Acalabrutinib (Calquence)

Acalabrutinib at a glance

Acalabrutinib is an oral targeted cancer medicine. Calquence is its verified brand name in the sources checked for this article. It blocks a protein that helps certain abnormal blood cells grow and survive. Treatment is commonly taken twice daily at home, with regular hospital assessment and blood tests.

Calquence comes as tablets and capsules. They contain the same active medicine but have important differences, particularly when taken with medicines for stomach acid. Check which formulation is written on your pack. A brand listed here does not establish Indian availability, and a formulation change should be arranged by your treating team.

This guide supports your own treatment plan. Your dose, treatment duration and any accompanying medicines depend on your circumstances. Keep your hospital’s urgent advice details available and tell the team about symptoms between appointments. Serious infection and bleeding are possible even when treatment feels easy to take.

What acalabrutinib is and how it works

Acalabrutinib inhibits Bruton’s tyrosine kinase, usually shortened to BTK. This is a protein involved in signals within B lymphocytes, a type of white blood cell. Blocking BTK can interfere with signals that support the survival, movement and multiplication of cancerous B cells.

Acalabrutinib is therefore called a BTK inhibitor. It is a targeted therapy, with a different action from conventional chemotherapy. The word targeted does not mean that only cancer cells are affected. Normal blood cells, immune defences and other body systems can also be affected.

You may receive acalabrutinib alone or with other anticancer medicines. Each part of a combination has its own purpose, timetable and precautions. Do not assume that a pause in one medicine means you should stop every medicine in the plan.

How your team decides whether it is suitable

Your specialist considers the exact diagnosis, test results, previous treatments, other illnesses and applicable prescribing information. Blood tests, examination of tissue or bone marrow, and scans may help establish the disease and the need for treatment. Acalabrutinib is not selected simply because a blood count is above the normal range.

Depending on the diagnosis, tests for changes such as TP53 abnormalities, deletion of part of chromosome 17, or IGHV status can help guide treatment decisions. These describe characteristics of the cancer cells; they do not all serve the same purpose. Your team will explain which results matter for your proposed treatment. There is no universal requirement for a positive “BTK test” before every prescription.

Previous treatment with another BTK inhibitor matters. The reason it stopped, such as intolerance or loss of benefit, affects the next decision. Tell the specialist about significant bleeding, abnormal heart rhythms, hepatitis, recurrent infections and liver problems. Discuss what treatment aims to achieve and how the team will assess benefit.

Before treatment starts

Expect a review of your medicines and a full blood count, liver tests and kidney assessment. Blood salts and other tests may be needed, particularly if the amount of disease creates a risk of rapid cell breakdown. Hepatitis B screening is important because a previous infection can reactivate. Other infection tests depend on your history and local practice.

Mention heart disease, palpitations, fainting, blood pressure problems and anticoagulants, sometimes called blood thinners. A heart tracing, or ECG, may be arranged when your history or symptoms warrant it. The team needs to know about planned operations, dental extractions and any recent injury or bleeding.

Bring prescriptions, occasional painkillers, acid-reducing medicines, vitamins and herbal products, with their names and doses. A photograph of the packaging can help. Pregnancy testing is needed before treatment if you could be pregnant. Discuss contraception, breastfeeding and future fertility before the first dose.

Before taking the medicine home, confirm the tablet or capsule formulation, daily timetable, blood-test appointments and who will arrange repeat prescriptions. Ask for a written plan for fever, diarrhoea and missed doses. Some patients need antiviral or other infection-prevention medicines; these are selected according to risk rather than prescribed identically to everyone.

How to take acalabrutinib

Dose and timing

A common adult prescription is 100 mg approximately every 12 hours, usually morning and evening. Both tablets and capsules can be taken with or without food and should be swallowed with water. Follow your own prescription if the team has changed the frequency because of side effects or an interaction. Never compensate for a reduced prescription by taking extra doses.

