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Tyrosine Kinase Inhibitor — CML / Ph+ ALL Pregnancy: Contraindicated — teratogenic; effective contraception essential; female patients must not become pregnant during treatment

Dasatinib

Brand names: Sprycel

Adult dose

Dose: CML chronic phase: 100 mg once daily; CML accelerated/blast phase or Ph+ ALL: 140 mg once daily
Route: Oral
Frequency: Once daily
Max: 140 mg/day
Second-generation BCR-ABL1/Src kinase inhibitor. Used for CML (first-line or imatinib-resistant/intolerant), Philadelphia chromosome-positive ALL. Active against most imatinib-resistant BCR-ABL1 mutations (except T315I — use ponatinib).

Paediatric dose

Dose: 60–80 mg/m² (age and weight-based dosing tables) mg/m²/kg
Route: Oral
Frequency: Once daily
Max: 100 mg/day (chronic phase)
BNFc: dasatinib licensed in children with Ph+ CML — weight-based dose calculation. Dispersible tablet formulation available for children unable to swallow tablets.

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment; no specific dose adjustment established

Paediatric weight-based calculator

BNFc: dasatinib licensed in children with Ph+ CML — weight-based dose calculation. Dispersible tablet formulation available for children unable to swallow tablets.

Clinical pearls

  • Pleural effusion is the most common serious toxicity — occurs in ~25% of patients; often managed with dose interruption, diuretics, and steroids
  • Pulmonary arterial hypertension (PAH) is a rare but serious complication — echocardiography before starting and if symptoms develop
  • DASISION trial: dasatinib superior to imatinib in MMR and CMR at 12 months in newly diagnosed CP-CML
  • Active against most imatinib-resistant BCR-ABL1 mutations EXCEPT T315I gate-keeper mutation — requires ponatinib or asciminib
  • PPIs and antacids significantly reduce absorption — avoid if possible; separate by 2+ hours from antacids if necessary
  • MHRA: monitor ECG at baseline, at 7 days, and periodically — dasatinib prolongs QTc

Contraindications

  • Hypersensitivity to dasatinib
  • Pregnancy (teratogenic)

Side effects

  • Myelosuppression (neutropenia, thrombocytopenia, anaemia)
  • Pleural effusion (most common class-specific toxicity)
  • Pulmonary arterial hypertension (rare but serious)
  • QT prolongation
  • Fluid retention
  • Diarrhoea
  • Headache

Interactions

  • CYP3A4 inhibitors (azoles, macrolides) — increase dasatinib levels; reduce dose
  • CYP3A4 inducers (rifampicin, carbamazepine) — reduce efficacy
  • Antacids, PPIs, H2 blockers — reduce absorption; avoid concomitant use or take dasatinib 2h before antacid

Monitoring

  • FBC (every 2 weeks for 3 months, then monthly)
  • BCR-ABL1 PCR (molecular monitoring every 3 months)
  • Echocardiogram (PAH surveillance)
  • ECG (QTc)
  • Pleural effusion symptoms

Reference: BNFc; BNF 90; BNFc; DASISION Trial (Kantarjian et al. NEJM 2010); NICE TA425; SPC Sprycel. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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