Cll. Acalabrutnib, famotidine

[Fwanni]

Does anyone take these?.I take

- half of 40mg tab famotidine 2/3 hours before

- 1 x 100mg capsule of acalabrutnib

Both in evening time.

Dies anyone have reaction particularly to famotidine? I have abs appalling bowel reaction, then 'bowel' pain , then skin splitting on fingers and now front hair breaking badly....oh dear...

[lankisterguy Volunteer]

Hi Fwanni,

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My pharmacy advised that next month I will be receiving the new tablet formulation of Calquence / Acalabrutinib. AstraZeneca has changed to the tablet so the interaction with drugs like famotidine is no longer an issue. You may want to contact your pharmacy to find our how soon that will happen for your script.

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See: drugs.com/newdrugs/calquenc...

SNIP: "Calquence Tablet Formulation Approved in the US Across Current indications

New formulation can be co-administered with gastric acid-reducing agents

Tablet offers equivalent efficacy, safety and consistent dosing compared to current capsule.

The tablet can be taken with gastric acid-reducing agents, including proton pump inhibitors (PPIs), antacids and H2-receptor antagonists (H2RAs). 5 August 2022 "

-

Len

[Fwanni in reply to lankisterguy]

Thank you. Maybe that might solve my extreme reaction.

[Vizilo]

I take a whole 40 mg Famotidine tablet most days but as my pharmacist has advised, I allow at least 2 hours between Acalabrutinib and Famotidine. Have been doing this for close to two years with no side effects.

I take the morning 100 gm Acalabrutinib around 7 in the morning then the Famotidine (if I need it) after 9 in the morning.

[jonathan7176]

I take famotidine along with acalabrutinib. I have no side effects, but just find it is not as good as omeprazole, which is forbidden with the acalabrutinib capsule. I usually take the acalabrutinib at 9am and 9pm, and the famotidine at 3pm to maximise the time between the two drugs.

[AussieNeil Administrator in reply to jonathan7176]

While your problems will be solved when a future order of acalabrutinib is the tablet formulation and you can switch back to omeprazole, the best separation of the two drugs is to take the acid reducing medication 2 hours after the acalabrutinib. That ensures your stomach acid is at its lowest to aid absorption of the acalabrutinib.

The reason acalabrutinib is supposed to be taken twice per day, compared to daily with ibrutinib, is because it has a shorter half life in your blood serum, so you need two doses per day, 12 hours apart to maintain CLL inhibition.

Neil

[jonathan7176 in reply to AussieNeil]

Neil – are you suggesting that taking famotidine midway between the two doses of Acalabrutinib is not optimal, and that it is better to take it two hours after the morning dose rather than six as I do at present?

[AussieNeil Administrator in reply to jonathan7176]

Yes, the 10 hours provides maximum time for your stomach to get most acidic, after which the next 2 hours provides adequate time for absorbtion of the acalabrutinib, before the famotidine begins to again suppress acid production.

I appreciate that you are correctly taking your two doses of acalabrutinib 12 hours apart. I've corrected my reply accordingly.

Neil

[jonathan7176 in reply to AussieNeil]

Many thanks - well worth knowing.

[Fwanni]

Thankyou everyone, very interesting. I tried acalabr and famotidine again, same dreadful reaction - weight loss, fast and hair loss, extreme sinus, tightened throat - hard to swallow 'dry' food. Certainly seems to be ' a reaction'.....Maybe not spacing correctly caused an issue?I've decided to stop, let my body 'rest' until I see haemotologist. Keep well.

[Artlover1908]

I take both. But acalabrutinib in capsule form should be taken 2 hours before famotidine. I take the acalabrutinib at 8pm and famotidine at 10pm (20mg). They recommend taking famotidine at night before bedtime.I looked it up on the interactions website before starting treatment . I've had no reaction at all. Hope this helps.

[meganbo]

Hi, sorry to hear that this is happening. How frustrating. Until recently I have been taking both. The two hour window is important because it impacts the absorption of the Acalabrutinib/Calquence. And not being a proton pump inhibitor like other options out there which are extremely bad to take with it.

Never had those side effects and was only taking 20 mg in the middle of the day. It was because I added Venclexta about a year ago and that triggered GERD aka acid reflux. I recently am trying a new replacement my Oncologist recommended. 4 times a day which is hard to squeeze in, but seems to be helping. Might check it out it is called Sucralfate. It’s a gigantic pill, but apparently comes in liquid form too. It’s making my life better. Good luck!

[flipperj]

It takes an hour or two for the Famotidine to achieve peak acid inhibition so taking Acalabrutinib at that time is more of a worst case situation. I took Famotidine an hour after the Acalabrutinib when I needed it. Famotidine does have side effects for some. It has some immune stimulation associated with it that gives folks with autoimmune type issues problems.