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Sprycel and Protonix Help


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#1 andreab

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Posted 15 April 2013 - 02:26 PM

My mom was just diagnosed with CML about a month ago and has been on Sprycel 100 mg for a week.  Coming into this diagnosis, she already had GERD and a hiatal hernia and was taking Protonix.  Oncologist told her to stop taking the Protonix as it interferes with the Sprycel.  She has tried antacids and carafate and it is no help and she is miserable.

I would like to know if it is possible to still take Protonix with the Sprycel if it is absolutely necessary.  Is there anyone on here that is doing this?  Did they have to increase your dosage of Sprycel to compensate.   Would it make sense for her to talk to her doc about switching her to Gleevac?

Any thoughts would be appreciated.  My mom is having a hard time with this, as she wasn't experiencing any symptoms when she was diagnosed and felt great, and now she is just miserable and starting to get depressed.



#2 Trey

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Posted 15 April 2013 - 06:06 PM

Sprycel appears to be the CML drug most affected by GERD drugs.  For instance, Pepcid reduced Sprycel uptake by 60% in one study.  So that is a big issue.  But studies are small groups and not all drugs have been tested so the data is not clear.  Another CML drug may be somewhat less affected, but all are likely affected to some degree since all require an acidic environment for uptake from the stomach and intestines.  But you could ask the Onc about Gleevec if your Mom is in early Chronic Phase CML.  Antacids also reduce uptake when taken within 2 hours of the Sprycel.

As far as your Mom feeling worse now than before, that is a common experience.  The drugs can make the patient feel worse in the short term, but you can be sure she would have felt much worse without the drugs as the leukemia progressed, which it would have done fairly quickly.  So our drugs do not usually make us feel better in the short term, only better over the longer term than the alternative.  It may be hard, but your Mom needs to understand that fighting cancer is neither easy nor free from pain.  So it requires some mental understanding of the need to fight hard and win.  But our drugs are usually better than the chemo and transplant route. 

Previous discussion related to this GERD drug issue:

http://community.lls.../message/162303



#3 CallMeLucky

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Posted 17 April 2013 - 09:51 AM

I'm certainly not a great example given the amount of time and my current CML status.  I am PCRU, I went on Sprycel due to Gleevec side effects and had some trouble with chest pain from Sprycel so they dropped my dose down to 50mg.  They increased to 60mg 30days later and then 70mg 30 days after that.  During that time they put me on Protonix to see if it would help with the chest pains since there was speculation it may have been GERD related.  The Protonix did little to help since the issue was most likely not GERD.  Ultimately 60mg was not great and when I got to 70mg the pain started to return so I stopped taking Protonix and we went back to 50mg Sprycel with monthly PCR to see how it goes.  During this time my PCR continued to be negative.  From what I can tell the Protonix had little to no impact.  I get a rash from Sprycel and during all this time it never went away.  I actually made the comment that I liked having the rash because it told me my body was still reacting to Sprycel even with the Protonix and the lower dosage.  I can tell you that I was uneasy about taking it and I would probably not want to take it for a long time given the literature, but my doctor who is a leukemia/CML specialist said "Protonix is not ideal but if it is needed we do it, there are plenty of people taking Sprycel who are taking Protonix you just have to monitor and make sure it is not adversely affecting the response"  In my case he was essentially saying that even if Protonix has an impact it doesn't completely negate it, it just may reduce it so you have to balance the dosage of each drug.  I was on 20mg Protonix and I took it in the morning - I take my Sprycel in the evening so I tried to space them out as much as I could.

Not suggesting she should take Protonix with Sprycel, but wanted to share my experience.

