Tyrosine Kinase Inhibitor — CML / Ph+ ALL Pregnancy: Suspected to cause congenital malformations (including neural tube defects) and harmful pharmacological effects on the foetus; should not be used during pregnancy unless the clinical condition requires it. Both sexually active men and women of childbearing potential should use effective contraception during treatment. Breast-feeding should be stopped during treatment.

Dasatinib

Brand names: Sprycel

Dasatinib is an oral BCR-ABL tyrosine kinase inhibitor used in chronic myeloid leukaemia and Philadelphia chromosome-positive acute lymphoblastic leukaemia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 100 mg (chronic phase CML); 140 mg (advanced phase CML or Ph+ ALL)

Route: Oral

Frequency: Once daily

Therapy should be initiated by a physician experienced in the diagnosis and treatment of leukaemia. Adults: chronic phase CML recommended starting dose 100 mg once daily; accelerated, myeloid or lymphoid blast (advanced) phase CML or Ph+ ALL 140 mg once daily. Dose escalation (in patients not achieving a haematologic/cytogenetic response) to 140 mg once daily (chronic phase CML) or 180 mg once daily (advanced phase CML or Ph+ ALL) was allowed in clinical studies. Dose reductions for myelosuppression (e.g. to 80 mg, 50 mg once daily) per SPC tables. May be taken with or without food; tablets swallowed whole (do not crush, cut or chew). Patients with hepatic impairment may receive the recommended starting dose (caution advised). Paediatric (Ph+ CML-CP and Ph+ ALL): dose by body weight, once daily — 10 to less than 20 kg: 40 mg; 20 to less than 30 kg: 60 mg; 30 to less than 45 kg: 70 mg; at least 45 kg: 100 mg. Tablet not recommended below 10 kg (use powder for oral suspension); recalculate dose every 3 months by body weight. No experience under 1 year of age.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Myelosuppression (anaemia, neutropenia, thrombocytopenia)
Fluid retention events (including pleural effusion)
Diarrhoea, nausea
Headache, fatigue, musculoskeletal pain
Skin rash; haemorrhage; dyspnoea; infection

Interactions

Potent CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir, telithromycin, grapefruit juice): increase dasatinib exposure — coadministration not recommended
CYP3A4 inducers (e.g. dexamethasone, phenytoin, carbamazepine, rifampicin, phenobarbital, St John's Wort): substantially reduce dasatinib exposure
Narrow-therapeutic-index CYP3A4 substrates (e.g. astemizole, terfenadine, cisapride, pimozide, quinidine, bepridil, ergot alkaloids): caution — dasatinib may increase their exposure
H2 antagonists (e.g. famotidine), proton pump inhibitors (e.g. omeprazole) and aluminium/magnesium hydroxide antacids: reduce dasatinib exposure (antacids to be separated by 2 hours)

Clinical monograph

How it works

It potently inhibits BCR-ABL and several SRC-family kinases, blocking the constitutive tyrosine kinase signalling that drives proliferation of Philadelphia chromosome-positive leukaemic cells, and is active against many imatinib-resistant mutations.

Prescribing in practice

Pleural effusion is a characteristic adverse effect; investigate breathlessness, cough or chest pain promptly, alongside the risks of myelosuppression and bleeding.
Pulmonary arterial hypertension is a recognised risk, and cardiac and fluid-retention effects should be considered.
It is a substrate for CYP3A4 and absorption is pH-dependent, so review interacting drugs and acid-suppressing therapy.

Monitoring

Monitor full blood count and for fluid retention or respiratory symptoms, with molecular response (BCR-ABL transcripts) assessed over time.

Counselling the patient

Report new breathlessness, cough, chest pain or swelling, as these may indicate fluid around the lungs.
Tell your team about all other medicines, including indigestion remedies, as they can affect this drug.
Take the medicine consistently and do not stop without advice.

Evidence & guidelines

The DASISION trial established dasatinib as first-line therapy in chronic myeloid leukaemia, and it is recommended by NICE in defined settings.

Reference: DASISION Trial (Kantarjian et al. NEJM 2010); NICE TA425; SPC Sprycel; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways