dasatinib (Rx)

Brand and Other Names:Sprycel
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 20mg
  • 50mg
  • 70mg
  • 80mg
  • 100mg
  • 140mg

Chronic Myeloid Leukemia

Also see Administration

Newly diagnosed

  • Indicated for newly diagnosed adults with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) in chronic phase
  • Start 100 mg PO qDay (morning or evening)
  • May increase to 140 mg qDay if inadequate response

Advanced CML

  • Indicated for treatment of chronic, accelerated, or myeloid or lymphoid blast phase Ph+ CML with resistance or intolerance to prior therapy including imatinib
  • Start 140 mg PO qDay
  • May increase to 180 mg qDay if inadequate response

Acute Lymphoblastic Leukemia

Indicated for Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) with resistance or intolerance to prior therapy

Start 140 mg PO qDay

May increase to 180 mg PO qDay if inadequate response

Dosage Modifications

Hepatic Impairment

  • Mild-to-moderate (Child Pugh A to B): No dosage adjustment necessary
  • Severe (Child Pugh C): Decreases mean Cmax by 43% and in mean AUC by 28% compared to normal liver function subjects

Gastric acid reducing agents

  • Do not administer H2 antagonists or proton pump inhibitors with dasatinib; consider the use of antacids in place of H2 antagonists or proton pump inhibitors
  • Administer the antacid at least 2 hr prior to or 2 hr after dasatinib dose
  • Avoid simultaneous administration of dasatinib with antacids

Concomitant strong CYP3A4 inducers

  • Avoid use
  • If coadministration of strong CYP3A4 inducer is unavoidable, consider increasing dasatinib dose and monitor for toxicity

Concomitant strong CYP3A4 inhibitors

  • Avoid use
  • Recommend an alternate concomitant medication with no or minimal enzyme inhibition potential, if possible
  • Recommended dosage adjustment if concomitant strong CYP3A4 inhibitors must be administered
    • Patient currently taking 140 mg PO qDay: Decrease to 40 mg PO qDay
    • Patient currently taking 100 mg PO qDay: Decrease to 20 mg PO qDay
    • Patient currently taking 70 mg PO qDay: Decrease to 20 mg PO qDay
    • Patients currently taking 40 or 60 mg PO qDay: Hold treatment until inhibitor is discontinued
    • If therapy is not tolerated after dose reduction, either discontinue strong CYP3A4 inhibitor or interrupt dasatinib until inhibitor is discontinued; allow a washout period of ~1 week after inhibitor is stopped before increasing dose of dasatinib

Dose adjustments for neutropenia and thrombocytopenia

  • ANC <0.5 X 10^9 or platelets <10 X 10^9
  • Chronic Phase CML
    • Hold treatment until ANC ≥1.0 X 10^9/L and platelets ≥50 X 10^9/L
    • Resume treatment at original starting dose if recovery occurs in ≤7 days
    • If platelets <25 x 10^9/L or recurrence of ANC <0.5 x 10^9/L for >7 days, hold treatment until ANC ≥1.0 X 10^9/L and platelets ≥50 X 10^9/L and resume at a reduced dose of 80 mg PO qDay for second episode
    • For third episode, further reduce dose to 50 mg PO qDay (for newly diagnosed patients) or discontinue dasatinib (for patients resistant or intolerant to prior therapy including imatinib)
  • Accelerated phase CML, blast phase CML and Ph+ ALL
    • Check if cytopenia is related to leukemia (marrow aspirate or biopsy)
    • If cytopenia is unrelated to leukemia, hold dasatinib until ANC ≥1 X 10^9/L and platelets ≥20 X 10^9/L and resume at original starting dose
    • Recurrence of cytopenia, check if cytopenia is related to leukemia and resume dasatinib at a reduced dose of 100 mg PO qDay (second episode) or 80 mg PO qDay (third episode)
    • If cytopenia is related to leukemia, consider dose escalation to 180 mg PO qDay

Dosing Considerations

In clinical studies, dasatinib in adults, children, and adolescents patients was continued until disease progression or unacceptable toxicity

The effect of stopping treatment on long-term disease outcome after the achievement of a cytogenetic response or major molecular response has not been established

Dosage Forms & Strengths

tablet

  • 20mg
  • 50mg
  • 70mg
  • 80mg
  • 100mg
  • 140mg

Acute Lymphoblastic Leukemia

Indicated for patients (≥1 year) with newly diagnosed Ph+ ALL in combination with chemotherapy

Begin therapy on or before day 15 of induction chemotherapy, when diagnosis is confirmed and continue for 2 years

Recommended initial dosage based on body weight

  • <10 kg: Not recommended
  • 10 to <20 kg: 40 mg PO qDay
  • 20 to <30 kg: 60 mg PO qDay
  • 30 to <45 kg: 70 mg PO qDay
  • ≥45 kg: 100 mg PO qDay

Chronic Myeloid Leukemia

Indicated for patients (≥1 year) with Ph+ CML in chronic phase

Recommended initial dosage based on body weight

  • <10 kg: Not recommended
  • 10 to <20 kg: 40 mg PO qDay
  • 20 to <30 kg: 60 mg PO qDay
  • 30 to <45 kg: 70 mg PO qDay
  • ≥45 kg: 100 mg PO qDay

Recommended dose escalation if hematological or cytogenetic response is not achieved