Some plans continue while treatment remains beneficial and tolerable. Others specify a course. For example, a particular plan with venetoclax uses acalabrutinib for up to 14 cycles, each lasting 28 days, with venetoclax starting later. This is not the schedule for every patient. Your calendar should identify which medicines start or stop on each date.

When acalabrutinib and obinutuzumab are prescribed on the same day, the checked instructions say to take acalabrutinib before obinutuzumab. Confirm the timing with the treatment unit. Accompanying infusions may need premedication and observation, although acalabrutinib itself is taken by mouth.

Swallowing and formulation

Swallow tablets whole: do not split, crush, chew or dissolve them. Swallow capsules whole: do not open, crush or chew them. If swallowing is difficult or you use a feeding tube, contact the oncology pharmacist before the dose. Do not improvise a liquid or tube preparation from these instructions.

Check the label whenever a new supply looks different. A clinician may arrange a switch between formulations, but the stomach-medicine instructions must be reviewed at the same time.

A missed dose or vomiting

If you remember within three hours of your usual dose time, take the missed dose. If more than three hours have passed, skip it and take the next dose at the usual time. Do not double the dose or take extra tablets or capsules.

If you vomit after taking acalabrutinib, do not repeat that dose; take the next scheduled dose normally. Contact the team if vomiting continues or you cannot retain fluids. If you accidentally take too much, seek urgent medical advice and give the exact amount and time taken.

Keeping and handling your medicine

Keep acalabrutinib in its supplied packaging, out of the reach of children and pets. Follow the temperature instructions on your pack. US labels specify 20–25°C (68–77°F), with permitted excursions to 15–30°C (59–86°F); the checked European product information has no special storage requirement. Avoid a hot car, damp bathroom or direct sunlight, and ask the pharmacist about safe storage during hot weather or travel.

Wash your hands after handling medicine. Do not share it or put unused doses into household drains. Return unwanted or expired medicine through the pharmacy’s recommended disposal service.

Monitoring and checking whether treatment is working

Blood counts show whether treatment is affecting infection-fighting cells, red cells or platelets. Liver tests are checked before and during treatment because injury can appear in blood results before obvious symptoms. Kidney function and blood salts are monitored according to your circumstances and accompanying medicines. The frequency may change after abnormal results, an infection or a dose adjustment.

Your team asks about bleeding, bowel symptoms, infections, tiredness, heartbeat changes and new medicines. They may examine lymph nodes and arrange scans or other disease assessments. Keep a brief symptom record with dates; it can reveal a pattern that is difficult to remember at a clinic visit.

Some people have a temporary increase in circulating lymphocytes after starting treatment. This can reflect cells moving into the blood and does not, by itself, prove that treatment has failed. The specialist interprets the trend alongside symptoms and other findings. Do not stop tablets because of one result viewed online.

A delay, change in frequency or treatment stop may be needed for significant toxicity. This protects your health while the cause is assessed. Never restart a held medicine simply because you feel better; obtain the team’s restart instructions.

Common side effects and practical care

Headache

Headache is a recognised effect, particularly early in treatment. Report it and check which pain relief is suitable. Rest and regular fluids may help if you are otherwise well. Do not automatically take aspirin or ibuprofen, because they can increase bleeding concerns. A sudden severe headache, a headache after a head injury, or headache with weakness, confusion or visual change needs urgent assessment.

Loose stools and nausea

Record changes from your normal bowel pattern. Drink regularly unless you have a prescribed fluid restriction and use only the anti-diarrhoea or anti-sickness medicines advised by the team. Smaller meals may be easier when nauseated. Report persistent or worsening diarrhoea, vomiting or poor intake. Blood in stools, severe pain, faintness or very little urine requires urgent help rather than continued home treatment.

Tiredness and muscle or joint aches

Plan demanding activities for times when energy is better, accept help and balance rest with gentle movement. Persistent fatigue can have several causes, including anaemia or infection. Tell the team if you are becoming less able to manage ordinary activities. Discuss suitable pain relief before taking a new tablet for aches, particularly if you also take a blood thinner.

