Zanubrutinib (Brukinsa®)

Zanubrutinib (Brukinsa®) is a type of drug called a tyrosine kinase inhibitor (TKI). It belongs to a group of targeted therapy drugs known as cancer growth inhibitors. Tyrosine kinases are proteins in the body that help cancer cells grow and divide.

Zanubrutinib blocks the proteins (kinases) from sending signals to the cancer cells to grow. Blocking the signals causes the cells to die. This may help to stop or slow down the cancer.

It is best to read this information with our general information about the type of cancer you have. 

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment. 

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

Your doctor, nurse or pharmacist will explain how to take your capsules. 

Always take zanubrutinib exactly as explained to you. This is important to make sure it works as well as possible for you.

Zanubrutinib comes as 80mg capsules. The usual dose of zanubrutinib is 320mg a day. 

You can either take zanubrutinib as: 

• 4 capsules (320mg) once a day 
• 2 capsules (160mg) in the morning and 2 capsules (160mg) in the evening. 

You should try and take the capsules at the same times each day. Swallow the capsules whole with a glass of water. They should not be chewed, broken, or opened. You can take the capsules with or without food.

If you take zanubrutinib once a day and forget to take a dose, take your next dose as usual the following day. 

If you take zanubrutinib twice a day and you forget to take it in the morning, take your next dose as usual in the evening. If you forget to take your evening dose, take your next dose as usual the following morning. 

If you forget a dose, do not take a double dose to make up for the forgotten one.

If you are not sure, contact your doctor, pharmacist or nurse about when to take your next dose.

Here are some other things to remember about your capsules:

• Do not have grapefruit or Seville oranges (bitter oranges) while you are taking zanubrutinib. This includes eating these fruits, drinking the juice, or taking supplements that might contain them. These fruits can increase the amount of zanubrutinib in your blood. 
• Wash your hands after taking your capsules.
• Other people should avoid direct contact with the capsules. 
• Keep the capsules in the original package and at room temperature, away from moisture, heat and direct sunlight.
• Keep the capsules safe, somewhere children cannot see or reach them. 
• If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
• If your treatment is stopped, return any unused capsules to the pharmacist. 

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.

Your doctor may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

• your temperature goes over 37.5°C (99.5°F)
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection
• your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough 
• breathlessness
• diarrhoea
• needing to pass urine (pee) a lot, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may reduce or stop your treatment for a while, until your cell count increases.

This treatment can reduce the number of red blood cells in your blood. 

Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:

• pale skin 
• lack of energy
• feeling breathless 
• feeling dizzy and light-headed. 

Tell your doctor or nurse if you have these symptoms. 

Sometimes, if you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Zanubrutinib can increase the risk of bleeding and reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. 

Tell your doctor or pharmacist if you are taking any medicines that can affect bleeding. This includes: 

• tablets such as aspirin and ibuprofen
• treatment to prevent blood clots such as warfarin, apixaban or rivoroxiban,  
• supplements such as fish oil, vitamin E or flaxseed 

If you have a low number of platelets in your blood, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• tiny red or purple spots on your skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. Sometimes, you may need a drip to give you extra platelets. This is called a platelet transfusion. 

You should contact your doctor straight away if you have any heavy or unusual bleeding. This includes: 

• vomiting or coughing up blood
• unexpected vaginal bleeding
• blood in your urine (pee) or stools (poo)

If you need surgery or dental treatment, your doctor may ask you to stop taking zanubrutinib for a few days before and after the treatment.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable. 

Tell them if the pain does not get better. Having warm baths and resting regularly may help. 

Zanubrutinib may affect your skin It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice and may prescribe creams or medicines to help. 

You may put on weight or your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if you notice this. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

If you have had a liver infection called hepatitis B in the past, this treatment can make it active again. Your doctor or nurse will talk to you about this. They will test you for hepatitis B.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. 

If you are on a hormonal contraception such as the pill, an injection or an implant, you will need to use a barrier type, such as a condom, as well. Your doctor, nurse or pharmacist can tell you more about this and advise you.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.