BTK inhibitor (specialist)
Zanubrutinib
Brand names: Brukinsa
Adult dose
Dose: 160mg BD or 320mg OD; per SmPC and regimen
Route: Oral
Frequency: BD or OD
Clinical pearls
- Indicated for MCL, CLL/SLL, Waldenström's macroglobulinaemia — per NICE TAs
- Specialist initiation; withhold before surgery (3–7 days)
- Selective BTK inhibitor; lower AF rate than ibrutinib in head-to-head studies
Contraindications
- Severe hepatic impairment
- Hypersensitivity
- Concurrent strong CYP3A4 inhibitors (dose adjust)
Side effects
- Infections (bacterial, viral, fungal, PJP)
- Neutropaenia
- Thrombocytopaenia
- Haemorrhage
- Atrial fibrillation
- Hypertension
- Second primary malignancy
- Diarrhoea
- Rash
Interactions
- Strong/moderate CYP3A4 inhibitors (increase zanubrutinib exposure)
- Strong CYP3A4 inducers (reduce exposure)
- Anticoagulants/antiplatelets (bleeding risk)
Monitoring
- FBC
- LFTs
- Renal function
- BP
- Cardiac rhythm
- Infections
Reference: BNF; NICE TA836 (CLL); NICE TA862 (WM); SmPC; https://bnf.nice.org.uk/drugs/zanubrutinib/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO