Does Dasatinib (Sprycel) have the potential to cause fluid retention?

From the Guidelines

Yes, dasatinib can cause water retention, which may manifest as pleural effusion, a condition where fluid accumulates in the lungs, as reported in 28% of patients in the DASISION study 1. This side effect is a significant concern, as it can lead to respiratory complications and impact the patient's quality of life. The mechanism behind this side effect involves dasatinib's inhibition of platelet-derived growth factor receptor (PDGFR) and SRC family kinases, which affects vascular permeability and fluid balance. Key points to consider include:

• Pleural effusion is more common with dasatinib, especially in patients with prior cardiac history, hypertension, and those receiving dasatinib 70 mg twice daily 1.
• The occurrence of pleural effusion is significantly reduced with dasatinib 100 mg once daily compared with 70 mg twice daily 1.
• Patients taking dasatinib should monitor for symptoms such as sudden weight gain, swelling in the ankles or legs, shortness of breath, or chest pain, and contact their healthcare provider immediately if these symptoms occur 1.
• Regular monitoring by healthcare providers is essential during dasatinib treatment to detect and manage fluid retention early, and dose adjustments or supportive measures like diuretics may be necessary 1. In terms of management, it is crucial to:
• Monitor cardiac function and manage other cardiac problems according to general rules of non-haematological toxicity 1.
• Treat arterial hypertension actively, especially in recipients of ponatinib, which has been associated with hypertension in 9% of recipients by 12 months 1.
• Use diuretics to manage fluid retention, which is normally manageable and reversible 1.

From the FDA Drug Label

Your body may hold too much fluid (fluid retention). Fluid retention is common with dasatinib tablets and can sometimes be severe In severe cases, fluid may build up in the lining of your lungs, the sac around your heart or your stomach cavity Dasatinib may cause fluid retention [see Adverse Reactions (6. 1)]. After 5 years of follow-up in the adult randomized newly diagnosed chronic phase CML study (n=258), Grade 3 or 4 fluid retention was reported in 5% of patients, including 3% of patients with Grade 3 or 4 pleural effusion

Dasatinib has the potential to cause water retention, also known as fluid retention, which can be severe in some cases. This may lead to the buildup of fluid in various parts of the body, including the lungs, heart, or stomach cavity.

• Key symptoms of fluid retention include:
  • Swelling all over the body
  • Weight gain
  • Shortness of breath
  • Dry cough
  • Chest pain when taking a deep breath 2 2

From the Research

Dasatinib and Water Retention

• Dasatinib has been associated with fluid retention, including pleural effusion, as a common adverse event in clinical trials 3, 4, 5.
• The incidence of fluid retention can be reduced by altering the dasatinib regimen from 70 mg twice daily to 100 mg daily 3, 4.
• Patients with a history of pleural effusion risk factors should be monitored closely while taking dasatinib 4.
• Tolvaptan may be useful in controlling fluid retention in patients with chronic myeloid leukemia treated with dasatinib 6.
• A pharmacovigilance study found that dasatinib had a high reporting odds ratio (ROR) for pleural effusion, pericardial effusion, and pulmonary oedema, particularly in patients aged ≥65 years 7.

Management of Fluid Retention

• Dasatinib should be interrupted until the condition resolves if pleural effusion develops 4.
• Patients should be educated to recognize and report key symptoms of fluid retention or pleural effusion 4.
• Tolvaptan may be an effective treatment for dasatinib-induced pleural effusions, allowing some patients to continue dasatinib therapy without complications 6.
• Close monitoring and management of fluid retention are crucial to minimize the risk of dasatinib-induced adverse events 3, 4, 7, 5.