Brukinsa (zanubrutinib) has potential interactions with other medications and some supplements. These interactions could affect how well the drug works or cause harmful effects.
Brukinsa is used in certain adults to treat:
- Waldenström macroglobulinemia
- mantle cell lymphoma (MCL)
- small lymphocytic lymphoma (SLL) or chronic lymphocytic leukemia (CLL)
- marginal zone lymphoma (MZL)
- follicular lymphoma
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Brukinsa’s possible interactions. For a detailed overview of this drug, check out this in-depth Brukinsa article.
Before you start taking Brukinsa, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions.
To learn whether Brukinsa interacts with herbs, vitamins, or supplements, see the “Are there other interactions with Brukinsa?” section.
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The following table lists drugs that may interact with Brukinsa. Keep in mind this table does not include all drugs that may interact with Brukinsa. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| certain antifungals | • fluconazole (Diflucan) • ketoconazole • itraconazole (Sporanox, Tolsura) | can increase the risk of side effects of Brukinsa |
| certain antibiotics | • ciprofloxacin (Cipro) • erythromycin (Eryc, Ery-Tab, others) • clarithromycin | can increase the risk of side effects of Brukinsa |
| certain seizure drugs | • carbamazepine (Epitol, Tegretol, others) • phenobarbital (Sezaby) • phenytoin (Dilantin, Phenytek) | can make Brukinsa less effective |
| certain immunosuppressants | • cyclosporine (Gengraf, Neoral, others) • tacrolimus (Astagraf XL, Prograf, others) • sirolimus (Fyarro, Rapamune, others) | can increase the risk of side effects of Brukinsa or make certain immunosuppressants less effective |
| certain antiarrhythmics | • dronedarone (Multaq) • amiodarone (Nexterone, Pacerone) | can increase the risk of side effects of Brukinsa |
| certain calcitonin gene-related peptide (CGRP) antagonists | • atogepant (Qulipta) • ubrogepant (Ubrelvy) | can make the CGRP antagonist less effective |
| certain antidepressants | • fluvoxamine (Luvox) • nefazodone | can increase the risk of side effects of Brukinsa |
| lumateperone (Caplyta) | — | can make lumateperone less effective |
| warfarin (Jantoven) | — | can make warfarin less effective |
| certain other cancer drugs | • adagrasib (Krazati) • duvelisib (Copiktra) • nilotinib (Danziten, Tasigna) | can increase the risk of side effects of Brukinsa |
Brukinsa is not known to interact with alcohol.
However, Brukinsa and alcohol can cause some similar side effects. Examples include dizziness and headache. So you may have worsened side effects if you drink alcohol during your Brukinsa treatment.
If you have questions about consuming alcohol while taking Brukinsa, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Brukinsa.
Interaction with certain antifungals
Brukinsa may interact with certain antifungals, which are used to treat fungal infections.
Certain antifungals may slow the breakdown of Brukinsa in your body. This can lead to a high level of Brukinsa in your system, increasing your risk of side effects.
Here are some antifungals that may interact with Brukinsa:
- fluconazole (Diflucan)
- ketoconazole
- itraconazole (Sporanox, Tolsura)
What you can do
If you need to take an antifungal during Brukinsa treatment, talk with your doctor. They can recommend an antifungal that is less likely to interact with Brukinsa.
In some cases, your doctor may still prescribe Brukinsa with an antifungal it interacts with. For example, they may do this if a different antifungal is not suitable for treating your infection.
In this case, your doctor may temporarily lower your Brukinsa dosage while you’re taking the antifungal. They can tell you when it’s safe to return to your typical dosage.
If you have questions about taking Brukinsa with an antifungal, talk with your doctor or pharmacist.
Interaction with certain CGRP antagonists
Brukinsa may interact with certain CGRP antagonists, which are used to treat and help prevent migraine.
Brukinsa may speed up the breakdown of certain CGRP antagonists in your body. This can lead to a low level of the CGRP antagonist in your system. As a result, the drug may be less effective.
CGRP antagonists that may interact with Brukinsa include atogepant (Qulipta) and ubrogepant (Ubrelvy).
What you can do
Before taking Brukinsa with a CGRP antagonist, talk with your doctor. They can advise you on whether it’s safe to take these medications together. If needed, they can also recommend the appropriate dosage of the CGRP antagonist to ensure that it’s effective.
If you have questions about taking Brukinsa with CGRP antagonists, talk with your doctor or pharmacist.
Interaction with certain other cancer drugs
Brukinsa may interact with certain other cancer drugs.
Certain other cancer drugs may slow the breakdown of Brukinsa in your system. This can lead to a high level of Brukinsa in your body, which may increase your risk of side effects.
Here are some other cancer drugs that may interact with Brukinsa:
- adagrasib (Krazati)
- duvelisib (Copiktra)
- nilotinib (Danziten, Tasigna)
What you can do
Before taking Brukinsa with another cancer drug, talk with your doctor. They can tell you whether it’s safe to take them together.
