Regarding dasatinib, imatinib and nilotinib with dialysis;
There is limited information on use of these drugs in renal impairment or with dialysis, so they should be used with caution - but overall it is thought that they are unlikely to be dialysed.
See further information below:
Dasatinib
• Mainly hepatic metabolism
• Minimal urinary excretion, <4% renally excreted
o Unlikely to be dialysed dose as in normal renal function
• Note, may cause fluid retention
o Monitor patient closely
Imatinib
• Mostly hepatic metabolism
• Some urinary excretion, ~13% renally cleared (drug and metabolites)
o Unlikely to be dialysed some references suggest can dose as in normal renal function, while others suggest to start with a reduced dose and monitor closely (one reported that a dose 100mg daily was tolerated in a limited number of patients with severe renal impairment, while the product information suggests that 400mg may be a suitable starting dose)
• Note fluid retention/oedema very common – monitor closely
o Higher probability if higher doses, age>65, Hx cardiac disease
• Also may rarely cause severe elevation of serum creatinine - monitor
Nilotinib
• Mainly hepatic metabolism
• Close to no renal excretion
o Unlikely to be dialysed (no information on this, but dosage adjustments for renal dysfunction unlikely to be necessary) dose as in normal renal function and monitor closely
References
• Drug Information Handbook for Oncology – 12th edition (American Pharmacist’s Association)
• eMIMS
• eviQ
• Renal Drug Handbook 3rd Edition (Ashley + Currie)