Dasatinib (Sprycel ®)
Dasatinib, which is also known as Sprycel®, is a drug that may be used to treat some people with chronic myeloid leukaemia (CML). It can also be used to treat some adults with acute lymphoblastic leukaemia (ALL).
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This section should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Dasatinib is a type of treatment called a tyrosine kinase inhibitor. Kinases are important proteins in the body that regulate how cells grow and divide.
Dasatinib works by blocking (inhibiting) signals within the leukaemia cells that make them grow and divide. Blocking the signals causes the cells to die.
When dasatinib is used
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Dasatinib is licensed as a treatment for people with:
Philadelphia chromosome positive chronic myeloid leukaemia (Ph+ CML) who have already had other treatments, including imatinib (Glivec®)
Ph+ acute lymphoblastic leukaemia (ALL) that is no longer responding to other treatments, or because the side effects are too much.
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. NICE has not recommended the use of dasatinib. The SMC has recommended its use for people with CML but does not recommend it as a treatment for people with ALL.
If dasatinib isn’t recommended for you, it may not be available on the NHS, although you may be given it as part of a clinical trial. We have more information on what you can do if a treatment isn’t available.
What dasatinib looks like
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Dasatinib is a white to off-white tablet. It comes in four strengths: 20mg, 50mg, 70mg and 100mg. The tablets are round, oval or triangle in shape depending on the strength.
How dasatinib is taken
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Dasatinib should be taken with a large glass of water, with or without a meal. It’s normally given once a day, and should be taken at approximately the same time each day. The tablets should not be crushed or broken. You will usually continue to take dasatinib for as long as it's controlling your cancer.
Possible side effects of dasatinib
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Each person’s reaction to dasatinib is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
The side effects of dasatinib are generally mild or moderate and usually stop once treatment finishes. However, sometimes more serious problems can occur. Side effects are most common during the first two months of treatment and may begin to gradually disappear after this.
However, late side effects can occur. Tell your doctor if any side effects continue or are troublesome.
Risk of infection
Dasatinib can reduce the number of white blood cells, which help the body fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even if your temperature is normal.
If the blood count is too low, your doctor may ask you to stop taking dasatinib or reduce the dose for a while.
Bruising and bleeding
Dasatinib can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low. Your doctor may ask you to stop taking dasatinib or reduce the dose for a while.
Anaemia (low number of red blood cells)
Dasatinib can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if your number of red blood cells becomes too low.
This can affect different parts of your body. Most commonly it causes swelling of the ankles or swelling around the eyes. Fluid retention often settles without treatment, but if it doesn't, drugs that make you pass more urine (diuretics) can help get rid of some of the fluid.
A short course of steroids may also be helpful. Sometimes fluid may collect in the lining of the lungs (pleural effusion). Rarely, it may collect in the abdominal space (ascites) or in the sac around the heart (pericardial effusion).
Tell your doctor straight away if you develop a cough, chest pain, feel more breathless than usual or if you gain weight suddenly.
Dasatinib can cause diarrhoea. This can usually be easily controlled with medicine but you should tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. It can also be reduced by taking the tablet with food.
If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Some people find that dasatinib causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Muscle and bone pain
Some people have muscle, joint and bone pain while having treatment. Your doctor can prescribe painkillers if you're affected.
Rashes, dryness, itching, increased sweating or greater sensitivity to sunlight are all quite common. These side effects are usually mild. Speak to your doctor or nurse if you have any of these skin changes. They can advise you about creams or lotions to use, or prescribe medicines to relieve itching.
This is common but usually mild. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. We have more tips about coping with fatigue that might be helpful.
Abdominal (tummy) pain
Some people have pain or discomfort in their tummy when taking dasatinib.
Effects on the eyes
Your eyes may become dry or you may notice changes to how well you can see (blurred vision). In some people, this may affect their ability to drive safely. Tell your doctor if you notice any of these changes.
Loss of appetite
Some people lose their appetite while they’re having dasatinib. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Some people have episodes of dizziness or feel light-headed at times. Tell your doctor if you have this. It may also affect your ability to drive.
Changes in sensation in hands and feet
Occasionally, dasatinib can cause tingling or numbness in the hands or feet. This may make tasks, such as doing up small buttons, difficult. Tell your doctor if this affects you.
Sore mouth and ulcers
Your mouth may become sore and you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Changes to heart rhythm
A small number of people may notice a change in their heart rhythm. Heartbeats may become less regular or the heart may feel as if it's beating too fast. If you notice any changes in your heart rhythm, tell your doctor immediately.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Additional information about dasatinib
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Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you’re taking dasatinib. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of dasatinib on a developing baby. Therefore, it is not advisable to become pregnant or father a child while taking this drug.
It’s not known whether dasatinib is present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that dasatinib may be present in breast milk so women are advised not to breastfeed during imatinib and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having dasatinib treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
Things to remember about dasatinib tablets
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It's important to take your tablets as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you’re taking a course of imatinib tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any tablets you have to the pharmacist. Don't flush them down the toilet or throw them away.
If you forget to take a tablet, don't take a double dose. Inform your doctor and keep to your regular dose schedule.
This information has been compiled using information from a number of reliable sources, including:
British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Dasatinib, high-dose imatinib and nilotinib for the treatment of imatinib-resistant chronic myeloid leukaemia (CML), and dasatinib and nilotinib for people with CML for whom treatment with imatinib has failed because of intolerance (TA241). National Institute for Health and Clinical Excellence (NICE). January 2012.
Dasatinib, nilotinib and standard-dose imatinib and for the first-line treatment of chronic myeloid leukaemia (CML) (TA251). National Institute for Health and Clinical Excellence (NICE). April 2012.
electronic Medicines Compendium (eMC) (accessed October 2012).
370/07 - Dasatinib (Sprycel). Scottish Medicines Consortium (SMC), May 2007.
371/07 - Dasatinib (Sprycel). Scottish Medicines Consortium (SMC), May 2007.
With thanks to: Helen Flint, Clinical Lead Pharmacist; and the people affected by cancer who reviewed this edition.
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