Bruising and skin changes

You may bruise more easily or notice small red or purple spots. Tell the team about new or increasing bruising, nosebleeds or bleeding gums. Use a soft toothbrush and take care with shaving and sharp objects. Do not dismiss large spontaneous bruises or persistent bleeding as an unavoidable treatment effect.

For mild skin dryness or irritation, use a plain moisturiser and gentle washing products. Report a new rash so that the team can assess it. A painful widespread rash, blisters, mouth involvement or facial swelling needs urgent advice or emergency care if severe.

Respiratory symptoms

Coughs and upper respiratory infections occur during treatment, but a new cough should not automatically be treated as a harmless cold. Report fever, worsening cough or breathlessness promptly. Infection can become serious even when a recent white-cell count was satisfactory.

Important side effects

Serious infection and viral reactivation

Acalabrutinib can weaken defences against bacteria, viruses and fungi. Serious infections may occur without a very low neutrophil count. Follow prescribed infection-prevention treatment and report illness promptly. Hepatitis B can become active again after a past infection, which is why screening and sometimes antiviral treatment are needed.

A rare brain infection called progressive multifocal leukoencephalopathy, or PML, has been reported. New changes in thinking, speech, vision, walking or strength require urgent assessment. These symptoms have several possible causes; patients should not try to diagnose PML themselves. If PML is suspected, the treating team suspends acalabrutinib while investigating, until PML has been excluded.

Major bleeding

Bleeding can occur in the digestive tract, brain or elsewhere. Emergency signs include vomiting blood, coughing up blood, black tar-like stools, uncontrolled bleeding, or sudden neurological symptoms. Bleeding risk may increase with anticoagulants or antiplatelet medicines, but stopping those medicines without advice can also be dangerous.

Before surgery or invasive dental work, the oncologist and procedural team should agree a pause and restart plan. US instructions describe considering a pause of three to seven days before and after surgery; European instructions say at least three days before and after. The actual interval depends on the procedure and bleeding risk. These are clinician planning ranges, not instructions to stop on your own.

Abnormal heart rhythm

Acalabrutinib can cause abnormal rhythms, including atrial fibrillation or flutter and, less commonly, serious ventricular rhythms. Report a racing, fluttering or irregular heartbeat, dizziness or new breathlessness. Chest pain, collapse or severe breathing difficulty requires emergency care. A heart problem may need an ECG and treatment changes; do not assume palpitations are only anxiety.

Liver injury and low blood counts

Liver injury can be severe. Report yellowing of the eyes or skin, dark urine, abdominal discomfort or unusual loss of appetite promptly. The team withholds treatment if drug-induced liver injury is suspected and stops it if confirmed. Regular tests also look for anaemia, low platelets and low infection-fighting cells. Increasing breathlessness, unusual weakness, bleeding or infection needs assessment between routine tests.

Tumour lysis syndrome and lung inflammation

Rapid breakdown of cancer cells can disturb blood salts and kidney function; this is called tumour lysis syndrome. Risk depends on the amount of disease, kidney function and the complete treatment. If venetoclax is added, its gradual dose increases, hydration instructions and timed blood tests are especially important. New vomiting with marked weakness, reduced urine, confusion, muscle cramps or an irregular heartbeat needs urgent assessment.

Lung inflammation has also been reported, particularly in some combination settings. A new or worsening cough or breathlessness needs prompt investigation for inflammation, infection and other causes. Do not wait to decide which explanation is most likely.

Other cancers and skin protection

Other cancers, including skin cancers, have occurred in people receiving acalabrutinib. Protect skin with clothing, shade and sunscreen, and report a changing mole, persistent sore or new skin lump. This precaution does not mean that every skin change is cancer. Continue the screening and skin checks recommended for you.

Other medicines and vaccinations

Stomach-acid medicines

For acalabrutinib capsules, proton pump inhibitors such as omeprazole can reduce absorption and should generally be avoided with that formulation. Merely separating the doses does not reliably solve this. Antacids should be separated by at least two hours. US capsule instructions place acalabrutinib two hours before an H2 blocker such as famotidine; European instructions also describe taking it ten hours after an H2 blocker. Have the pharmacist prepare an exact timetable.