  • Starting dose 40 mg PO qDay: May increase 50 mg PO qDay
  • Starting dose 60 mg PO qDay: May increase 70 mg PO qDay
  • Starting dose 70 mg PO qDay: May increase 90 mg PO qDay
  • Starting dose 100 mg PO qDay: May increase 120 mg PO qDay

Also see Administration

Dosage Modifications

Hepatic impairment

  • Mild-to-moderate (Child Pugh A to B): No dosage adjustment necessary
  • Severe (Child Pugh C): Decreases mean peak plasma concentration by 43% and in mean AUC by 28% compared to normal liver function subjects

Gastric acid reducing agents

  • Do not administer H2 antagonists or proton pump inhibitors with dasatinib; consider the use of antacids in place of H2 antagonists or proton pump inhibitors
  • Administer the antacid at least 2 hr prior to or 2 hr after dasatinib dose
  • Avoid simultaneous administration of dasatinib with antacids

Concomitant strong CYP3A4 inducers

  • Avoid use
  • If coadministration of strong CYP3A4 inducer is unavoidable, consider increasing dasatinib dose and monitor for toxicity

Concomitant strong CYP3A4 inhibitors

  • Avoid use
  • Recommend an alternate concomitant medication with no or minimal enzyme inhibition potential, if possible
  • Recommended dosage adjustment if concomitant strong CYP3A4 inhibitors must be administered
    • Patient currently taking 140 mg PO qDay: Decrease to 40 mg PO qDay
    • Patient currently taking 100 mg PO qDay: Decrease to 20 mg PO qDay
    • Patient currently taking 70 mg PO qDay: Decrease to 20 mg PO qDay
    • Patients currently taking 40 or 60 mg PO qDay: Hold treatment until inhibitor is discontinued
    • If therapy is not tolerated after dose reduction, either discontinue strong CYP3A4 inhibitor or interrupt dasatinib until inhibitor is discontinued; allow a washout period of ~1 week after inhibitor is stopped before increasing dose of dasatinib

Dose adjustments for neutropenia and thrombocytopenia

  • Cytopenia persists for >3 weeks, check if cytopenia is related to leukemia (marrow aspirate or biopsy)
  • Cytopenia is unrelated to leukemia, stop treatment until ANC ≥1 X 10^9/L and platelets ≥75 X 10^9/L and resume at original starting dose or at a reduced dose
  • Cytopenia recurs, repeat marrow aspirate/biopsy and resume at a reduced dose
  • Patients with chronic phase CML: If Grade ≥3 neutropenia or thrombocytopenia recurs during complete hematologic response (CHR), interrupt treatment and resume at a reduced dose; implement temporary dose reductions for intermediate degrees of cytopenia and disease response as needed
  • Patients with Ph+ ALL: Neutropenia and/or thrombocytopenia delays next block of treatment by > 14 days; interrupt dose and resume at the same dose level once the next block of treatment is started
  • Patients with Ph+ ALL: Neutropenia and/or thrombocytopenia persist and next block of treatment is delayed another 7 days; perform a bone marrow assessment to assess cellularity and percentage of blasts; if marrow cellularity <10%, interrupt treatment until ANC >500/mcL; if marrow cellularity >10%, consider resumption of treatment
  • One-level dose reduction
    • Starting dose 40 mg PO qDay: May increase 20mg PO qDay
    • Starting dose 60 mg PO qDay: May increase 40 mg PO qDay
    • Starting dose 70 mg PO qDay: May increase 60 mg PO qDay
    • Starting dose 100 mg PO qDay: May increase 80 mg PO qDay
  • Two-level dose reduction
    • Starting dose 40 mg PO qDay: Lower tablet dose not available
    • Starting dose 60 mg PO qDay: May increase 20 mg PO qDay
    • Starting dose 70 mg PO qDay: May increase 50 mg PO qDay
    • Starting dose 100 mg PO qDay: May increase 70 mg PO qDay

Dose adjustments for nonhematologic adverse reactions

  • Ph+ CML: Severe nonhematologic adverse reaction develops: Withhold treatment until the event resolves or improves; resume as appropriate at a reduced dose depending on severity and recurrence of the event
  • Ph+ ALL: Interrupt treatment for cases of Grade >3 nonhematologic adverse reactions with the exception of liver function test abnormalities, and resume at a reduced dose when resolved to Grade ≤1; if direct bilirubin is >5x ULN or AST/ALT >15x ULN, interrupt therapy until recovery to Grade ≤1 and then resume treatment at original starting dose or at a reduced dose for recurrent events
  • One-level dose reduction
    • Starting dose 40 mg PO qDay: May increase 20mg PO qDay
    • Starting dose 60 mg PO qDay: May increase 40 mg PO qDay
    • Starting dose 70 mg PO qDay: May increase 60 mg PO qDay
    • Starting dose 100 mg PO qDay: May increase 80 mg PO qDay
  • Two-level dose reduction
    • Starting dose 40 mg PO qDay: Lower tablet dose not available
    • Starting dose 60 mg PO qDay: May increase 20 mg PO qDay
    • Starting dose 70 mg PO qDay: May increase 50 mg PO qDay
    • Starting dose 100 mg PO qDay: May increase 70 mg PO qDay
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Interactions

Interaction Checker

and dasatinib

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            Contraindicated (3)

            • lefamulin

              lefamulin will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

            • pimozide

              dasatinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

            • saquinavir

              saquinavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            Serious - Use Alternative (80)

            • abametapir

              abametapir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • aluminum hydroxide

              aluminum hydroxide will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • amiodarone

              amiodarone and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • amitriptyline

              dasatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • apalutamide

              apalutamide will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • arsenic trioxide

              arsenic trioxide and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • calcium carbonate

              calcium carbonate will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • carbamazepine

              carbamazepine will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • chloramphenicol

              chloramphenicol will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • cimetidine

              cimetidine will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              cimetidine will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • clomipramine

              dasatinib will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • colchicine

              dasatinib will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment.

            • deferiprone

              deferiprone, dasatinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

            • desipramine

              dasatinib will increase the level or effect of desipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • dexlansoprazole

              dexlansoprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • dihydroergotamine

              dasatinib will increase the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • dihydroergotamine intranasal

              dasatinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • disopyramide

              dasatinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

            • dronedarone

              dasatinib will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • enzalutamide

              enzalutamide will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • ergotamine

              dasatinib will increase the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • erythromycin base

              dasatinib will increase the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

              erythromycin base will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              dasatinib will increase the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              dasatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              dasatinib will increase the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • esomeprazole

              esomeprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • everolimus

              dasatinib will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • famotidine

              famotidine will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and dasatinib both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              fexinidazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • ibuprofen/famotidine

              ibuprofen/famotidine will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ibutilide

              dasatinib and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • idelalisib

              idelalisib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • imipramine

              dasatinib will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • indapamide

              dasatinib and indapamide both increase QTc interval. Avoid or Use Alternate Drug.

            • itraconazole

              itraconazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Not recommended during and 2 weeks after itraconazole.

            • ivosidenib

              ivosidenib and dasatinib both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

              ivosidenib will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • ketoconazole

              ketoconazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lansoprazole

              lansoprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • lonafarnib

              dasatinib will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              lonafarnib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • lopinavir

              lopinavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lovastatin

              dasatinib will increase the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • mefloquine

              mefloquine increases toxicity of dasatinib by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • mifepristone

              mifepristone will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration necessary, concomitant use of mifepristone not recommended in patients receiving dasatinib 40-60 mg daily; consider a dasatinib dose reduction to 40 mg PO daily if original dose was 140 mg daily, 20 mg PO daily if original dose was 100 mg daily, or 20 mg PO daily if original dose was 70 mg daily; If dasatinib is not tolerated after dose reduction, consider alternative therapies; if mifepristone stopped, wait approximately 1 week before increasing dasatinib dose

            • nefazodone

              nefazodone will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • nizatidine

              nizatidine will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • omeprazole

              omeprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ondansetron

              dasatinib and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • palifermin

              palifermin increases toxicity of dasatinib by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

            • panobinostat

              dasatinib and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • pantoprazole

              pantoprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • pazopanib

              dasatinib will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

            • pentamidine

              dasatinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • pimozide

              dasatinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              dasatinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • quinidine

              quinidine and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • rabeprazole

              rabeprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ranolazine

              dasatinib will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • ribociclib

              ribociclib increases toxicity of dasatinib by QTc interval. Avoid or Use Alternate Drug.

            • rifabutin

              rifabutin will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rifampin

              rifampin will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • ritonavir

              ritonavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. May require decreased dasatinib dose or adjustment of dosing interval. Both ritonavir and dasatinib are CYP3A4 inhibitor, however, ritonavir is a strong CYP3A4 inhibitor and more likely to increase dasatinib levels and increase risk for toxicity including prolonged QT interval.

            • silodosin

              dasatinib will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • simvastatin

              dasatinib will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • sirolimus

              dasatinib will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • sodium bicarbonate

              sodium bicarbonate will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • sodium citrate/citric acid

              sodium citrate/citric acid will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • sotalol

              dasatinib and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • St John's Wort

              St John's Wort will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • tipranavir

              tipranavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • tolvaptan

              dasatinib will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • toremifene

              dasatinib and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • tucatinib

              tucatinib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • umeclidinium bromide/vilanterol inhaled

              dasatinib increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              dasatinib, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and dasatinib both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • vilanterol/fluticasone furoate inhaled

              dasatinib increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • voxelotor

              voxelotor will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (231)

            • acalabrutinib

              acalabrutinib, dasatinib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

            • albuterol

              albuterol and dasatinib both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              dasatinib and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and dasatinib both increase QTc interval. Use Caution/Monitor.

            • almotriptan

              dasatinib will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • alprazolam

              dasatinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amiodarone

              dasatinib will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amitriptyline

              amitriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • amobarbital

              amobarbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amoxapine

              amoxapine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • apomorphine

              apomorphine and dasatinib both increase QTc interval. Use Caution/Monitor.

            • aprepitant

              aprepitant will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • arformoterol

              arformoterol and dasatinib both increase QTc interval. Use Caution/Monitor.

            • aripiprazole

              dasatinib will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              aripiprazole and dasatinib both increase QTc interval. Use Caution/Monitor.

            • armodafinil

              armodafinil will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • artemether/lumefantrine

              dasatinib will increase the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and artemether/lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • atazanavir

              atazanavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine and dasatinib both increase QTc interval. Use Caution/Monitor.

