Acalabrutinib - single dose regime

[Virosafe2001]

Hello, I have been on 1 cycle of alacabrutinib (28 days). Total WBC count initially rose from 140 to 300 (x 10^9/L), now down to 200. Have had problems with bruising and bleeding (platelets 60 to 80). Consultant suggests going from 2 x 100mg/day, down to a single dose of 100mg PD. However my (ancient) pharmacology recollections suggested that to halve the dose, but yet to maintain a constant blood-level of drug, it would be better to have 2 x 50mg PD. Is the drug available in 50mg capsules?

[AussieNeil Administrator]

You are following a familiar path after starting treatment with acalabrutinib. You are also right about the best way to halve the dose while still endeavouring to keep the CLL tumour inhibited, but sadly acalabrutinib doesn't come in a 50mg capsule. (The reason acalabrutinib and other later generation BTK inhibitors are prescribed twice daily compared to the daily ibrutinib protocol, is that the newer BTKi drugs have shorter half lives.) That said, we do have quite a few members taking one acalabrutinib capsule daily in order to improve their side effect tolerance.

Neil

[Virosafe2001 in reply to AussieNeil]

Thanks for that. Mind you, I am never sure if some of the side effects (now including mouth ulcers) are due in part to the "prophylactic" extras that I am taking (Acyclovir, Entecavir, Co-trimoxazole, allopurinol), whether individually, or in synergistic combination.

[JLJC]

Hi. I have been on acalabrutinib since January and about 3 separate times, due to side affects my Dr has adjusted my dosage to alternating 1 a day then 2 a day and so on. Usually no longer than a weeks time so my side affects can improve, which are mostly rashy itching. But even with the dosage adjustments my labs continue to improve in the right directions. I was concerned at first about changing the dose but for me the dosage adjustment has worked for my body. Good luck 🍀💪🏼