The reality here is the doctor should never have started your mom on Sprycel if she was already being treated with Protonix, he set her up for failure.  It is probably best that she switch drugs but if she is going to switch why go to Gleevec instead of Tasigna?  If the doctor feels Gleevec is not as good a drug and jeapordize her outcome, then Tasigna (another 2nd generation TKI), which in trials is pretty much just as effective as Sprycel would be the proper choice.  Sorry but your doctor sounds like kind of a jerk.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#4 beverly

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Posted 17 April 2013 - 09:57 AM

My cough on Sprycel got worse and worse to the point I just had 1 litter of fluid removed not fun between left lung and rib cage. 1/3 of my lung was collapsed had been going on for 3 months they believe. Diagnosed Sept last year been on it since Oct. I want off of it and my Dr have put me on ant biotic's for infection in lung they sent liquid of to be tested now told it could be cancer. So like a diet some work for others you have to find the right one.  (((HUG)))



#5 beverly

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Posted 17 April 2013 - 10:00 AM

BTW not suppose to take antacids on Sprycel or eat grapefruit see list on pill inserts not to eat.



#6 andreab

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Posted 17 April 2013 - 02:10 PM

CallMeLucky wrote:

The reality here is the doctor should never have started your mom on Sprycel if she was already being treated with Protonix, he set her up for failure.

This was my thought exactly.  He should have just started her on the Gleevac, but it seemed that now the first line is the second gen TKI (atleast at this practice).  He told her that Tasigna had the same restrictions as the Sprycel with regard to the Protonix.   I have been trying to encourage her to stick with the Sprycel for a few more weeks.  She just had her first blood test after taking Sprycel for a week and her WBC count is down from 113,000 to 63,000. 



#7 CallMeLucky

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Posted 17 April 2013 - 02:51 PM

Sprycel and Tasigna do not have the exact same restrictions when it comes to Protonix.  Proton Pump inhibitors are an issue because they may interfere with absorption, however, Protonix label specifically states that you should not take it if you are taking Sprycel.  There is no such warning for Tasigna.  The Tasigna site states "Since proton pump inhibitors affect pH of the upper GI tract for an extended period, separation of doses may not eliminate the interaction. The concomitant use of proton pump inhibitors with TASIGNA should be used with caution."

The Sprycel site has the same type of warning, but it is a little more direct it says "SPRYCEL® (dasatinib) is best absorbed from your stomach into your bloodstream in the presence of stomach acid. You should avoid taking medicines that reduce stomach acid, such as: Protonix"

Bosulif has similar "Proton Pump Inhibitors: Consider using  short-acting antacids or H2 blockers instead of PPIs. Separate antacid or H2  blocker dosing and BOSULIF dosing by more than 2 hours."

Studies I read (like this one http://bloodjournal....8/e75.full.html) show that this problem is most prevalent with Sprycel.

So again, the doctor picked the worst TKI drug for someone in your mother's situation.  Gleevec is probably the best choice in terms of interaction with Protonix, but Gleevec can be hard on stomach (same for bosutinib) which may not work for your mom's stomach.  That is why I thought Tasigna.  I think it also depends if there is something high risk about her case that suggests she needs a second generation drug instead of Gleevec.  If no high risk, then Gleevec is probably the best choice and see how she tolerates it, otherwise it would seem like Tasigna is a reasonable option as well, it will just need to be monitored

This study further reiterates the point http://www.ncbi.nlm....les/PMC2766475/.

"Our results indicate that the use of omeprazole does not significantly affect the pharmacokinetics of imatinib, as opposed to, for example, dasatinib where PPI decreased AUC and Cmax two-fold."

*omeprazole is Prilosec, which is another type of Proton pump inhibitor very similar to Protonix


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#8 andreab

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Posted 17 April 2013 - 07:12 PM

Thanks for the information

I think I'm going to talk to her about maybe finding a more knowledgeable doctor. 



#9 beverly

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Posted 26 April 2013 - 03:30 PM

1 litter of fluid sucked out of my back stat a couple weeks ago and now it is back. They want to set me up with a 2nd tap when my back still hurts from the last one. Sprycel and Drs are killing me not the CML. I wasn't even sick.. I have been on 100mg Spry since last Oct. Stopping today as my Oncologist 2 weeks ago told me not to stop and there are other things that can be done. She acted like I was being a pain. Hello? It is my body in pain and I have to pay the pills and hospital procedures not them. I feel like a Guinea pig and hate it. I have a new old Dr I am returning to in Gainesville Fl she works with ShandsHospital. All records are just a button push away and she can set it all up for me.  They have a cancer center pulmonary and I feel my body will be in better hands there as I also worked there and they have state of the art facilities. So Firing 2 internists in Ocala FL and probably my 2nd Oncologist. When it comes to painful mistakes that we pay for I don't have the patience anymore.

