Bosulif

Pronunciation: BAH-su-lif
Generic name: bosutinib
Dosage form: oral capsules, oral tablets
Drug class: BCR-ABL tyrosine kinase inhibitors

Medically reviewed by Carmen Pope, BPharm. Last updated on Oct 11, 2023.

What is Bosulif?

Bosulif is a kinase inhibitor that may be used to treat adults and some children aged 1 year and older with a type of cancer called chronic myelogenous leukemia (CML; also called chronic myeloid leukemia).

Bosulif is approved to treat:

Adults and children aged 1 year and older with Philadelphia chromosome-positive chronic myelogenous leukemia (Ph+ CML) in chronic phase (CP) that is newly diagnosed, resistant, or intolerant to other treatments
Adults with accelerated, or blast phase Ph+ CML that is resistant or intolerant to prior treatment.

Bosulif is a targeted treatment that works by inhibiting the action of BCR-ABL kinase—a protein typically overproduced by CML cells, stopping, or slowing the growth of CML cells. In addition to its role in targeting BCR-ABL, it also inhibits Src, Lyn, and Hck, which are part of the Src family of kinases. Bosulif belongs to the class of medicines known as tyrosine kinase inhibitors.

Bosulif was first FDA-approved on September 4, 2012.

Warnings

May cause severe diarrhea and other gastrointestinal side effects. Tell your doctor if you develop any intolerable gastrointestinal side effects. They may need to withhold, reduce the dose, or discontinue Bosulif.

Bosulif can cause myelosuppression and lower blood cells that can help your body fight infections and help your blood clot. You may get an infection or bleed more easily. Call your doctor if you have unusual bruising or bleeding, or signs of infection (fever, chills, body aches).

May increase the risk of liver problems. Stop using Bosulif and call your doctor at once if you have a fever, easy bruising or bleeding, shortness of breath, jaundice (yellowing of the skin or eyes), swelling or rapid weight gain, blood in your stools, or severe and ongoing vomiting, stomach pain, or diarrhea. Your doctor will monitor your liver enzymes at least monthly for the first 3 months and as needed.

May increase the risk of fluid retention or heart problems. Tell your doctor if you have swelling or rapid weight gain, shortness of breath, fast or slow heart rate, weak pulse, or fainting. There is also an increased risk of kidney toxicity, your doctor will measure your kidney function before you start treatment and while you are taking Bosulif.

Bosulif can cause harm to an unborn baby and should not be used during pregnancy. Your doctor should conduct a pregnancy test if you are a woman of childbearing age before prescribing Bosulif and you should use adequate contraception during treatment. Do not breastfeed.

Do not break or crush a Bosulif tablet. The medicine from a crushed or broken pill can be dangerous if it gets on your skin. Ask your doctor or pharmacist how to safely handle and dispose of a broken tablet.

Before taking this medicine

You should not use Bosulif if you are allergic to bosutinib or any of the inactive ingredients in the tablets or capsules.

To make sure Bosulif is safe for you, tell your doctor if you have ever had:

heart disease
high blood pressure
diabetes
liver disease
kidney disease
are pregnant or intend to become pregnant
are breastfeeding.

Pregnancy and breastfeeding

Bosulif can harm your unborn baby. Females who can become pregnant should have a pregnancy test before starting treatment and use effective birth control (contraception) during treatment and for 2 weeks after the last dose. Talk to your doctor about suitable birth control methods. Tell your doctor right away if you inadvertently become pregnant during treatment.

Do not breastfeed during treatment with Bosulif and for 2 weeks after the last dose.

How should I take Bosulif?

Bosulif is usually taken once per day. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take it with food.
Swallow the tablet whole and do not crush, chew, or break it. The medicine from a crushed or broken pill can be dangerous if it gets on your skin. If this happens, wash your skin with soap and water. Ask your pharmacist how to safely dispose of a broken pill.
If you cannot swallow the capsules whole, you can put on gloves, open the number of Bosulif capsules you need, and mix them with room-temperature applesauce or yogurt (see the product information for full instructions). Do not mix Bosulif with other foods. Swallow all of the mixture right away, without chewing; do not store it for later use. Take it with a full meal.
If you are giving Bosulif capsules/tablets to a child, wear gloves when taking them out of the container and putting them in their mouth. Your doctor will adjust the dose of Bosulif as the child grows.
Do not take Bosulif within 2 hours of an antacid or H2 blocker medicine. If you take a Proton Pump Inhibitor (PPI), talk to your doctor or pharmacist. Avoid grapefruit, grapefruit juice, and supplements that contain grapefruit extract during treatment with Bosulif.
The dosage may need adjusting for toxicity or kidney or liver disease.