            • atorvastatin

              dasatinib will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avanafil

              dasatinib will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors

            • avapritinib

              dasatinib will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              dasatinib increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bazedoxifene/conjugated estrogens

              dasatinib will increase the level or effect of bazedoxifene/conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bedaquiline

              dasatinib and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • belzutifan

              belzutifan will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

            • bexarotene

              dasatinib will increase the level or effect of bexarotene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bosentan

              bosentan will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • budesonide

              dasatinib will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              budesonide will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • buspirone

              dasatinib will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • butabarbital

              butabarbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • butalbital

              butalbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • carbamazepine

              dasatinib will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • chloroquine

              chloroquine increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • cilostazol

              dasatinib will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cinacalcet

              dasatinib will increase the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • citalopram

              citalopram and dasatinib both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clarithromycin

              clarithromycin and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • clobetasone

              dasatinib will increase the level or effect of clobetasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • clomipramine

              clomipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • clopidogrel

              dasatinib will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation

            • clozapine

              dasatinib will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cobicistat

              cobicistat will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dosage adjustment of dasatinib may be necessary upon coadministration with cobicistat coadministered with atazanavir or darunavir. Refer dasatinib prescribing information for dosing instructions.

            • conivaptan

              conivaptan will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • conjugated estrogens

              dasatinib will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • conjugated estrogens, vaginal

              dasatinib will increase the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cortisone

              dasatinib will increase the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              cortisone will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • crizotinib

              crizotinib increases levels of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • crofelemer

              crofelemer increases levels of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • cyclosporine

              cyclosporine will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dabrafenib

              dabrafenib will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • darifenacin

              darifenacin will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • darunavir

              darunavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dasatinib may require adjustment of dose or dosing interval if coadministered.

            • deferasirox

              deferasirox will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • desipramine

              desipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • dexamethasone

              dasatinib will increase the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dexamethasone will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • DHEA, herbal

              DHEA, herbal will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • diazepam

              dasatinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and dasatinib both decrease serum potassium. Use Caution/Monitor.

            • didanosine

              didanosine will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • dienogest/estradiol valerate

              dasatinib will increase the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for potential adverse effects such as nausea, irregular uterine bleeding, breast tenderness and headache.

            • diltiazem

              diltiazem will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dofetilide

              dasatinib and dofetilide both increase QTc interval. Modify Therapy/Monitor Closely.

              dofetilide increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

            • dolasetron

              dasatinib and dolasetron both increase QTc interval. Use Caution/Monitor.

            • doxepin

              doxepin and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • doxorubicin

              dasatinib will increase the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • doxorubicin liposomal

              dasatinib will increase the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and dronedarone both increase QTc interval. Modify Therapy/Monitor Closely.

            • droperidol

              dasatinib and droperidol both increase QTc interval. Modify Therapy/Monitor Closely.

            • duvelisib

              duvelisib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

            • efavirenz

              efavirenz will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • eletriptan

              dasatinib will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, dasatinib. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • erlotinib

              dasatinib will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin base

              dasatinib and erythromycin base both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin ethylsuccinate

              dasatinib and erythromycin ethylsuccinate both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin lactobionate

              dasatinib and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin stearate

              dasatinib and erythromycin stearate both increase QTc interval. Modify Therapy/Monitor Closely.

            • escitalopram

              escitalopram increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

            • eslicarbazepine acetate

              eslicarbazepine acetate will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • estradiol

              dasatinib will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • estrogens conjugated synthetic

              dasatinib will increase the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • estrogens esterified

              dasatinib will increase the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • estropipate

              dasatinib will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ethinylestradiol

              ethinylestradiol will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • etonogestrel

              dasatinib will increase the level or effect of etonogestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • etoposide

              dasatinib will increase the level or effect of etoposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • etravirine

              dasatinib will increase the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              etravirine will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ezogabine

              ezogabine, dasatinib. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fedratinib

              fedratinib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • felodipine

              dasatinib will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fesoterodine

              dasatinib will increase the level or effect of fesoterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • finerenone

              dasatinib will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flecainide

              dasatinib and flecainide both increase QTc interval. Use Caution/Monitor.

            • flibanserin

              dasatinib will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluconazole

              fluconazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and fluconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • fludrocortisone

              dasatinib will increase the level or effect of fludrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fluoxetine

              dasatinib and fluoxetine both increase QTc interval. Use Caution/Monitor.

            • fluphenazine

              fluphenazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluvoxamine

              fluvoxamine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • formoterol

              dasatinib and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • fosamprenavir

              dasatinib will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • foscarnet

              dasatinib and foscarnet both increase QTc interval. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fostemsavir

              dasatinib and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • grapefruit

              grapefruit will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • green tea

              green tea, dasatinib. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

            • griseofulvin

              griseofulvin will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • haloperidol

              dasatinib and haloperidol both increase QTc interval. Modify Therapy/Monitor Closely.

            • hydrocortisone

              dasatinib will increase the level or effect of hydrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • hydroxyprogesterone caproate

              dasatinib will increase the level or effect of hydroxyprogesterone caproate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • hydroxyurea

              dasatinib, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

            • iloperidone

              dasatinib will increase the level or effect of iloperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and iloperidone both increase QTc interval. Use Caution/Monitor.

              iloperidone increases levels of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • imipramine

              imipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • indacaterol, inhaled

              indacaterol, inhaled, dasatinib. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • indinavir

              dasatinib will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              indinavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isoniazid

              isoniazid will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • ixabepilone

              dasatinib will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lapatinib

              dasatinib will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and lapatinib both increase QTc interval. Use Caution/Monitor.

