Acalabrutinib and Venetoclax

[dave20]

Hi Everyone, I am on combo of Acalabrutinib and Venetoclax. Does any one know is it better to take these two medicines at the same time or it is better to spread out ?

Thanks. Dave

[lankisterguy Volunteer]

Hi dave20,

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I was on Venetoclax for 6 years and in combination with Acalabrutinb / Calquence for the first half of 2022. When I reported having some minor gastro issues, my CLL expert suggested taking the Venetoclax in the evening. Calquence is prescribed at 2X per day 12 hours apart, so the timing is not easy to space apart.

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The package insert venclexta.com/previously-un... says

" Take VENCLEXTA with a meal and water around the same time of day every day

Drink plenty of water (6-8 glasses) every day when taking VENCLEXTA"

Of course this may mean multiple trips to the bathroom at night unless you take all the water during daylight hours and the Venetoclax after your evening meal.

drugs.com/food-interactions... says:

Venclexta and Alcohol/Food Interactions

There is 1 alcohol/food/lifestyle interaction with Venclexta (venetoclax).

Food helps to increase the absorption of venetoclax. You should take each dose of venetoclax with a meal and water at approximately the same time each day. Do not consume grapefruit, grapefruit juice, Seville oranges, or starfruit (or pomegranates) during treatment with venetoclax.

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drugs.com/food-interactions...

says: "Food may delay the absorption of acalabrutinib, but does not appear to affect the overall extent of absorption. When a single 75 mg dose of acalabrutinib was administered with a high-fat, high-calorie meal (approximately 918 calories; 59 grams carbohydrate, 59 grams fat, 39 grams protein) in healthy study subjects, mean acalabrutinib Cmax was decreased by 73% and time to reach Cmax was delayed by 1 to 2 hours compared to administration under fasted conditions. However, mean AUC was not affected.

MANAGEMENT: Acalabrutinib may be administered with or without food. Patients should avoid consumption of grapefruit and grapefruit juice during treatment with acalabrutinib.

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Len

[Indolent in reply to lankisterguy]

Len,

This seems to suggest that ingested fat has a tendency to lower the peak level and spread the dosage over a longer interval. Am I reading this correctly?

[lankisterguy Volunteer in reply to Indolent]

That's how I would read it also. Not certain if the fat, protein or the entire meal causes the delay. And whether any of that has an impact on side effects, etc. Apparently the Area Under the Curve apparently is assumed to equal efficacy.

Len

[dave20 in reply to lankisterguy]

Hi Len, Thanks for you reply. I guess the rule of thumb is to take Venetoclax with food and Acalabrutinib should taken with empty stomach. Dave

[spi3]

As instructed by his Dr., my hubby takes them both in the morning with breakfast. I ensure I put a pat of butter (fat) and it helps him digest them. He has no complaints. It's been 6 months.

[Horatio2]

My doctor recommended taking Acalabrutinib before breakfast and the Venetoclax with or immediately after.