Bosulif can lower your blood cell counts. Your blood will need to be tested often. Your cancer treatments may be delayed based on the results.

Do not stop using Bosulif without your doctor's advice.

Dosing information

Usual adult dose

Newly-diagnosed: 400 mg orally once daily.
Chronic/accelerated/blast phase: 500 mg orally once daily

Usual child dose

Newly diagnosed: 300 mg/m2 orally once daily.
Chronic phase with resistance or intolerance to prior therapy: 400 mg/m2 orally once daily.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if you are more than 12 hours late for the dose. Do not take two doses at one time.

If you are mixing Bosulif with applesauce or yogurt and do not swallow the entire mixture, do not mix another dose. Wait until the next day to take your regularly scheduled dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What to avoid

Grapefruit may interact with bosutinib and lead to unwanted side effects. Avoid the use of grapefruit products. Avoid antacids within 2 hours of a Bosulif dose.

What are the side effects of Bosulif?

Get emergency medical help if you have signs of an allergic reaction to Bosulif: hives, itching; dizziness; back pain, joint pain; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using Bosulif and call your doctor at once if you have:

severe or ongoing nausea, vomiting, stomach pain, or diarrhea
blood in your stools
urinating more or less than usual
feeling light-headed or short of breath
heart problems - swelling, rapid weight gain, feeling short of breath
low blood cell counts - fever, chills, tiredness, flu-like symptoms, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet
liver problems - upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes) or
swelling or fluid build-up in the lungs - anxiety, sweating, pain when you breathe, feeling short of breath while lying down, wheezing, gasping for breath, cough with foamy mucus, chest pain, fast or uneven heart rate.

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

The most common Bosulif side effects reported in 20% or more patients include:

diarrhea
stomach pain
vomiting
nausea
rash
fatigue
liver dysfunction
headache
fever
decreased appetite
respiratory tract infection
constipation
laboratory abnormalities.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

What other drugs will affect Bosulif?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective. Tell your doctor about all the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements. Interactions include:

Antacids or stomach acid reducers (such as famotidine or cimetidine)
Proton pump inhibitors (such as omeprazole)
Strong and moderate CYP3A inhibitors such as clarithromycin, diltiazem, erythromycin, itraconazole, ketoconazole, ritonavir, and verapamil
Strong CYP3A inducers such as glucocorticoids, rifampin, carbamazepine, phenobarbital, and phenytoin.

Avoid grapefruit, grapefruit juice, and supplements that contain grapefruit extract.

Many other drugs can interact with bosutinib. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Storage

Store at room temperature 20°C to 25°C (68°F to 77°F) away from moisture and heat.

Ingredients

Available as 100mg, 400mg, and 500mg tablets; and 50mg, and 100mg capsules.

Bosulif tablets

Active: bosutinib in 3 strengths: 100 mg, 400 mg, and 500 mg.
Inactive ingredients: croscarmellose sodium, iron oxide red (for 400 mg, and 500 mg tablet) and iron oxide yellow (for 100 mg, and 400 mg tablet), magnesium stearate, microcrystalline cellulose, poloxamer, polyethylene glycol, polyvinyl alcohol, povidone, talc, and titanium dioxide.

Bosulif capsules

Active: bosutinib in 2 strengths: 50 mg and 100 mg.
Inactive: croscarmellose sodium, gelatin, magnesium stearate, mannitol, microcrystalline cellulose, poloxamer, povidone, red iron oxide, titanium dioxide, yellow iron oxide. The printing ink contains black iron oxide, potassium hydroxide, propylene glycol, shellac, and strong ammonia solution.

Manufacturer

Pfizer Labs

Popular FAQ

How does it work for chronic myeloid leukemia?

Bosulif is a targeted chemotherapy drug that works by stopping or slowing the growth of CML cells. It is a tyrosine kinase inhibitor and works by inhibiting BCR-ABL kinase, as well as Src family kinases. Continue reading

Is this a chemotherapy drug?

Bosulif (bosutinib monohydrate) is used to treat cancer but is known as a targeted treatment because it inhibits specific kinases that promote the growth of chronic myeloid leukemia (CML). Targeted treatments differ from traditional chemotherapy agents because they only target specific proteins on a cell, rather than having an effect on all dividing cells, like traditional chemotherapy agents do. Continue reading