
- ibuprofen
- ibuprofen lysine
- ibutilide
- icosapent ethyl
- iloprost inhaled
- imatinib
- indomethacin
- influenza H5N1 vaccine
- influenza vaccine
- inotuzumab ozogamicin
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- isavuconazonium
- isoflurane
- Japanese encephalitis vaccine
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- leflunomide
- lenacapavir
- lenvatinib
- letermovir
- leuprolide
- levofloxacin
- levomilnacipran
- lifileucel
- linezolid
- lofexidine
- lovotibeglogene autotemcel
- lumateperone
- lymphocyte immune globulin, anti-thymocyte globulin
- macimorelin
- magnesium carbonate
- magnesium hydroxide
- magnesium oxide
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- meningococcal vaccine
- mercaptopurine
- mesalamine
- mesalamine rectal
- methadone
- methotrexate
- milnacipran
- monomethyl fumarate
- moxifloxacin
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- naproxen
- nattokinase
- nepafenac ophthalmic
- netupitant
- niacin (vitamin B3)
- nilotinib
- nintedanib
- nirogacestat
- nusinersen
- oliceridine
- olsalazine
- omega-3-acid
- ondansetron
- osimertinib
- oxaliplatin
- oxaprozin
- paliperidone
- palonosetron
- panobinostat
- paroxetine
- pasireotide
- pazopanib
- pegaspargase
- pegfilgrastim (G-CSF)
- peginterferon alfa 2a
- peginterferon beta 1a
- pegloticase
- penicillin G
- pentamidine
- pentosan polysulfate sodium
- piperacillin
- piroxicam
- pirtobrutinib
- plasminogen, human
- pneumococcal vaccine
- poliovirus vaccine
- ponatinib
- porfimer
- pralsetinib
- prasugrel
- probenecid
- procainamide
- proguanil
- propafenone
- pyrimethamine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- ramucirumab
- ranibizumab
- rasburicase
- regorafenib
- respiratory syncytial virus vaccine
- resveratrol
- reteplase
- revakinagene taroretcel
- revumenib
- ribavirin
- rituximab
- rivaroxaban
- romidepsin
- rucaparib
- ruxolitinib topical
- salsalate
- sargramostim (GM-CSF)
- sarilumab
- satralizumab
- saw palmetto
- selpercatinib
- selumetinib
- sepiapterin
- sertraline
- sevoflurane
- sirolimus
- sirolimus albumin-bound
- smallpox/mpox vaccine, live
- sodium bicarbonate
- sodium citrate
- sodium zirconium cyclosilicate
- sorafenib
- sotatercept
- stiripentol
- succimer
- sulfasalazine
- sulindac
- sunitinib
- telavancin
- tenecteplase
- teplizumab
- teriflunomide
- tetrabenazine
- thalidomide
- ticagrelor
- tick-borne encephalitis vaccine
- tirofiban
- tisotumab vedotin
- tivozanib
- tocilizumab
- tofacitinib
- tolmetin
- tovorafenib
- tramadol
- trametinib
- trazodone
- treprostinil
- triclabendazole
- trifluridine
- trimethoprim
- triptorelin
- typhoid vaccine
- upadacitinib
- vadadustat
- valproic acid
- vancomycin
- vemurafenib
- venlafaxine
- verapamil
- vilazodone
- vinpocetine
- vorapaxar
- vortioxetine
- warfarin
- willow bark
- zanubrutinib
- zidovudine
- ziv-aflibercept
Caution Advised
- argatroban
- armodafinil
- belzutifan
- bexarotene
- bosentan
- brigatinib
- cenobamate
- clobazam
- dabrafenib
- darolutamide
- dexamethasone
- dicloxacillin
- echinacea
- efavirenz
- elafibranor
- elagolix
- enasidenib
- eslicarbazepine acetate
- etravirine
- felbamate
- ginseng, Asian
- glycerol phenylbutyrate
- griseofulvin
- lorlatinib
- mavacamten
- meropenem
- mitapivat
- modafinil
- nadofaragene firadenovec intravesical
- nafcillin
- nevirapine
- odevixibat
- olutasidenib
- omaveloxolone
- oxcarbazepine
- perampanel
- pexidartinib
- pioglitazone
- prednisone
- repotrectinib
- rifapentine
- rufinamide
- sotorasib
- sunvozertinib
- suzetrigine
- tazemetostat
- tecovirimat
- telotristat ethyl
- topiramate
- vaborbactam
- vamorolone
- vinblastine
- vorasidenib
Adverse Reactions .
Serious Reactions
- myelosuppression
- febrile neutropenia
- pneumonia
- sepsis
- HBV reactivation
- hemorrhage
- thrombotic microangiopathy
- fluid retention, severe
- pleural effusion
- pericardial effusion
- pulmonary edema
- ascites
- cardiac dysfxn
- arrhythmia
- cardiac ischemia
- QT prolongation
- pulmonary HTN
- chylothorax
- interstitial lung dz
- Stevens-Johnson syndrome
- erythema multiforme
- tumor lysis syndrome
- nephrotic syndrome
- hepatotoxicity
- growth suppression (peds patients)
- carcinogenicity (animal studies)
Common Reactions
- fluid retention
- neutropenia
- thrombocytopenia
- anemia
- diarrhea
- headache
- hemorrhage
- musculoskeletal pain
- fever
- rigors
- fatigue
- pruritus
- rash
- nausea
- vomiting
- dyspnea
- cough
- infection
- pain
- appetite decr.
- asthenia
- arthralgia
- myalgia
- mucositis
- stomatitis
- dizziness
- constipation
- neuropathy
- weight changes
- abdominal pain
- arrhythmia
- febrile neutropenia
- developmental abnormalities (peds patients)
Safety/Monitoring .
Monitoring Parameters
Chronic Phase CML: LFTs at baseline, then qmo or as clinically indicated; CBC w/ diff q2wk x12wk, then q3mo thereafter; uric acid; electrolytes incl. Mg; cardiac eval; bone growth (peds)
Accelerated Phase CML or Blast Phase CML or Ph-Positive ALL: LFTs at baseline, then qmo or as clinically indicated; CBC w/ diff qwk x8wk, then qmo thereafter; uric acid; electrolytes incl. Mg; cardiac eval; bone growth (peds)
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; risk of teratogenicity based on limited human data; risk of embryo-fetal toxicities based on animal data at 0.1x systemic exposure
Individuals of Reproductive Potential
avoid pregnancy by using effective contraception during tx and x30 days after D/C in patients of childbearing potential and male patients
Lactation
Clinical Summary
avoid breastfeeding during tx and x2wk after D/C; no human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver extensively; CYP450: 3A4 substrate; Info: active metabolite
Excretion: feces 85% (19% unchanged), urine 4% (0.1% unchanged); Half-life: 3-5h
Subclass: Kinase Inhibitors, BCR-ABL Inhibitors
Mechanism of Action
inhibits BCR-ABL tyrosine kinase, inducing apoptosis in BCR-ABL-positive cell lines
Formulary .
No Formulary Selected
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