            • lemborexant

              dasatinib will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • lenvatinib

              dasatinib and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • levofloxacin

              dasatinib and levofloxacin both increase QTc interval. Use Caution/Monitor.

            • lofepramine

              lofepramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • lomitapide

              dasatinib increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • lopinavir

              dasatinib will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • loratadine

              dasatinib will increase the level or effect of loratadine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lorlatinib

              lorlatinib will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lumefantrine

              dasatinib will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • lurasidone

              dasatinib decreases levels of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Concurrent use of weak CYP3A4 inhibitors can theoretically lead to an increased risk of lurasidone-related adverse reactions.

            • maprotiline

              maprotiline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • maraviroc

              dasatinib will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • marijuana

              marijuana will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • mestranol

              dasatinib will increase the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • methadone

              dasatinib will increase the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and methadone both increase QTc interval. Use Caution/Monitor.

            • methylprednisolone

              dasatinib will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • metronidazole

              metronidazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • miconazole vaginal

              miconazole vaginal will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • midazolam

              dasatinib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • midazolam intranasal

              dasatinib will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • mifepristone

              mifepristone, dasatinib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • mitotane

              mitotane decreases levels of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • modafinil

              modafinil will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • moxifloxacin

              dasatinib and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • nelfinavir

              dasatinib will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              nelfinavir will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nevirapine

              nevirapine will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nicardipine

              dasatinib will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nifedipine

              nifedipine will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nilotinib

              dasatinib will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and nilotinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • nisoldipine

              dasatinib will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nortriptyline

              nortriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide

              dasatinib and octreotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide (Antidote)

              dasatinib and octreotide (Antidote) both increase QTc interval. Modify Therapy/Monitor Closely.

            • ofatumumab SC

              ofatumumab SC, dasatinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

            • ofloxacin

              dasatinib and ofloxacin both increase QTc interval. Use Caution/Monitor.

            • olodaterol inhaled

              dasatinib and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

              osilodrostat and dasatinib both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and dasatinib both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxcarbazepine

              oxcarbazepine will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ozanimod

              ozanimod and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

              dasatinib and paliperidone both increase QTc interval. Use Caution/Monitor.

            • paroxetine

              dasatinib and paroxetine both increase QTc interval. Use Caution/Monitor.

            • pasireotide

              dasatinib and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pentobarbital

              pentobarbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • perphenazine

              perphenazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • phenobarbital

              phenobarbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • phenytoin

              phenytoin will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Concomitant use will lead to decreased dasatinib plasma concentrations. Consider using alternative therapeutic agents with low enzyme induction potential for coadministration with dasatinib. However, if concomitant use with phenytoin is required, consider increasing the dasatinib dose and monitor the patient closely for dasatinib toxicity (myelosuppression, fluid retention, diarrhea, hemorrhage, or skin rash).

            • posaconazole

              posaconazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and posaconazole both increase QTc interval. Use Caution/Monitor.

            • prednisone

              dasatinib will increase the level or effect of prednisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • primidone

              primidone will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • prochlorperazine

              prochlorperazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • promazine

              promazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • promethazine

              promethazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • protriptyline

              protriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • quetiapine

              dasatinib will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              quetiapine, dasatinib. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinidine

              dasatinib will increase the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • quinine

              dasatinib and quinine both increase QTc interval. Use Caution/Monitor.

            • quinupristin/dalfopristin

              quinupristin/dalfopristin will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ranolazine

              dasatinib and ranolazine both increase QTc interval. Use Caution/Monitor.

            • repaglinide

              dasatinib will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ribociclib

              ribociclib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of dasatinib by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

            • risperidone

              dasatinib and risperidone both increase QTc interval. Use Caution/Monitor.

            • ritonavir

              dasatinib will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • romidepsin

              dasatinib will increase the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and romidepsin both increase QTc interval. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • rufinamide

              rufinamide will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • saquinavir

              dasatinib will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • secobarbital

              secobarbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • selpercatinib

              selpercatinib increases toxicity of dasatinib by QTc interval. Use Caution/Monitor.

            • siponimod

              siponimod and dasatinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • sodium zirconium cyclosilicate

              sodium zirconium cyclosilicate will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate.

            • solifenacin

              dasatinib will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • sorafenib

              sorafenib and dasatinib both increase QTc interval. Use Caution/Monitor.

            • stiripentol

              stiripentol, dasatinib. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • sulfamethoxazole

              sulfamethoxazole and dasatinib both increase QTc interval. Use Caution/Monitor.

            • sunitinib

              dasatinib will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tacrolimus

              dasatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tadalafil

              dasatinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tamoxifen

              dasatinib, tamoxifen. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibition decreases metabolism of tamoxifen to N-desmethyl tamoxifen (active metabolite with similar biologic activity).

            • tazemetostat

              dasatinib will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • telavancin

              dasatinib and telavancin both increase QTc interval. Use Caution/Monitor.

