Bonitar is a vital medication for managing resistant or intolerant cases of Ph+ CML, offering hope to patients who have limited options. However, its use requires careful monitoring due to potential side effects and interactions.Bonitar is an oral tyrosine kinase inhibitor used in the treatment of certain types of leukemia. It is particularly effective in patients with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) who are resistant or intolerant to prior therapies. Bonitar works by targeting and inhibiting the BCR-ABL protein, which drives the proliferation of cancer cells in Ph+ CML.

Indications 

Chronic Myeloid Leukemia (CML)

Chronic Phase (CP)

Accelerated Phase (AP)

Blast Phase (BP)

Particularly in patients with resistance or intolerance to prior tyrosine kinase inhibitor therapy.

Bonitar selectively inhibits the BCR-ABL kinase, the abnormal fusion protein responsible for the progression of Ph+ CML. By blocking this protein, Bonitar reduces the growth and survival of leukemia cells. It also inhibits other kinases, including Src-family kinases, contributing to its anticancer effects.

Side Effects

Common side effects of Bonitar include:

• Nausea and vomiting
• Diarrhea
• Fatigue
• Rash
• Abdominal pain
• Elevated liver enzymes (transaminitis)

Serious side effects:

• Myelosuppression (low blood counts)
• Liver toxicity
• Pancreatitis
• Cardiac arrhythmias

Monitoring Parameters: Regular blood counts, liver function tests, and kidney function tests are essential during treatment.

Precautions and Warnings

• Hepatic Impairment: Use with caution; dose adjustment may be necessary.
• Renal Impairment: Dose reduction is recommended for patients with kidney dysfunction.
• Pregnancy and Lactation: Bonitar is not recommended during pregnancy or breastfeeding due to potential harm to the fetus or infant.
• Drug Interactions: Avoid concomitant use with strong CYP3A inhibitors or inducers, as these can affect Bonitar levels. Grapefruit juice should also be avoided.

Dosage and Administration

• Recommended Dose: 400-500 mg orally once daily with food.
• Adjustments: Dose modifications may be required based on patient tolerance, renal/hepatic impairment, or adverse effects.

Storage Instructions

• Store at room temperature (20-25°C).
• Keep the medication in its original container, away from moisture and heat.