Zanubrutinib (BRUKINSA)

Chronic lymphocytic leukemia  

Mantle cell lymphoma

Marginal zone lymphoma  

Waldenstrom’s macroglobulinemia

Chronic lymphocytic leukemia

• Dose – Oral: 160mg twice daily or 320mg daily continuously until disease progression or unacceptable toxicity

Mantle cell lymphoma

• Dose – Oral: 160mg twice daily or 320mg daily continuously until disease progression or unacceptable toxicity

Marginal zone lymphoma

• Dose – Oral: 160mg twice daily or 320mg daily continuously until disease progression or unacceptable toxicity  

Waldenstrom’s macroglobulinemia

• Dose – Oral: 160mg twice daily or 320mg daily continuously until disease progression or unacceptable toxicity

Available as 80 mg hard gelatin capsules. Capsules should NOT be opened. Store at room temperature.

Bruton’s Tyrosine Kinase Inhibitor

Take with or without food

Once daily dosing: If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Twice daily dosing: If a dose is missed, patients should be instructed to take it as soon as they can if it is within 6 hours of the missed dose. If it is over 6 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Neutropenia, Thrombocytopenia, Diarrhea, Fatigue, Infections, Upper respiratory infection, Glucose increase, Musculoskeletal pain, Rash, Hemorrhage.

Less Common: Atrial fibrillation, Cardiomegaly, Second primary malignancies, Interstitial lung disease.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before first treatment: CBC & differential, platelets, creatinine, bilirubin, ALT, IgM level if clinically indicated, PTT, INR, HBsAg, HBcoreAb.

During treatment: CBC & differential, platelets, bilirubin, ALT.

If clinically indicated: Baseline ECG should be arranged if patient has cardiac risk factors such as hypertension, diabetes mellitus, pre-existing arrythmias or history of heart failure.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Fatal and serious hemorrhage has occurred in patients with hematological malignancies treated with Zanubrutinib. Monitor for signs and symptoms of bleeding.
• Fatal and serious infections (including bacterial, viral, or fungal infections) and opportunistic infections have occurred. Monitor and evaluate patients for fever or other signs and symptoms of infection and treat appropriately.
• Grade 3 or 4 cytopenias, including neutropenia, thrombocytopenia and anemia have been reported.  Monitor complete blood counts regularly during treatment and interrupt treatment, reduce the dose, or discontinue treatment as warranted.
• Second primary malignancies have occurred in patients taking zanubrutinib. Advise patients to monitor for suspicious skin lesions and to take appropriate sun protection measures.

BC Cancer. BC Cancer Drug Manual. Zanubrutinib.  Vancouver, British Columbia: BC Cancer Agency. Available at:  http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Zanubrutinib_monograph.pdf. Updated January  1, 2024. Accessed January 22, 2024.

Lexicomp. Zabubrutinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/6884010?cesid=9ogcKnsrF4V&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dzanubrutinib%26t%3Dname%26acs%3Dtrue%26acq%3DZanbrutinib. Updated January 24, 2024. Accessed January 31, 2024.Cancer Care Ontario. Zanubrutinib Provider Monograph. Drug Formulary. Toronto, Ontario:

Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/70361. Updated April 2023. Accessed January 22, 2024

Innomar Strategies Inc. BRUKINSA® Product Monograph. Milton, ON. Updated February 17, 2022.