Ibrutinib interactions

Food & lifestyle

• grapefruit juice

  Major

  Metabolism

  Coadministration with grapefruit, grapefruit juice, or Seville oranges may significantly increase the plasma concentrations of ibrutinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

  What to do: Patients treated with ibrutinib should avoid consumption of Seville oranges, grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Ibrutinib should be taken once daily at approximately the same time each day.

  2 sources

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

Conditions

Conditions in which Ibrutinib needs care, as documented in this source.

• Atrial Fibrillation

  Moderate

  Atrial fibrillation and atrial flutter have occurred in patients treated with ibrutinib. The risk is increased in patients with cardiac risk factors, hypertension, acute infections, and a previous history of atrial fibrillation. It is recommended to monitor patients clinically for atrial fibrillation periodically and those patients who develop arrhythmic symptoms (e.g., palpitations, lightheadedness) or new onset dyspnea should have an ECG performed. Atrial fibrillation should be managed appropriately, and if it persists to consider the risks and benefits of ibrutinib treatment and follow dose modification according to clinical guidelines.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Hemorrhage

  Moderate

  Cases of bleeding, including bruising, petechia, intracranial hemorrhage, including subdural hematoma; gastrointestinal bleeding, hematuria, post procedural hemorrhage, some leading to fatal bleeding events have been reported in patients treated with ibrutinib. Patients receiving antiplatelet or anticoagulant therapy may be at an increased risk of hemorrhage and these patients should be closely monitored for signs of bleeding. It is recommended to consider withholding ibrutinib for at least 3 to 7 days pre- and post-surgery depending upon the type of surgery and the risk of bleeding.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Hepatic Insufficiency

  Moderate

  Ibrutinib is metabolized in the liver. In clinical trials, patients with hepatic impairment showed an increase in ibrutinib exposure following a single dose administration. It is recommended to monitor patients for signs of toxicity and follow dose modification as appropriate. The use of ibrutinib is not recommended in patients with moderate or severe hepatic impairment.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Hypertension

  Moderate

  The use of ibrutinib may cause hypertension. It is recommended to monitor for new onset hypertension or hypertension that is not adequately controlled after starting therapy and to adjust hypertensive medications and/or initiate antihypertensive treatment per clinical practices. Close monitoring of blood pressure is recommended.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Infections

  Moderate

  Fatal and non-fatal infections, including cases of progressive multifocal leukoencephalopathy (PML) and Pneumocystis jirovecii pneumonia (PJP), have been reported with the use of ibrutinib. It is recommended to assess patients for fever and infections and treat appropriately.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Kidney Diseases

  Moderate

  The use of ibrutinib in patients with mild to moderate renal impairment is not expected to influence on the exposure to ibrutinib. Caution and close monitoring is recommended in patients with severe renal impairment or patients on dialysis as there are no data available for these patients.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Lung Diseases

  Moderate

  The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, permanently discontinue these agents and institute appropriate measures. Immediately withhold treatment in patients diagnosed with ILD/pneumonitis and permanently discontinue therapy if no other potential causes of ILD/pneumonitis have been identified.

  7 sources

  1. "Product Information. Vandetanib (vandetanib)." Astra-Zeneca Pharmaceuticals (2011):
  2. "Product Information. Zelboraf (vemurafenib)." Genentech (2011):
  3. "Product Information. Xalkori (crizotinib)." Pfizer U.S. Pharmaceuticals Group (2011):
  4. "Product Information. Mekinist (trametinib)." GlaxoSmithKline (2013):
  5. "Product Information. Zykadia (ceritinib)." Novartis Pharmaceuticals (2014):
  6. "Product Information. Zydelig (idelalisib)." Gilead Sciences (2014):
  7. "Product Information. Alecensa (alectinib)." Genentech (2015):

• Pancytopenia

  Moderate

  Cytopenias including neutropenia, thrombocytopenia, and anemia have been reported with use of ibrutinib. Care should be taken with patients at risk, and it is recommended to monitor for complete blood counts monthly or as clinically appropriate.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):

• Tumor Lysis Syndrome

  Moderate

  Tumor lysis syndrome has been reported with ibrutinib therapy. It is recommended to assess the baseline risk (e.g., high tumor burden) and take appropriate precautions. Monitor patients closely and treat as appropriate.

  1 source

  1. "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc (2013):