What is Brukinsa?

Brukinsa is among the very few treatment options available for Waldenström’s macroglobulinemia and mantle cell lymphoma, which are rare white blood cell cancers.

Let’s understand more about the medication, including its uses, side effects, and precautions to be followed.

Uses

Label Uses

Brukinsa or zanubrutinib is an oral prescription medication used to treat a type of rare cancer affecting your white blood cells (Waldenström’s macroglobulinemia) and mantle cell lymphoma (fast-growing cancer affecting white blood cells). 

Brukinsa has been recently approved (March 2021) in Canada for treating waldenström’s macroglobulinemia. It is a rare type of cancer that begins in white blood cells. The bone marrow of a person produces too many abnormal white blood cells that crowd out normal healthy white blood cells. The abnormal white blood cells generate a protein that gathers in blood, impairs blood circulation and causes complications. 

Brukinsa is also used in the treatment of mantle cell lymphoma. It also affects white blood cells. However, Brukinsa can be used in adult patients with mantle cell lymphoma who have received at least one prior therapy. 

Off-label Use

There is no off-label use of the medicine so far.

Brukinsa may be prescribed for other uses; ask your doctor or pharmacist for more information.

Directions for Use and Dosage

• Brukinsa is available as a capsule to be taken orally once or twice daily.
• The drug can be taken with or without food. 
• Take Brukinsa at the same time daily. Follow the instructions on the prescription label carefully; please consult your doctor or pharmacist in case of any queries. 
• Take the medication as directed do not deviate from the instructions.  The capsule is available in 80 mg strength. 
• The treatment may be continued until disease progression or unacceptable toxicity. In case of toxicity during the treatment, your physician may reduce the dose, discontinue the treatment temporarily or discontinue it depending upon the toxicity symptoms. 
• You must swallow the capsule as a whole with water. 
• Do not open, chew or break the capsules. 
• You must continue taking the treatment even if you feel well. Do not stop the medicine on your own.   
• If you miss your dose, take the dose as soon as possible and continue your regular dosing schedule from the next day onwards. You must not take a double dose in case of a missed dose. 

Dose

The recommended dose for treating waldenström’s macroglobulinemia and mantle cell lymphoma is usually 320 mg daily. 

Brukinsa may be taken as either 320 mg (4 capsules of 80 mg) once daily or 160 mg (2 capsules of 80 mg) twice daily.  

Your physician may modify your dose if you have severe hepatic impairment. The recommended dose is 80mg orally twice daily in case of severe hepatic impairment.

Storage

• Brukinsa is available in a bottle with 120 capsules. 
• The bottle has a child-resistant cap. But still, it is better to keep the medicine away from the reach of pets and children.
• The bottle must be stored between 15°C to 30°C. 

Ingredients:

Active Ingredient: 80 mg zanubrutinib

Zanubrutinib belongs to the group of drugs known as BTK kinase inhibitors. BTK kinase is a chemical responsible for signaling the growth of white blood cells. But it also aids in the growth of malignant cells.

BTK inhibition thus results in blocks signals resulting in cancer cell multiplication. This helps in preventing the spreading of cancer cells.

Side Effects

Like all the medications, Brukinsa also has side effects. Inform your doctor if the following side effects do not go away;

• Muscle pain
• Joint pain 
• Back pain 
• Diarrhea
• Cough
• Constipation 

Some of these effects can be serious. If you experience any of the following symptoms, please get in touch with your physician immediately or get emergency medical treatment:

• Rash
• Fast heartbeat
• Irregular heartbeat 
• Feeling Dizzy
• Fainting 
• Painful, frequent, or urgent urination 
• Feeling lightheaded
• Chest pain while breathing
• Shortness of breath
• Feeling weak
• Confusion
• Changes in speech
• Headache that lasts longer
• Unusual bleeding
• Unusual bruising
• Fever
• Sore throat 
• Infections
• Blood in stools
• Black stools
• Pink or brown urine
• Vomiting blood
• Coughing up blood

Brukinsa may also increase the risk of developing skin cancers. 

This is not a complete list of side effects. If you experience severe side effects or symptoms that are persistent, please contact your doctor immediately.

Contraindications

Inform your healthcare provider in case of an allergy to Brukinsa or any other medication or any of the ingredients in Brukinsa. Ask your pharmacist or check the medication guide for a list of the ingredients.

Do not take or inform your doctor if you have or had following conditions;

• Recent surgery, including dental surgery
• Recent infection
• Hepatic impairment 
• High blood pressure
• Irregular heartbeat 
• Bleeding issues

Besides, inform your doctor if you are pregnant or breastfeeding or planning to be pregnant. You should not become pregnant while you are on treatment with Brukinsa. You should take the necessary steps to avoid pregnancy during the treatment with Brukinsa and one week after the last dose. If you or your partner becomes pregnant while on treatment with Brukinsa, call your doctor immediately. Brukinsa may harm your fetus.  

If you are breastfeeding, you should inform your physician. Also, you must stop breastfeeding your child if you are on Brukinsa and for two weeks after the last dose. 

Warnings and Precautions

• In female patients, your physician may request you to undergo a pregnancy test as the medication can harm your baby. 
• You must inform your doctor if you are undergoing surgery or a dental procedure. The doctor may decide to stop the treatment for a while before and after the surgery. 
• Brukinsa may make your skin sensitive to light. Plan to avoid direct sunlight or take necessary precautions and wear protective clothing, sunglasses and sunscreen.
• Your doctor will monitor your blood count during the course of treatment. Also, it is advised to get checked by a dermatologist frequently. 
• Monitor for cardiac abnormalities as well during the course of treatment. 
• Monitor for any signs of bleeding. 

Interactions

Inform your health worker about other prescription and non-prescription medications that you are taking. Also, inform about vitamins, herbal and nutritional supplements that you are taking or planning to take. 

The following drugs may interact with Brukinsa. Please consult or inform your physician if you are or about to take the following medications:

• Warfarin 
• St. John’s Wort
• Fluconazole
• Itraconazole
• Ketoconazole
• Clarithromycin 
• Diltiazem
• Ritonavir 
• Rifampin
• Midazolam
• Methylprednisolone 
• Dexamethasone
• Omeprazole
• Digoxin 
• Phenobarbital 
• Phenytoin
• Prednisolone 

This is not a complete list of medications that interact with Brukinsa. You should consult your physician if you are to initiate a new treatment regime. 

Frequently Asked Questions

Is Brukinsa A Chemotherapy Drug?

No, it is not a chemotherapy drug. Usually, chemotherapy medicines work by destroying rapidly multiplying cells of your body. As cancer cells multiply quickly, chemotherapy destroys those cells. However, they may also kill some normal cells in the process.

But Brukinsa is a targeted therapy that works on chemicals responsible for signaling the multiplication of cancer cells. So, it works by preventing the cells from multiplying.

Why Should I Avoid Sun Exposure while Taking Brukinsa?

Brukinsa increases the sensitivity of your skin to light and the sun. It can thus increase the risk of various skin cancers. So, it is best to avoid sun exposure and use sunscreen when going out in the sun.

Is There A Generic Version?

No. For now, there is no generic version of Brukinsa available in Canada.

How Is This Medication Different from Others In The Treatment Of Ailment?

Brukinsa is among the very few treatment options available for Waldenström’s macroglobulinemia and mantle cell lymphoma, which are rare white blood cell cancers.

Who Makes This Drug and What Is Their Manufacturing Record of Success?

BeiGene Pharmaceuticals, a biopharmaceutical company, makes Brukinsa. They aim to provide the highest quality therapies to millions of people.