            • temsirolimus

              dasatinib will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • theophylline

              dasatinib will increase the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • thioridazine

              thioridazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • tinidazole

              dasatinib will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tipranavir

              dasatinib will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tolterodine

              dasatinib will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • topiramate

              topiramate will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • trastuzumab

              trastuzumab, dasatinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trastuzumab deruxtecan

              trastuzumab deruxtecan, dasatinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trazodone

              dasatinib will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              trazodone and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • triamcinolone acetonide injectable suspension

              dasatinib will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • triazolam

              dasatinib will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimipramine

              trimipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • tropisetron

              dasatinib and tropisetron both increase QTc interval. Use Caution/Monitor.

            • vardenafil

              dasatinib will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • venlafaxine

              dasatinib and venlafaxine both increase QTc interval. Use Caution/Monitor.

            • verapamil

              dasatinib will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • vilazodone

              dasatinib increases levels of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No dose adjustment needed with mild CYP3A4 inhibitors.

            • voclosporin

              voclosporin, dasatinib. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • voriconazole

              voriconazole will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              dasatinib and voriconazole both increase QTc interval. Use Caution/Monitor.

            • warfarin

              dasatinib will increase the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • zafirlukast

              zafirlukast will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • zidovudine

              dasatinib, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of myelosuppression.

            • ziprasidone

              dasatinib and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

            Minor (50)

            • alfentanil

              dasatinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • alfuzosin

              dasatinib will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • alosetron

              dasatinib will increase the level or effect of alosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • amlodipine

              dasatinib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • armodafinil

              dasatinib will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • atazanavir

              dasatinib will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • azithromycin

              azithromycin and dasatinib both increase QTc interval. Minor/Significance Unknown.

            • bosentan

              dasatinib will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • cevimeline

              dasatinib will increase the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • clarithromycin

              dasatinib will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • dapsone

              dasatinib will increase the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • disopyramide

              dasatinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • docetaxel

              dasatinib will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • donepezil

              dasatinib will increase the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • dutasteride

              dasatinib will increase the level or effect of dutasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • efavirenz

              dasatinib will increase the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • eplerenone

              dasatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • eucalyptus

              dasatinib will increase the level or effect of eucalyptus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • finasteride

              dasatinib will increase the level or effect of finasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • galantamine

              dasatinib will increase the level or effect of galantamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • imatinib

              dasatinib will increase the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • isradipine

              dasatinib will increase the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ketoconazole

              dasatinib will increase the level or effect of ketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • lansoprazole

              dasatinib increases levels of lansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • montelukast

              dasatinib will increase the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • nifedipine

              dasatinib will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • nimodipine

              dasatinib will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • nitrendipine

              dasatinib will increase the level or effect of nitrendipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • oxybutynin

              dasatinib will increase the level or effect of oxybutynin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • paclitaxel

              dasatinib will increase the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • paclitaxel protein bound

              dasatinib will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • parecoxib

              dasatinib will increase the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • pazopanib

              dasatinib and pazopanib both increase QTc interval. Minor/Significance Unknown.

            • pimozide

              dasatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • pioglitazone

              dasatinib will increase the level or effect of pioglitazone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • propafenone

              dasatinib will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • quinine

              dasatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • rabeprazole

              dasatinib will increase the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ramelteon

              dasatinib will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ruxolitinib

              dasatinib will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • saxagliptin

              dasatinib will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sufentanil

              dasatinib will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • vinblastine

              dasatinib will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • vincristine

              dasatinib will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • vincristine liposomal

              dasatinib will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • vinorelbine

              dasatinib will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • zaleplon

              dasatinib will increase the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ziprasidone

              dasatinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • zolpidem

              dasatinib will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • zonisamide

              dasatinib will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Fluid retention, incl CHF, pulm edema, pleural effusion (50%)

            Diarrhea (49%)

            Headache (40%)

            Hemorrhage (40%)

            Fatigue (39%)

            Pyrexia (39%)

            Skin rash (35%)

            Infection (34%)

            Nausea (34%)

            Dyspnea (32%)

            Cough (28%)

            Pain (26%)

            Abdominal pain (25%)

            Vomiting (22%)

            Anorexia (19%)

            Arthralgia (19%)

            Asthenia (19%)

            Constipation (14%)

            Dizziness (14%)

            Musculoskeletal pain (14%)

            Weight loss (14%)

            Chest pain (13%)

            Neuropathy (13%)

            Myalgia (12%)

            Abdominal distention (11%)

            Arrhythmia (11%)

            Chills (11%)

            Pneumonia (11%)

            Pruritus (11%)

            Weight gain (11%)

            1-10% (selected)

            Anemia

            Febrile neutropenia

            Thrombocytopenia

            Mucosal inflammation

            Postmarketing Reports

            Cardiac disorders: Atrial fibrillation/atrial flutter

            Vascular disorders: Thrombosis/embolism (including pulmonary embolism, deep vein thrombosis)

            Respiratory, thoracic, and mediastinal disorders: Interstitial lung disease, pulmonary arterial hypertension

            Dermatologic reactions: Stevens-Johnson syndrome, erythema multiforme

            Infections: Hepatitis B virus reactivation

            Renal and urinary disorders: Nephrotic syndrome

            Blood and lymphatic system disorders: Thrombotic microangiopathy

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            Warnings

            Contraindications

            None

            Cautions

            Use caution in hepatic impairment

            Use with caution in patients who have or may develop prolongation of QT interval; may increase risk of prolongation of QTc in patients including those with hypokalemia or hypomagnesemia, patients with congenital long QT syndrome, patients taking antiarrhythmic medicines or other medicinal products that lead to QT prolongation, and cumulative high-dose anthracycline therapy; correct hypokalemia or hypomagnesemia prior to and during therapy

