BRUKINSA (ZANUBRUTINIB): USES, SIDE EFFECTS, DOSING AND COST

Brukinsa (zanubrutinib) is an oral cancer medicine used to treat chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma, Waldenström macroglobulinemia and certain other lymphomas in adults. This guide covers how Brukinsa works, its side effects, how it is taken, drug interactions and what it costs. If you need help paying for it, see our Brukinsa (zanubrutinib) copay assistance page.

What Is Brukinsa (Zanubrutinib)?

Brukinsa (zanubrutinib) is a Bruton tyrosine kinase (BTK) inhibitor, first approved by the FDA on November 14, 2019. In adults, it is approved to treat:

Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL)
Waldenström macroglobulinemia
Mantle cell lymphoma after at least 1 prior therapy
Relapsed or refractory marginal zone lymphoma after at least 1 anti-CD20-based treatment
Relapsed or refractory follicular lymphoma after 2 or more treatments, together with obinutuzumab

Brukinsa comes as 80 mg capsules and 160 mg scored tablets. MedlinePlus has a plain-language overview.

Source: Lexidrug, zanubrutinib monograph (last updated 8/3/2026, accessed 9/30/2026); Brukinsa prescribing information, BeOne Medicines USA, July 2026. Not a complete list. Follow your oncologist’s instructions.

How Does Brukinsa Work?

Brukinsa blocks Bruton tyrosine kinase (BTK), a signaling protein that B cells, including cancerous B cells, use to grow and survive. It binds to BTK and turns off its activity.

Brukinsa Side Effects

The most common Brukinsa side effects are upper respiratory infections, muscle and bone pain, bleeding or bruising, rash, tiredness and diarrhea. In adults, Lexidrug lists these among side effects reported in more than 10% of patients:

Upper respiratory infections (27% to 44%) and pneumonia (12% to 18%)
Muscle and bone pain (26% to 45%)
Bleeding of any kind (24% to 42%) and bruising (16% to 24%)
Rash (20% to 29%)
Tiredness (13% to 31%)
Diarrhea (14% to 22%)
High blood pressure (14% to 19%)
Cough (11% to 16%)
Lab changes such as low white blood cells, low platelets and high blood sugar

Call your doctor right away for signs of infection, bleeding you cannot stop, black or bloody stools, chest pain or an irregular heartbeat, fainting, yellow skin or eyes, or weakness on one side of the body or trouble speaking.

“Infections, bleeding and bruising are among the side effects reported most often with Brukinsa.* Tell your oncologist and our pharmacists about every blood thinner, aspirin or supplement you take, and call right away if you notice a fever or bleeding that will not stop, so your care team can decide what to do next.”

Julia Kravtsova, PharmD, Head Patient Navigator, QuickRx Specialty Pharmacy

*Source: Lexidrug, zanubrutinib monograph (Adverse Reactions, Warnings/Precautions, Drug Interactions), last updated 8/3/2026. This quote is general information, not medical advice for your own treatment. Do not start, stop, skip or change how you take this medicine without talking to your prescriber, and always follow your prescriber’s instructions and the FDA-approved labeling.

Brukinsa Warnings and Precautions

The main safety concerns with Brukinsa are bleeding, infections, heart rhythm problems, low blood counts, liver injury and second cancers.

Bleeding: serious and fatal bleeding has occurred; the risk may be higher with blood thinners or antiplatelet medicines.
Infections: serious infections, including pneumonia and hepatitis B reactivation, have occurred.
Heart rhythm: atrial fibrillation, atrial flutter and ventricular arrhythmias have occurred.
Low blood counts: severe drops in white cells, platelets and red cells have been reported.
Liver: serious, including fatal, drug-induced liver injury has occurred.
Second cancers: new cancers have been reported, most often non-melanoma skin cancer. Use sun protection.
Older adults: patients 65 and older had more serious side effects than younger patients.

How Is Brukinsa Taken?

The usual adult dose of Brukinsa is 160 mg twice a day or 320 mg once a day, taken until the disease progresses or side effects become too hard to manage.

