Calquence (acalabrutinib) is a brand-name oral medication primarily prescribed for adults to treat specific types of cancer, including small lymphocytic lymphoma, chronic lymphocytic leukemia, and mantle cell lymphoma (in cases where prior treatments have been ineffective). As a kinase inhibitor, Calquence functions by targeting and blocking Bruton tyrosine kinase (BTK), a protein crucial for the growth of cancer cells. This article provides a detailed overview of the potential side effects associated with Calquence, strategies for their management, and important precautions to consider.
Common and Mild Side Effects of Calquence
Calquence, like other medications, can cause a range of side effects. Many of these are mild and temporary, often resolving as the body adjusts to the drug. Common mild side effects reported in clinical trials include:
- Slightly Low Levels of Blood Cells: This can include platelets (cells that help your blood clot), white blood cells (neutrophils), and red blood cells.
- Problems with Digestion: Diarrhea, nausea, abdominal pain, vomiting, and constipation.
- Joint or Muscle Pain
- Headache
- Fatigue
- Skin Rash
- Bruising
- Upper Respiratory Infection: Symptoms such as sneezing, coughing, stuffy or runny nose, and scratchy throat.
These side effects are usually temporary, lasting from a few days to weeks. However, it's important to consult your doctor or pharmacist if they persist, worsen, or become bothersome.
Serious Side Effects of Calquence
While less common, Calquence can also cause serious side effects. If you experience any of the following, it's crucial to contact your doctor immediately. If symptoms seem life-threatening, seek emergency medical attention by calling 911 or your local emergency number.
- Serious Infections: Infections such as cytomegalovirus and pneumonia can occur. Symptoms vary but may include fatigue, fever, body aches, and loss of appetite.
- New Cancers: Including skin cancer. Symptoms can include new or changing moles, red, discolored, scaly, or swollen skin.
- Severely Low Levels of Certain Blood Cells: This may not always cause noticeable symptoms but can be detected with a blood test. Examples include low levels of platelets, white blood cells, and red blood cells.
- Liver Damage: Symptoms include fatigue, nausea, loss of appetite, unexplained weight loss, abdominal pain, jaundice, and swelling in the feet or lower legs.
- Irregular Heart Rate or Rhythm: Symptoms can include shortness of breath, fainting, dizziness, and heart palpitations.
- Bleeding: Mild or severe bleeding can occur, with severe cases potentially being life-threatening.
- Allergic Reaction: Although not reported in clinical trials, allergic reactions are possible.
Specific Side Effects Explained
Irregular Heart Rate or Rhythm
Calquence may cause atrial flutter (irregular heart rate) or atrial fibrillation (irregular heart rhythm). Symptoms can include shortness of breath, fainting, dizziness, and heart palpitations. Individuals with a history of irregular heart rate or rhythm, infection, high blood pressure, or other heart problems may be at increased risk.
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What you can do: Before taking Calquence, inform your doctor about any existing heart conditions. If you experience symptoms of an irregular heart rate or rhythm while taking Calquence, seek medical attention immediately.
Bleeding
Calquence can cause mild or serious bleeding. Symptoms of serious bleeding include bloody stool or urine, bleeding that is not easily managed, and bruising more easily than usual. A low platelet level, a common side effect of Calquence, can also contribute to bleeding or bruising.
What you can do: Inform your doctor about all medications you are taking, especially blood thinners like warfarin, as they can increase the risk of bleeding. Also, tell your doctor if you have an upcoming surgery, as they may advise you to stop taking Calquence temporarily before and after the procedure to minimize bleeding risk.
Upper Respiratory Infection
Symptoms of an upper respiratory infection include sneezing, coughing, stuffy or runny nose, and scratchy throat.
What you can do: Stay hydrated and get plenty of rest. Your doctor can suggest ways to ease your symptoms and recommend over-the-counter medications. However, consult your doctor or pharmacist before taking any new medications to ensure they are safe to use with Calquence.
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Allergic Reaction
As with most drugs, Calquence can cause an allergic reaction in some people. Symptoms can be mild or serious and can include skin rash, itching, flushing, swelling under your skin, swelling of your mouth, tongue, or throat, and difficulty breathing.
What you can do: For mild symptoms of an allergic reaction, call your doctor right away. For serious symptoms, immediately call 911 or your local emergency number.
