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Sprycel Dosage, where do I start?


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#1 LCasey

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Posted 21 March 2011 - 09:55 AM

OK guys, I need help!

I am currently negotiating with my oncologist as to my starting dose of Sprycel. I wouldn't be so concerned, but I haven't had great luck with these drugs in the past.

When first diagnosed I started Gleevec at 400mg. After one month I was taken off due to myleosuppresion. It took 3 months for my counts to stabilize in order to try a reduced dosage.

So then I started Gleevec 300mg. Again, within one month myelosupression and took another 3 months for my counts to stabilize.

So then I started Tasigna at a reduced dose of 300mg once per day. It took 4 days for good ole' Bilirubin to spike up to 5.8. Which is when they discovered I have something called Gilbert's disease- which basically just affects the livers' ability to process toxins- great. Anyway so then my oncologist suggested Sprycel.

So Sprycel- due to my sensitivities with the other drugs I asked my oncologist if I could start at a reduced dose of 50mg per day. He suggested 100mg ever other day.

What do I do?



#2 Trey

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Posted 21 March 2011 - 06:25 PM

Taking full dosage (100mg) every other day would likely continue to jolt your system.  I would want to take no more than 80mg every day under myelosuppression conditions like yours as discussed at the link below.  However, If it were me, I would try to reduce it to 50mg and work back up.

http://www.drugs.com...ge/sprycel.html



#3 scuba

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Posted 21 March 2011 - 06:48 PM

I concur with Trey.  Start at 50 mg. and work back up.  Given your myelosuppression (I have as well) - you may need to start will less drug to get the desired result (may take a bit longer, but no alternative).


Diagnosed 11 May 2011 (100% FiSH, 155% PCR)

with b2a2 BCR-ABL fusion transcript coding for the 210kDa BCR-ABL protein

 

Sprycel: 20 mg per day - taken at lights out with Quercetin and/or Magnesium Taurate

6-8 grams Curcumin C3 complex.

 

2015 PCR: < 0.01% (M.D. Anderson scale)

2016 PCR: < 0.01% (M.D. Anderson scale) 

March        2017 PCR:     0.01% (M.D. Anderson scale)

June          2017 PCR:     "undetected"

September 2017 PCR:     "undetected"


#4 Marnie

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Posted 21 March 2011 - 07:24 PM

I recently switched from Gleevec to Sprycel.  I suggested to my onc that I start with half doseage (50mg), and then move to full dose.  This worked great for me.  I did 50 mg for 5 days, and then 100 mg.  I had very minimal headaches for about 3 days, and then no side effects.  The only thing I would do over, is ask the doc to write a prescription for the full number of pills (50 mg) so that I would end the month with a few extra pills, as I like to try to build up a bit of an extra supply by ordering as early as my insurance allows.  The doc wrote it for 5 days of 1 pill and the rest of the month at 2 pills.   So. . .my recommendation, for what it's worth:

Ask your doc to prescribe a month's supply of 50mg tablets, and then start for about 3 - 4 days on half dose.  I got really antsy to start full doseage. . had trouble waiting the full 5 days.  Now I'm really antsy for my first post-Sprycel PCR test.  Doc didn't want to start with a 90-day supply until he saw how I reacted to it.

I have to go one more month on a 30-day supply, and then will have the doc write a scrip for 90-day supply, 100 mg tablets,  so that it fits well with my summer travel schedule. . .it's a real problem to deal with ordering and receiving medications while we are off galivanting around on our motorcycle trips.  

Good luck, and I hope that Sprycel is as good to you as it is to me (though to be perfectly honest. . .the last couple of weeks the gas has been terrible.  Feel like I"m living in a green cloud. . .seems to be clearning up, so hopefully it won't be a side-effect I live with forever).

Too Much Information there. . .but good luck anyway

Marnie



#5 hannibellemo

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Posted 21 March 2011 - 07:48 PM

Hi, L,

I agree with everyone else except for one thing. I would not split a 100 mg. dose into two 50 mg. doses. This has been throughly discussed on another CML site http://newcmldrug.com

Jerry Mayfield was one of the first three people in the Sprycel trials and is the originator of the above highly regarded web site. He said in a recent post:

"The reason that splitting the dose causes more side effects is that levels of Sprycel in the blood are higher for longer periods of time when the drug is taken in two daily doses as shown in this Dasatinib Pharmacokinetics Chart."

Here is a link for the Dasatinib Pharmacokinetics Chart that Jerry Mayfield mentioned in the post above.

http://newcmldrug.co...asatinib-pk.jpg

"It clearly demonstrates that blood levels are significantly higher when Sprycel is split into two doses (BID) as opposed to one daily dose (QD)."

This is the reason that the recommended dosage was dropped from 70 mg. BID to 100 mg. QD. The incidence of seriously negative side effects were much lower when they changed the dosage to QD.

If it were me I would take 1- 50 mg. tab per day until I was ready to increase the dose and go straight to 1 - 100 mg. dose.

Pat


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#6 Marnie

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Posted 21 March 2011 - 08:13 PM

Yep. . that's what I did. . .50 mg 1x per day for 5 days and then 100 mg 1x per day.  I don't have myelosuppresion issues, though, so you may want to work up to full dosege more slowly, if you work up to full doseage at all.  The pills come in quite a variety of sizes (is that the right term??) so you and your onc can figure out what works for you. I take my pill(s) in the evening, and that works best for me.



#7 Trey

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Posted 21 March 2011 - 09:00 PM

We were all discussing one dose of 50mg per day.



#8 hannibellemo

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Posted 22 March 2011 - 06:22 AM

Sorry, I understood 1 - 50 mg. per day and then bumping up to 100 mg. per day by either 2 - 50s or 1-100s.

I still found the chart interesting - not what I would have expected.

Pat


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#9 cpsn0000

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Posted 22 March 2011 - 07:40 PM

My oncologist will have me start on 50mg of Sprycel because of the same problems.......Been going at this since 10/2010.......First Gleevec, then Tasigna, and hopefully Sprycel if my neurophils come up after taking a wbc stim shot.



#10 LCasey

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Posted 22 March 2011 - 11:18 PM

Thank you all so much for your help.

I am going in for my weekly CBC tomorrow and hopefully I can convince my oncologist to prescribe 50mg- maybe just 10 days of it, if not the whole month's prescription.

It has just been so hard to stand up for myself and trust my instinct about all this. We will see.

Thanks again






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