Take with or without food.
Capsules: swallow whole with water; do not open, break or chew.
Tablets: swallow whole with water; do not chew or crush; the tablet may be split in half.
Missed dose: take it as soon as you can the same day, then return to your normal schedule the next day.
Food to avoid: grapefruit, grapefruit juice and Seville oranges.
Surgery: your team may pause Brukinsa for 3 to 7 days before and after surgery, depending on bleeding risk.

Kidney and Liver Dosing

No dose change is needed when CrCl is 15 mL/minute or higher; lower kidney function and dialysis have not been studied, though Lexidrug notes a change is unlikely. No change is needed for mild or moderate liver problems. For severe liver problems (Child-Pugh C), the dose is reduced to 80 mg twice a day.

Always follow the exact dose your oncologist gives you. Source: Lexidrug, zanubrutinib monograph (accessed 9/30/2026).

Does Brukinsa Interact With Other Drugs?

Yes, Brukinsa has important drug interactions, mainly with medicines that affect the liver enzyme CYP3A4 and with blood thinners.

Strong CYP3A4 inducers: avoid; they lower Brukinsa levels.
Moderate CYP3A4 inducers: avoid if possible; if needed, the Brukinsa dose is raised to 320 mg twice a day.
Strong CYP3A4 inhibitors: Brukinsa is lowered to 80 mg once a day. Moderate inhibitors: lowered to 80 mg twice a day.
Blood thinners and antiplatelet medicines: may raise the risk of bleeding.
Live vaccines: avoid during treatment.

Tell every doctor and pharmacist about every medicine, supplement and herbal product you take. QuickRx pharmacists can review your list; call (917) 830-2525.

What Monitoring Is Needed on Brukinsa?

Your care team will check your blood counts regularly and your liver tests at the start and during treatment. They will also watch for bleeding, infection and heart rhythm problems, check for new skin or other cancers, and may screen for hepatitis B before you start.

Can You Take Brukinsa During Pregnancy or Breastfeeding?

Brukinsa may harm an unborn baby, so pregnancy should be checked before starting. Patients who could become pregnant, and patients whose partners could become pregnant, should use effective birth control during treatment and for 1 week after the last dose. Breastfeeding is not recommended during treatment and for 2 weeks after the last dose.

Is There a Generic, and How Much Does Brukinsa Cost?

No, there is no generic zanubrutinib in the United States, and at Average Wholesale Price 30 days at the usual dose runs about $18,893 to $20,008.

What Brukinsa Costs Before Insurance

Tablet,160mg 333.46 each

Form	Average Wholesale Price
Capsule, 80 mg	157.44each
30 days at 320 mg a day	about $18,893 to $20,008

Source: Lexidrug, zanubrutinib monograph (Medi-Span AWP, accessed 9/30/2026). AWP is a reference benchmark, not a retail price, not a quote and not what you will pay. The 30-day range is simple math for illustration (120 capsules or 60 tablets). No US generic is listed as of 9/30/2026.

Copay cards, patient assistance programs and foundation grants may lower what you pay. According to BeOne Medicines, eligible patients with commercial insurance may pay $0 per prescription.* QuickRx applies on your behalf. Learn more on our Brukinsa (zanubrutinib) copay assistance page or call (917) 830-2525.

*According to BeOne Medicines (myBeOne Support, accessed 9/30/2026). Eligibility and benefit limits are set by BeOne, not by QuickRx. Not all patients qualify. Manufacturer copay coupons generally cannot be used by patients whose prescriptions are paid for by Medicare, Medicaid or other federal health care programs (HHS OIG, 2014).

What Studies Support Brukinsa?

Brukinsa has been studied in large randomized trials in CLL and Waldenström macroglobulinemia, including a head-to-head trial against ibrutinib. These include a trial comparing zanubrutinib with ibrutinib in relapsed or refractory CLL (NEJM, 2023), the SEQUOIA trial in untreated CLL/SLL (Lancet Oncology, 2022) and the ASPEN study in Waldenström macroglobulinemia (J Clin Oncol, 2023).

Study citations as listed in Lexidrug, zanubrutinib monograph references. Ask your oncologist how these results apply to you.

How Should Brukinsa Be Stored?