            Cardiac adverse reactions were reported in 5.8% of 258 patients including cardiomyopathy (1.6%), congestive heart failure, diastolic dysfunction, fatal myocardial infarction, and left ventricular dysfunction; monitor patients for signs or symptoms and treat appropriately

            Tumor lysis syndrome reported; maintain adequate hydration and correct uric acid levels prior to initiating therapy; monitor electrolyte levels; patients with advanced-stage disease and/or high tumor burden may be at increased risk and should be monitored more frequently

            Risk of fluid retention and pleural/pericardial effusion; manage with supportive care measures and/or dose modification; evaluate patients who develop symptoms of pleural effusion or other fluid retention, such as new or worsened dyspnea on exertion or at rest, pleuritic chest pain, or dry cough, promptly with a chest x-ray or additional diagnostic imaging as appropriate; fluid retention events were typically managed by supportive care measures that may include diuretics or short courses of steroids; severe pleural effusion may require thoracentesis and oxygen therapy; consider dose reduction or treatment interruption

            Embryofetal toxicity reported (see Pregnancy)

            In pediatric trials of dasatinib in chronic phase CML after at least 2 years of treatment, adverse reactions associated with bone growth and development were reported, including epiphyses delayed fusion, osteopenia, growth retardation, and gynecomastia; monitor bone growth and development in pediatric patients

            Myelosuppression including severe thrombocytopenia, neutropenia and anemia

            • May manage by dose interruption, dose reduction, or discontinuation of therapy
            • Hematopoietic growth factor has been used with resistant myelosuppression

            Patients with chronic phase CML and pediatric Ph+ ALL

            • Perform complete blood cell counts (CBCs) every 2 weeks for 12 weeks, then q3Months thereafter, or as clinically indicated
            • Perform CBCs weekly for the first 2 months and then monthly thereafter, or as clinically indicated in patients with advanced phase CML or Ph+ ALL

            Pediatric patients with Ph+ ALL treated in combination with chemotherapy

            • Perform CBCs prior to start of each block of chemotherapy and as clinically indicated
            • During consolidation blocks of chemotherapy, perform CBCs every 2 days until recovery

            Bleeding

            • Can cause serious and fatal bleeding; incidence of Grade 3/4 hemorrhage, most commonly gastrointestinal, reported, requiring treatment interruptions and transfusions
            • Most bleeding events associated with severe thrombocytopenia; also shown to cause platelet dysfunction in vitro
            • Concomitant medications that inhibit platelet function or anticoagulants may increase risk of hemorrhage
            • Severe hemorrhage may require treatment interruption and transfusion

            Pulmonary arterial hypertension

            • Increased risk of developing pulmonary arterial hypertension (PAH)
            • May be reversible upon discontinuation of therapy
            • Evaluate patients for signs and symptoms of underlying cardiopulmonary disease prior to initiation and during treatment
            • If PAH confirmed permanently discontinue therapy

            Severe mucocutaneous dermatologic reactions

            • Cases of severe mucocutaneous dermatologic reactions, including Stevens-Johnson syndrome and erythema multiforme, reported
            • Discontinue permanently in patients who experience severe mucocutaneous reaction during treatment if no other etiology can be identified

            Drug interactions overview

            • Avoid concomitant CYP3A4 inducers/inhibitors
            • If unavoidable, consider dose modification as appropriate (see Dosage Modifications)
            • Coadministration of dasatinib with a gastric acid reducing agent may decrease the concentrations of dasatinib and reduce efficacy (see Dosage Modifications)
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            Pregnancy & Lactation

            Pregnancy

            Based on limited human data, dasatinib can cause fetal harm when administered to a pregnant woman; adverse pharmacologic effects (eg, hydrops fetalis, fetal leukopenia, and fetal thrombocytopenia) have been reported with maternal exposure to dasatinib

            Animal reproduction studies in rats have demonstrated extensive mortality during organogenesis, the fetal period, and in neonates; skeletal malformations were observed in a limited number of surviving rat and rabbit conceptuses; these findings occurred at dasatinib plasma concentrations below those in humans receiving therapeutic doses of dasatinib

            Advise a pregnant woman of the potential risk to a fetus

            Transplacental transfer of dasatinib has been reported

            Advise females of reproductive potential and males with female partners of reproductive potential to use effective contraception during treatment and for 30 days after last dose

            Based on animal data, dasatinib may result in damage to female and male reproductive tissues

            Lactation

            No data are available regarding the presence of dasatinib in human milk, the effects of the drug on the breastfed child, or the effects of the drug on milk production

            However, dasatinib is present in the milk of lactating rats

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Multi-kinase inhibitor that inhibits BCR-ABL, SRC family (SRC, LCK, YES, FYN), c-Kit, EPHA2 and PDGFR-beta kinases; tyrosine kinase inhibition possibly blocks angiogenesis and cellular proliferation

            Absorption

            Peak plasma time: 0.5-6 hr

            Peak plasma concentration: 82.2 ng/mL (100 mg PO qDay)

            AUC: 397 ng/mL·hr (100 mg PO qDay)

            High-fat meal increased mean AUC of dasatinib following a single dose of 100 mg by 14%