Good luck I



#10 Susan61

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Posted 26 April 2013 - 04:46 PM

Hi Andrea:  First let me say that I am sorry your Mom was diagnosed with CML, but it will all balance out for her as to what she should take.  I have been on Gleevec for a long time, and I developed GERD very bad.  I had to go on Nexium and its been 12 years that I take both the Gleevec along with the Nexium.  It has worked very well for me.

Right now I am waiting to go in for a Endoscopy to evaluate me for  Hiatal Hernia.  They cannot get me in till May 28th, but I am having throat problems now which I do not think are related to my Gleevec, as I also have a horrible nasal drip from Sinuses.  I agree with Billie's response.  They have to try the right combination for her.  I do not know if she can take Nexium with the Sprycel.  I have not seen a post on that, unless I missed it.  I also know that we should not eat grapefruit with these drugs, and I never have since I started on Gleevec.

Wishing Your Mom Some Good Results

Susan



#11 andreab

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Posted 26 April 2013 - 09:09 PM

Thanks for the kind words Susan and I'm sorry you have to wait so long to get in for your endoscopy.   It's encouraging to hear of someone that is taking the same medication as my mom and doing well.  She has switched to Gleevac and has been taking that for almost a week now with no side effects yet.  Her last blood work showed that her WBC was down from 63,500 to 11,000.  So hopefully, the Gleevac can continue to keep her counts down.  She is trying to get her counts down so that she can look into having a procedure for her hiatal hernia.  She is definitely in a better state of mind now about the whole thing. 



#12 Susan61

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Posted 26 April 2013 - 10:31 PM

HI:  Glad your Mom is in a good state of mind, and I hope the Gleevec continues to work for her.  Let her know that she might develop some side effects down the road, but in most cases they are something you can deal with.  I still get side effects after all these years of being on Gleevec, but the main thing is that it has gotten me to this point.  I was diagnosed in 1998, but did not start Gleevec till 2000.  Maybe that will encourage her also.

     In most cases they do not do anything for a Hiatal Hernia, unless its a real problem.  I know a lot of people who are living with large hernias, but they just watch their diet and eat small meals as well as eating slowly to help digest the food better.  I am anxious to find out what is going on with me too, but I guess I will find out soon enough.



#13 beverly

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Posted 28 April 2013 - 01:17 PM

Anyone with ideas on this? Note from my doctor yesterday for all on Sprycel. Remember I never felt sick until Sprycel. On it Since Oct last year. Diagnosed Sept 14th 2012

Beverly

Dr Warman is a good doctor

Besides she's also a Pulm doctor

I did talk to her Friday and she says the effusion is back

Unilateral effusions in this situation is worrisome for lung cancer

We can change your cml drug but we still need to make sure this is not lung cancer

So go get the pleural tap she recommends

Also we need to see you this week after tap

So call or email the scheduling gals to make an appointment to come in

30 min visit

You will end up short of breath in ER if you don't get rid of the fluid in the lung

Rama



#14 CallMeLucky

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Posted 29 April 2013 - 07:49 AM

Any doctor who would send you an email and tell you you might have lung cancer is an idiot!


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#15 beverly

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Posted 29 April 2013 - 09:56 AM

I now know that thanks Lucky Going to Shands Hospital in Gainesville from now on. What a bunch of idiots here in Ocala FL!!!! I wll keep in touch.

Take care



#16 momruns

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Posted 29 April 2013 - 12:50 PM

Greetings,

I am blessed to have no heartburn or anything close.  But, I do work in an operating room.  Patients who take the "little purple pill" are only masking the symptoms of reflux.  The only true fix for a hiatal hernia is a Laparoscopic Nissen.  We do those all the time.  It is usually just an overnight stay.  All laparoscopic and is a "cure".  No more meds.  The acid with those meds still attack the esophagus.  Look into a "Nissen fundoplication" and make an educated decision.  All the TKI meds are anti protonix type meds.

Loreta






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