This page tells you about the biological therapy bosutinib and its possible side effects. There are sections about
Bosutinib is pronounced boss-oo-tin-ib. It has the brand name Bosulif (pronounced boss-oo-lif).
Bosutinib treats a type of leukaemia called Philadelphia chromosome positive chronic myeloid leukaemia. It is used when other CML treatments no longer work or cause severe side effects. It is sometimes used in other types of cancer or leukaemia as part of clinical trials.
Bosutinib is a type of drug called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that act as chemical messengers to stimulate cancer cells to grow. Bosutinib blocks (inhibits) a protein made by CML cells that have an abnormal chromosome called the Philadelphia chromosome. Blocking this protein stops the leukaemia cells growing. 95 out of 100 people with CML (95%) have the Philadelphia chromosome.
Bosutinib comes as tablets that you take once a day, in the morning, with food. You should swallow them whole with a glass of water.
You usually carry on taking bosutinib for as long as it works, unless it causes bad side effects.
It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
If you accidentally take too many bosutinib tablets, or a higher dose than you need, contact your doctor straight away.
If you forget to take bosutinib take your next dose at your regular time on the following day. Don’t take a double dose to make up for the forgotten dose.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.
We've listed the side effects associated with bosutinib. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You might have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects might be different if you are having bosutinib with other medicines.
Tell your doctor, nurse or pharmacist straight away if any of the side effects get severe.
Because bosutinib is a relatively new drug we are still learning about the side effects, especially longer term ones. Always tell your doctor or specialist nurse if you have a new symptom or side effect. They can decide whether it is due to the drug or to something else. They can then work out how to help you.
More than 10 in every 100 people have one or more of these effects.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You might have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you might need a blood transfusion
- Bruising more easily due to a drop in platelets – you might have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae). Tell your nurse or doctor if you have petechiae
- Diarrhoea affects 8 out of 10 people (80%) but this is usually mild – tell your doctor or nurse as you can have medicines to control it
- Feeling and being sick occurs in 4 in 10 people (40%) – your doctor or nurse can give you anti sickness medicines
- Abdominal pain happens in 3 out of 10 people (30%)
- Skin changes affect 3 out of 10 people (30%) – your skin may be drier, become red, or have an itchy rash
- Tiredness and weakness (fatigue) affects about 2 out of 10 people (20%)
- A mild effect on the liver happens in 2 out of 10 people (20%) – you are unlikely to notice any symptoms and it usually goes back to normal after the treatment ends
- Shortness of breath and a cough due to changes in the lung tissues
- Joint pains
- Loss of appetite
- A high temperature
- Loss of fertility – you might not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these effects.
- Changes to your blood chemistry – the levels of potassium and phosphate may be higher than normal. You might not have any symptoms from this but you will have regular blood tests to check the levels
- An allergic reaction – tell your doctor or nurse know straight away if you have any swelling of the lips, tongue or throat, or sudden breathlessness
- Dehydration – causing thirst, dry skin, a dry mouth, tiredness, headaches, and dizziness
- Aching muscles or back pain
- Taste changes
- Changes to how the heart works – the changes may cause fainting, dizziness or a sensation of the heart beating (palpitations). If you have a heart problem you might not be able to have bosutinib
- Fluid collecting around the lungs (pleural effusion) – tell your doctor or nurse straight away if you have swollen ankles, feet or legs, difficulty breathing, chest pain or a cough
- A mild effect on the kidneys – you are unlikely to notice any symptoms from this and it will usually go back to normal after the treatment finishes. Tell your doctor or nurse straight away if you are losing weight or have swelling of your feet, ankles, legs, hands or face
- Higher blood pressure than normal – you will have regular blood pressure checks
- A cough, chest pain or breathlessness due to a chest infection – you might need to have antibiotics
Fewer than 1 in 100 people have these effects.
- An increased risk of bleeding in the stomach or bowel – let your doctor or nurse know if you have sudden pain in your chest or tummy (abdomen) or blood in your vomit or stools
- Inflammation of your stomach, pancreas or the area around the heart, causing pain, sickness and a high temperature – tell your doctor or nurse straight away if you have any of these effects
- Ringing in your ears (tinnitus)
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Other medicines and foods
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
You shouldn't eat grapefruit or drink grapefruit juice while having this treatment because they can make the side effects worse.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don't breastfeed during this treatment because the drug may come through in the breast milk.
You shouldn't have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
We don’t list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk/emc.
If you have a side effect we don’t mention here and you think may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk.
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