Store Brukinsa capsules and tablets at room temperature, 20°C to 25°C (68°F to 77°F). Brief exposure to 15°C to 30°C (59°F to 86°F) is allowed.

Brukinsa FAQs

Is Brukinsa chemotherapy?

Brukinsa (zanubrutinib) is an oral targeted cancer medicine. It is a kinase inhibitor that blocks Bruton tyrosine kinase (BTK), rather than a traditional IV chemotherapy.

Is Brukinsa the same as Imbruvica?

No. Brukinsa (zanubrutinib) and Imbruvica (ibrutinib) are different medicines. Lexidrug lists their names as a look-alike pair, so always check the name on your prescription label.

Can I split Brukinsa tablets?

Yes. The 160 mg tablet is scored and may be split in half. Swallow tablets with water and do not chew or crush them. Capsules must be swallowed whole and not opened, broken or chewed.

What if I miss a dose of Brukinsa?

Take the missed dose as soon as you can on the same day, then go back to your normal schedule the next day. Do not change your dose without talking to your oncologist.

Can I drink grapefruit juice while taking Brukinsa?

No. Avoid grapefruit, grapefruit juice and Seville oranges during treatment, because they can raise Brukinsa levels in your blood.

How do I get help paying for Brukinsa?

Help may come from a manufacturer copay card, a patient assistance program or a foundation grant, depending on your insurance. QuickRx applies on your behalf; see our Brukinsa (zanubrutinib) copay assistance page or call (917) 830-2525.

References

Zanubrutinib. Lexidrug via UpToDate (Wolters Kluwer Health). Last updated August 3, 2026. Accessed September 30, 2026. (Subscription required.)
Zanubrutinib. MedlinePlus, US National Library of Medicine.
Chronic Lymphocytic Leukemia. MedlinePlus, US National Library of Medicine.
Brown JR, Eichhorst B, Hillmen P, et al. Zanubrutinib or ibrutinib in relapsed or refractory chronic lymphocytic leukemia. N Engl J Med. 2023. PubMed 36511784
Tam CS, Brown JR, Kahl BS, et al. Zanubrutinib versus bendamustine and rituximab in untreated chronic lymphocytic leukaemia and small lymphocytic lymphoma (SEQUOIA). Lancet Oncol. 2022. PubMed 35810754
Final analysis from the randomized phase III ASPEN study in Waldenström macroglobulinemia. J Clin Oncol. 2023;41(33):5099-5106. PubMed 37478390
HHS Office of Inspector General. Special Advisory Bulletin: Pharmaceutical Manufacturer Copayment Coupons. September 2014.

Prescribing information: Brukinsa (zanubrutinib). Pennington, NJ: BeOne Medicines USA Inc; July 2026.

Medical Disclaimer: This article is for educational purposes only and is not medical advice, diagnosis or treatment. Do not start, stop or change any medication based on this article; always follow your prescriber’s instructions and the FDA-approved labeling. Side effect, warning and interaction lists are not complete. Drug information is current as of September 2026 and prescribing information may be updated.

Pricing Disclaimer: Prices are Average Wholesale Price (AWP) benchmarks from Medi-Span, published in Lexidrug and accessed September 30, 2026. AWP is a reference price only. It is not a retail price, not a quote and not the amount you will pay.

Assistance Disclaimer: Copay cards, patient assistance programs and foundation grants are offered by manufacturers and independent organizations, not by QuickRx. Eligibility and availability are set by each sponsor and may change without notice. Not all patients qualify. QuickRx does not issue copay cards; we apply on your behalf. QuickRx Specialty Pharmacy is not affiliated with, endorsed by or sponsored by BeOne Medicines or any manufacturer named in this article; brand names are used for identification only.

Written by Paola Larrabure, Pharma Content Manager, QuickRx Specialty Pharmacy

Medically reviewed by Julia Kravtsova, PharmD (LinkedIn), Head Patient Navigator, QuickRx Specialty Pharmacy. Reviewed September 30, 2026.

Last Updated: September 30, 2026

Need help paying for Brukinsa? Call QuickRx at (917) 830-2525 or visit our Brukinsa (zanubrutinib) copay assistance page.