The film-coated tablets can be taken with acid-reducing medicines under the checked European instructions; US tablet data also show no clinically meaningful interaction with the tested proton pump inhibitor. The capsule restriction should not automatically be applied to tablets. Conversely, do not use tablet advice for a capsule pack.

Other interactions and vaccines

Some antibiotics, antifungals, antiviral medicines and epilepsy treatments alter an enzyme called CYP3A, which affects acalabrutinib levels. St John’s wort is another important interaction. A temporary interruption or prescription change may be needed, but only the treating team should arrange it. Tell any clinician prescribing an infection treatment that you take acalabrutinib.

Blood thinners, antiplatelet medicines and anti-inflammatory painkillers need special review because of bleeding. European information advises against warfarin and similar vitamin K antagonists with acalabrutinib. Do not stop an existing anticoagulant yourself; the team should choose a safe plan. Check grapefruit products with the pharmacist before using them regularly.

Discuss vaccinations before and during treatment. Timing and expected protection depend on your immune function and other medicines, especially accompanying antibody treatment. Do not arrange a live vaccine without specialist clearance. Ask about appropriate non-live vaccines and continue infection precautions even after vaccination.

Everyday life during treatment

Food does not need to be timed around acalabrutinib itself. Aim for regular meals and sufficient fluids, adjusting for bowel symptoms and any heart or kidney restrictions. Avoid restrictive diets or supplements promising to enhance treatment. Discuss alcohol if liver tests are abnormal or you are taking medicines that cause drowsiness.

Work and activity may remain possible with flexible hours and time for monitoring. Avoid activities with a high risk of injury or falls when bruising or bleeding is a concern. Do not drive when dizzy, unusually tired, visually affected or unable to concentrate safely. New neurological symptoms need assessment rather than simply waiting to feel fit to drive.

Plan travel around blood tests and medicine supplies. Carry the labelled pack and a treatment summary, and discuss long journeys, time-zone changes and destinations far from urgent care before booking. Let dentists and other healthcare professionals know about treatment before procedures.

Wash hands regularly, use safe food handling and avoid close contact with people who are unwell. Ask about precautions tailored to your blood counts rather than assuming you need complete isolation. Sex and intimacy can continue if comfortable, with contraception as advised. Tell the team about persistent anxiety, poor sleep or low mood; practical and emotional support can make a long course of treatment easier.

Fertility pregnancy and breastfeeding

Acalabrutinib may harm a developing baby. If you could become pregnant, pregnancy status should be checked before treatment and effective contraception used during treatment. US prescribing information specifies continuing contraception for one week after the last acalabrutinib dose. European information advises avoiding pregnancy during treatment without the same explicit post-treatment interval. Agree a plan for the actual product and the complete treatment.

Do not breastfeed during treatment. US information specifies avoiding breastfeeding for two weeks after the final dose; the checked European information specifies two days. Do not restart on the shorter interval without an agreed feeding plan. Accompanying medicines can require longer restrictions, which take precedence.

Human fertility effects are not established. Discuss sperm, egg or embryo preservation before starting if this matters to you. Do not assume that an animal study establishes safety for future human fertility. The one-week contraception interval above is for a treated person who could become pregnant; it is not a universal interval for male partners. Ask for partner advice that accounts for every medicine used. Report pregnancy or contraceptive failure promptly.

After treatment finishes

Continue the follow-up tests and appointments recommended by the team. Some infections, blood-count problems or other effects need monitoring after the last dose. Continue antiviral or other preventive medicines for their own prescribed duration; do not stop them automatically when acalabrutinib ends.

Keep a summary of the formulation, dates, treatment pauses, significant reactions and ongoing medicines. If treatment stops because of a serious reaction, make sure future clinicians know the reason. Continue the applicable contraception and breastfeeding precautions and seek help for new severe symptoms between follow-up visits. Recovery, return to work and activity can be gradual.

Frequently asked questions