switching capsule acalabrutinib to tablet form promoted vomiting, migraine headache, anyone else?

[234me]

switching capsule acalabrutinib to tablet promoted vomiting, migraine headache

Recent posting about switching from capsules to tablet form for Acalabrutinib have been discussed. Here is my experience and perhaps others.

I had been on capsule acalabrutinib with great results and no ill side effect for 4 months , the day I started on tablet acalabrutinib, I experienced dizziness, and slight headache within an hr, the next three days I had vomiting, sever migraine headache, chills and dizziness could hardly stand .

I stopped for 2 days in order to see if perhaps I had a flue, but symptoms went away after 24 hrs.. Once I started again, I became more ill this time with extreme vomiting and dry heaves and severe headache, dizziness and chills again. I quit forever, and my oncologist has been told . He did not know about the tablet form replacing the capsule form. I told him I learned about it from this site.

His suggestion was perhaps after the stomach cancer surgery, I cannot process the tablet.

There is something in the new tablet formula that caused my symptoms, it's too bad cause I take no other medication, I am healthy, so the capsules worked for me and I didn't need the change.

[lindalou5]

I was sick for three full months with severe diahrrea, vomitting and stomach pain and bloating. Eventually went away. Still have to be careful what types of foods I eat. I think I was down about 30 pounds when it quit affecting me so badly.

[234me in reply to lindalou5]

Wow,you lasted that long. Your stronger than me. The nausea and dizziness was so bad. I only weigh 100pds @5'5, so I can't afford to lose. Tks for responding, I always find such kind people on this site. Did yr Dr suggest trying a different drug, perhaps with out the side effects?

[lindalou5 in reply to 234me]

no. just had to get used to it. Thank fully I did. My normal doctor is not too bright on a few things so I often have had to manage my own stuff. And I had a lot of input and help from the folks on here when I went through it. I think I was slightly out of my head also from loss of nutrients during that time.

[234me in reply to lindalou5]

I just read yr bio, should have done that before I replied to you. what a journey you've been on and so positive still. Tks and I wish you well

[Walkingtall62]

Hi, I do hope you find a way around this. I too had no problems with the capsule form - for many years. No problem. I have been on the tablet form for three months. My body doesn’t seem to accept medication with copovidone and I wonder why it’s use is in this pill. It isn’t in the thyroxine pill I take. I haven’t been ‘on form’ recent,y and put it down to Covid, or winter, or anything else I could think of. But it is getting me down. Similarly, what is the cellulose used for and the medium-chain triglycerides. I have an excel spreadsheet for thyroxine as the company I used for many years was sold and when comparing additives in other companies drugs I found some interesting things. Hope you can get this sorted. Apologies to Neil, who I know needed a tablet form. So I hope my queries are acceptable. Thanks

[234me in reply to Walkingtall62]

thanks walkingtall62 for the info about the ingredients in the acalabrutinib tablet form, I did find the ingredients in both capsule and tablet searching the web and that is my mission today to find out more about the ingredients . But, I guess it doesn't matter much as I can't take it anyways. but, it makes me feel like I'm being proactive. They probably did not do a trail run for the tablet form for side effects. Just what ever make the most $$.

[AussieNeil Partner Administrator in reply to 234me]

234me, I'm sorry that you are going through this and hope your investigation into the constituents of the acalabrutinib/Calquence tablets helps. If not, are you able to switch to another BTKi? (Even without the capsule/tablet formulation issue, people do find that their ability to tolerate a given BTKi is highly individual - what suits one person is the opposite for someone else. Thankfully we do have a growing choice of BTKi options, though I appreciate that's still frustratingly slowly occurring in Canada.)

With respect to your thoughts about no trial run being done prior to the switch to tablet form, companies can't do that if they wish to keep approvals for use. As reported here,

astrazeneca-us.com/media/pr...

"The approval by the US Food and Drug Administration (FDA) was based on results from the ELEVATE-PLUS trials presented during the 63rd American Society of Hematology (ASH) Annual Meeting & Exposition in December 2021.1

In the trials, results showed the CALQUENCE capsule and tablet formulations are bioequivalent, indicating the same efficacy and safety profile can be expected with the same dosing strength and schedule.1 The tablet can be taken with gastric acid-reducing agents, including proton pump inhibitors (PPIs), antacids and H2-receptor antagonists (H2RAs).1,2 The majority of observed adverse events (AEs) in these studies were mild with no new safety concerns identified.1"

The reference in that quoted text is;

1. Sharma S, Pepin X, Burri H, et al. New acalabrutinib formulation enables co-administration with proton pump inhibitors and dosing in patients unable to swallow capsules (ELEVATE-PLUS). [abstract and poster]. Poster presented at: 63rd American Society of Hematology Annual Meeting and Exposition; December 11-14, 2021; Atlanta, Georgia. Abs 4365.