Low Blood Cell Levels
Calquence can cause blood disorders, such as low red blood cell levels (anemia), low platelet levels (thrombocytopenia), low white blood cell levels (leukopenia), and low neutrophil levels (neutropenia). Stop taking Calquence and get help right away if you have any of the following symptoms of blood disorders:
- Fever
- Shortness of breath
- Pale or yellowish skin
- Easy bruising or bleeding
- Frequent infection
- Unusual weakness or tiredness
- Dizziness, lightheadedness, or feeling like you are about to pass out
- Headache
- Fast or abnormal heartbeat
Heart Rhythm Changes
Calquence may cause heart rhythm problems that can lead to an irregular heartbeat and fainting. In rare cases, this may cause the heart to suddenly stop beating (cardiac arrest). Some people have a higher risk of this, including people with existing heart disease or who take other medicines that affect the heart. Get emergency help if you have any of the following signs of heart rhythm changes:
- Chest pain
- Shortness of breath
- Feeling dizzy, lightheaded, or fainting
- Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
Liver Damage
Liver damage, also called hepatotoxicity, can happen when taking Calquence. Call your healthcare provider right away if you have any of the following symptoms of liver damage:
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- Nausea or vomiting
- Stomach or belly pain
- Fever
- Weakness or unusual tiredness
- Itching
- Loss of appetite
- Light-colored poop
- Dark-colored urine (pee)
- Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
Managing Common Side Effects
Digestive System Issues
Digestive side effects such as diarrhea, nausea, vomiting, constipation, and abdominal pain can occur. Eating small, frequent meals that include bland foods may help. Staying hydrated is also essential. If symptoms become severe or persistent, consult your doctor, who may recommend medical treatment such as intravenous fluids or anti-diarrheal or anti-nausea medications.
Headache
Headache is a common side effect that is usually temporary. Over-the-counter pain relievers like acetaminophen (Tylenol) may provide relief. Staying hydrated, engaging in light to moderate exercise, and consuming caffeine (if safe) may also help.
Muscle Pain
Muscle pain or discomfort, back pain, neck pain, and pain in the arms, hands, legs, or feet are possible side effects. The tips for relieving headache (acetaminophen, hydration, exercise) may also help with muscle pain. Applying heat, stretching, and using topical menthol treatments may also provide relief.
Rash
Rash is typically a mild and temporary side effect. Consult your doctor if you develop a rash, as they may suggest ways to ease this side effect. If you experience other symptoms with a rash, such as swelling or difficulty breathing, seek immediate medical attention, as it could be an allergic reaction.
Calquence and Weight Gain
While not listed as a common side effect in the official prescribing information, some studies have suggested a potential link between Calquence and weight gain, particularly in patients with Chronic Lymphocytic Leukemia (CLL). One study published in the American Journal of Hematology found that some patients treated with similar drugs like ibrutinib experienced weight gain. The study tracked 118 individuals treated for CLL, revealing that at six months, the average weight gain was four pounds, and after one year of treatment, patients gained an average of five pounds. The weight gain is significant, the study said, because it pushed some patients who were normal weight into the overweight category, or from overweight to obese. The study suggests that as the drug reverses the cancer load, a person ends up eating more but needing less.
Treatment-related weight gain can have serious consequences for patients who also have cardiovascular risk factors such as high blood pressure and high cholesterol, and for patients who have diabetes. It is important to discuss any unexpected weight changes with your healthcare provider.
Precautions and Warnings
Before starting Calquence, it's crucial to discuss your medical history with your doctor, including any existing conditions such as liver problems (including hepatitis B), heart problems (including high blood pressure and irregular heart rhythms), bleeding problems, and infections.
Calquence can interact with other medications, including certain antifungals, proton pump inhibitors (PPIs), H2 blockers, and antacids. Inform your doctor about all medications, vitamins, and herbal supplements you are taking to avoid potential interactions.
Pregnancy and Breastfeeding
Calquence can harm an unborn baby if taken during pregnancy. Women who can become pregnant should use effective birth control during treatment and for at least one week after the last dose. It is not recommended to breastfeed while taking Calquence and for at least 2 weeks after your last dose, as the drug may pass into breast milk and cause side effects in a breastfed child.
Dosage and Administration
Calquence tablets should be swallowed whole with a glass of water. If you miss a dose, take it as soon as you remember. However, if it is more than 3 hours past your usual dosing time, skip the missed dose and take your next dose at your regularly scheduled time. Do not double the dose to make up for a missed one.
Calquence vs. Imbruvica
Calquence and Imbruvica (ibrutinib) belong to the same class of drugs (kinase inhibitors) and are used to treat similar types of cancer. While they share many of the same side effects, some differences exist. In a clinical trial involving people with previously treated chronic lymphocytic leukemia, Calquence caused fewer cardiovascular side effects than Imbruvica. However, more research is needed to determine whether Calquence causes fewer side effects overall.