            Distribution

            Protein Bound: 96% (dasatinib); 93% (active metabolites)

            Vd: 2505 L

            Metabolism

            Metabolism: extensively metabolized primarily by CYP3A4

            Enzymes inhibited: CYP3A4 (weak)

            Dasatinib is a P-gp substrate

            Elimination

            Half-Life: 3-5 hr

            Clearance: 363.8 l/hr

            Excretion: Feces (85%); urine (4%)

            Pharmacogenomics

            Tyrosine kinase inhibitors (TKIs) inhibit activity of BCR-ABL fusion protein, resulting in both hematologic response (ie, normal cell counts in the peripheral blood and normal bone marrow morphology), as well as cytogenetic response (ie, disappearance or reduction of the Philadelphia [Ph] chromosome)

            NCCN clinical practice guidelines recommends TKIs in CML with confirmed BCR-ABL transcripts in bone marrow or evidence of translocation on cytogenetics

            Genetic testing laboratories

            • The following companies currently offer FISH and/or transcript quantification testing for BCR-ABL
            • Asuragen (http://www.asuragen.com/)
            • Dako (http://www.dakousa.com/)
            • Invitrogen (http://www.invitrogen.com/)
            • Ipsogen (http://www.ipsogen.com)
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            Administration

            Oral Administration

            Take with or without meals, either in the morning or evening

            Swallow tablet whole; do not cut, crush, or chew

            Follow special handling and disposal procedures

            Personnel who are pregnant should avoid exposure to crushed or broken tablets

            Storage

            Tablets: Store at room temperature at 20-25°C (68-77°F); excursions permitted between 15-30°C (59-86°F)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Sprycel oral
            -
            100 mg tablet
            Sprycel oral
            -
            50 mg tablet
            Sprycel oral
            -
            20 mg tablet
            Sprycel oral
            -
            70 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            dasatinib oral

            DASATINIB - ORAL

            (da-SA-ti-nib)

            COMMON BRAND NAME(S): Sprycel

            USES: This medication is used to treat certain types of cancer (chronic myeloid leukemia-CML, acute lymphoblastic leukemia-ALL). It works by slowing or stopping the growth of cancer cells.

            HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking dasatinib and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once daily. Swallow the tablets whole. Do not crush, chew, or break the tablets.The dosage is based on your medical condition, response to treatment, lab tests, and other medications you may be taking. Children's dosage is also based on weight. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of serious side effects will increase.Avoid taking antacids (such as aluminum/magnesium hydroxide, calcium carbonate) within 2 hours before or after taking this medication because they will prevent your body from fully absorbing this drug.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets.

            SIDE EFFECTS: See also Precautions section.Diarrhea, nausea/vomiting, muscle/joint pain, stomach/abdominal pain, and headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: dry cough, swelling/pain in the hands/ankles/feet, sudden/unexplained weight gain, shortness of breath.Get medical help right away if you have any very serious side effects, including: vomit that looks like coffee grounds, black/bloody stools, severe dizziness, fainting, fast/slow/irregular heartbeat, chest pain, confusion, weakness on one side of the body.Dasatinib sometimes causes side effects due to the rapid destruction of cancer cells (tumor lysis syndrome). To lower your risk, your doctor may add a medication and tell you to drink plenty of fluids. Tell your doctor right away if you have symptoms such as: low back/side pain (flank pain), signs of kidney problems (such as painful urination, pink/bloody urine, change in the amount of urine), muscle spasms/weakness.This medication decreases bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This effect can cause anemia, decrease your body's ability to fight an infection, or cause easy bruising/bleeding. Tell your doctor right away if you develop any of the following symptoms: unusual tiredness, pale skin, signs of infection (such as sore throat that doesn't go away, fever, chills), easy bruising/bleeding.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking dasatinib, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as lactose), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, current/recent infection, heart problems (such as irregular heartbeat), liver problems (such as hepatitis B).Dasatinib may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using dasatinib, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using dasatinib safely.Dasatinib can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.This medication may affect a child's bone growth and development. Consult the doctor or pharmacist for more details.Older adults may be more sensitive to the side effects of this drug, especially diarrhea, swelling hands/ankles/feet, sudden/unexplained weight gain, unusual tiredness, shortness of breath, and QT prolongation (see above).Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets.Tell your doctor if you are pregnant or plan to become pregnant. Your doctor may order a pregnancy test before starting this medication. You should not become pregnant while using dasatinib. Dasatinib may harm an unborn baby. Women of childbearing age should ask about reliable forms of birth control while using this medication and for 30 days after the last dose. Men with female partners of childbearing age should use reliable forms of birth control while using this medication and for 30 days after the last dose. If you or your partner becomes pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug and for 2 weeks after stopping treatment is not recommended. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as warfarin/dabigatran), drugs that reduce stomach acid (for example, antacids, H2 blockers such as famotidine/ranitidine, proton pump inhibitors such as omeprazole).Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Other medications can affect the removal of dasatinib from your body, which may affect how dasatinib works. Examples include azole antifungals (such as itraconazole, ketoconazole), dexamethasone, macrolide antibiotics (such as clarithromycin), rifamycins (such as rifampin, rifabutin), saquinavir, St. John's wort, telithromycin, among others.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Lab and/or medical tests (such as bone growth and development in children, complete blood count) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.