Have you discussed your predicament with a hospital pharmacist? They might have some suggestions to get around this. After your experiences, I can appreciate that you'll be very wary about trying to restart acalabrutinib and you'll also want to know what's in any available alternative!

Neil

[234me in reply to AussieNeil]

Thanks AussieNeil, I am waiting on my Oncologist to find answers and as well I am going to write Vancouver cancer clinic to see if they have some information to help me get on Zanabrutinib not approved as yet in BC but has been approved in Canada. As we all know, everyone reacts differently to drugs so hopefully Zana will work with few side effect. And after stomach cancer I just digest differently than others. Life sure is interesting. Thanks again for responding. wow, what a great bunch of people on this site. So positive.

[croakerUK]

I switched to acalabrutinib tablets on Monday, the only effect so far is that emptying my bowel is easier, when previously it was not always the case.

[Katie-LMHC-Artist]

I have only been on the tablet. The second night of taking it I spent the night in the bathroom with all those symptoms. I believe the migraine brought on the nausea. I then saw a post through this site to take Excedrin Tension Headache. I took it at night and it was a game changer. I helped get me through the night. I took it for a month so I could get use to the medication. Then my oncologist mentioned rebound effect if I stoped the headache medication. I stopped taking it after a month. It helped during the first month. Unfortunately I still wake up with a headache after 14 months on Acalabrutinib but it’s not as severe as the beginning of taking it. I think your reaction was common with taking the tablet in the first few days. I hope you’re able to manage this. Take care!

[234me in reply to Katie-LMHC-Artist]

Thanks for your reply. Your stronger than me. I just could not tolerate those side effects for the first 3 days I tried it and then the second go around for 2 days. The dizziness was so severe that I could not stand without bouncing off walls and that was a pretty pathetic site to see. I live by myself so felt so as not to endanger my self anymore to stop taking it. It felt like sea sickness but 10 times worse. It also took 2 full days for those side effects to fully dissipate from my body after ceasing the drug. My oncologist agreed with my decision to do so . I'm hoping that perhaps the company is still producing the capsules and we don't know about it as yet. Another door will open. Thanks again for responding.

[Katie-LMHC-Artist in reply to 234me]

I wish you luck with this. Having severe side effects is awful. I wonder if the capsule is the original form and the tablet is like the generic form. I know Astra Zeneca makes it. Perhaps you could find out from the company. Let us know how you make out. Sending you a hug!!!💜

[234me in reply to Katie-LMHC-Artist]

I will, tks for hug and back to you as well.

[MB60]

Sorry to hear of your tolerability issues with the Acala tablet. I’m in the US, and I was told that it wasn’t a complete switch out and capsules were still being produced and available. Maybe incorrect info from my specialty pharmacy but I was given a choice, maybe until they ran out of capsules?

[234me in reply to MB60]

Hi MB60, Gee, that's a bit of good news, I hope so. Haven't heard back from my oncologist as yet as I think that is his job to find out for me. Then, I'll decide if I have to research on my own after hearing back from him . But, hey thanks for that info.

[sportage21]

I did not experience any changes when I switched from capsule to tablet. The changeover was seamless.

[Silvafoxe]

I’m

Not on calquence but read that the capsule is more tolerable. They also allow you to take other meds that weren’t well tolerated with the pill version. I would tell my doctor to indicate capsule only.

[234me in reply to Silvafoxe]

Tks silvafoxe, still waiting on oncologist to get back to me. Some times, just sitting back and letting the situation flow a bit on its own fixes itself for the better.

[Silvafoxe in reply to 234me]

Hope the oncologist gets it straight for you. Initially oncologist planned to put me on calquence so I did a lot of reading on it. Then Brukinsa was approved so he put me on it. It’s newer than calquence and seems to be working well for me. Just don’t suffer in silence . Take care

[234me in reply to Silvafoxe]

oh, tks, yes, Brukinsa/zanubrutinib is available in Canada and hopefully is approved for the province of BC. And hopefully it will help with the SLL, as the capsule acalabrutinib took away the tumors in the tailbone and sacrum in just 4 months and was still working on getting rid of the sll in rest of body and of course it was working for the CLL part also as my numbers were getting better. . I agree, its silly to be so sick with a treatment just in hopes it will help the disease. Quality of life is so much more important than the quantity of life to me, no offense to any one.

[Janie67]

Didn’t bother me