If you take Brukinsa with a cancer drug it interacts with, your doctor may give you a lower Brukinsa dosage. Doing so can help reduce your risk of side effects.
If you have questions about taking Brukinsa with other cancer drugs, talk with your doctor or pharmacist.
Brukinsa may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests.
Here are additional interactions that may occur with Brukinsa. Note that this is not a full list of all other possible interactions with Brukinsa.
Does Brukinsa interact with supplements?
Before you start taking Brukinsa, talk with your doctor and pharmacist about any herbs, vitamins, or supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Brukinsa interactions with herbs
Brukinsa can interact with St. John’s wort, which is used to ease symptoms of depression and other conditions.
St. John’s wort may speed up the breakdown of Brukinsa in your system. Taking them together may cause the level of Brukinsa in your system to become low. As a result, the drug may not work as well to treat your condition.
For this reason, your doctor may advise you to avoid St. John’s wort while taking Brukinsa.
Brukinsa interactions with vitamins
There are currently no reports of Brukinsa interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s important to check with your doctor or pharmacist before taking any of these products while taking Brukinsa.
Does Brukinsa interact with food?
Brukinsa can interact with grapefruit and grapefruit juice.
Grapefruit products may slow the breakdown of Brukinsa in your system. This can lead to a high level of the drug in your body, increasing your risk of Brukinsa side effects.
For this reason, your doctor may advise you to avoid grapefruit products while taking Brukinsa.
Does Brukinsa interact with vaccines or lab tests?
There are currently no reports of Brukinsa interacting with vaccines or lab tests.
However, people with a severely weakened immune system should avoid getting live vaccines, as they may have an increased risk of infection from them. Live vaccines include those for influenza (flu), varicella, yellow fever, and measles, mumps, and rubella (MMR).
If you have questions about getting certain vaccines or lab tests during your Brukinsa treatment, talk with your doctor.
Does Brukinsa interact with cannabis or CBD?There are currently no reports of Brukinsa interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Brukinsa.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Brukinsa. Before taking this medication, talk with your doctor about your health history. They’ll determine whether Brukinsa is right for you.
Health conditions or other factors that might interact with Brukinsa include:
Liver problems: Before taking Brukinsa, tell your doctor if you have a liver problem such as liver failure. Brukinsa may cause liver damage as a side effect. Taking the drug could worsen any liver problems you have.
Having a liver problem may also increase your risk of side effects from Brukinsa. For this reason, your doctor may prescribe a lower Brukinsa dosage than is typical.
If you have a liver problem, your doctor can recommend whether Brukinsa is a safe treatment option for you.
Bleeding problems: Before starting Brukinsa treatment, tell your doctor if you have a bleeding problem. The drug may cause bleeding as a side effect and so could worsen your bleeding problem.
Your doctor can advise you on whether Brukinsa is a safe treatment option.
Planned surgery: Brukinsa may increase the risk of bleeding with surgery. Before having surgery, talk with your doctor or surgeon. They may advise you to stop taking Brukinsa for up to 7 days before and after surgery.
If you have other questions about Brukinsa and surgery, talk with your doctor.
Heart rhythm problems or related factors: Certain factors may increase the risk of heart rhythm problems as a side effect of Brukinsa. Examples include infection or high blood pressure. Your doctor can tell you more about the factors that affect this risk.
Infection: Before taking Brukinsa, tell your doctor if you have an infection. Also tell them if you’ve had hepatitis B or other past infections. Treatment with Brukinsa may worsen infections or trigger symptoms of certain past infections.
Your doctor can advise you on whether Brukinsa is a safe treatment option based on your health history.
Pregnancy: It’s not known whether Brukinsa is safe to take during pregnancy. However, the drug has been shown to cause fetal harm and miscarriage when given to pregnant animals. It’s important to remember that animal studies don’t always predict what will happen in humans. But because of possible risks with Brukinsa, it’s recommended that pregnancy be avoided while you’re taking this drug.
If you’re pregnant or able to conceive, talk with your doctor before starting this medication.
Breastfeeding: It’s not known whether it’s safe to take Brukinsa while breastfeeding or if the drug passes into breast milk. To be safe, your doctor may recommend that you not breastfeed while taking Brukinsa. They may also advise you to avoid breastfeeding for at least 2 weeks after your final dose.
If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Brukinsa or any of its ingredients, your doctor will likely not prescribe Brukinsa for you. You can ask them about other treatments that may be better options for you.
Taking certain steps can help you avoid interactions with Brukinsa. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- the
list of medications you take, as well as any vitamins, supplements, and herbs - what to do if you start taking a new drug during your Brukinsa treatment
It’s also important to understand Brukinsa’s
If you did not get paperwork with Brukinsa, ask your pharmacist to print a copy for you. If you have difficulty reading or understanding this information, your doctor or pharmacist can help.
Taking Brukinsa exactly as prescribed can also help prevent interactions.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
