Generic Name: Ibrutinib
Brand Name: Imbruvica
Drug Classification: Covalent Bruton Tyrosine Kinase (BTK) Inhibitor
INDICATIONS FOR USE
- For CLL and SLL without 17p deletion or TP53 mutation: Ibrutinib may be taken alone or in combination with another medication as an initial (first-line) treatment. When used as a combination therapy for front-line treatment, it is usually combined with either rituximab, obinutuzumab, or venetoclax. Ibrutinib may be taken alone as a second-line or subsequent treatment in those without 17p deletion or TP53 mutation.
- For CLL and SLL with 17p deletion or TP53 mutation: Ibrutinib may be taken alone or in combination with venetoclax as an initial (first-line) treatment, or alone as a second-line or subsequent treatment.
ADMINISTRATION ROUTE
Taken orally by mouth (available as a capsule, tablet, or liquid suspension).
LENGTH OF TIME ADMINISTERED
This medication should be taken indefinitely until either the disease progresses while on the medication (which would require switching to a medication to treat the CLL or SLL), or until certain unacceptable side effects occur requiring discontinuation of the drug.
DOSING
420 mg taken once per day, at the same time each day.
MISSED DOSE
If a dose is missed by more than three hours, it should be skipped. Then take the next dose at the regularly scheduled time.
Do not take an extra dose to make up for the missed dose.
HOW TO TAKE THIS MEDICATION
- Swallow the medication with a full glass of water. Do not chew, break, open, or crush.
- If taking the liquid suspension form of this medication, shake well before use and measure the liquid dose carefully using the measuring device that is provided by your pharmacy.
- Drink lots of noncaffeinated liquids unless you are told otherwise by your healthcare provider.
- Do not ingest any starfruit, grapefruit juice, grapefruit, bitter orange/marmalade products, Seville oranges or pomegranate juice. Certain citrus foods are known to interfere with the metabolism of this medication and can potentially cause toxic levels of the drug to build up in the blood.
COMBINATION THERAPIES
Can be used in combination with other medications (i.e., obinutuzumab, rituximab, venetoclax).
COMMON SIDE EFFECTS
Side effects can occur as a result of any medication, some of which may go away with time as your body adjusts to the new medication. Please notify your healthcare provider right away if any of the following side effects occur:
- Low red blood cell count, low white blood cell count, or low platelet count
- Irregular heartbeat (heart palpitations or racing heartbeat)
- Respiratory infection
- Shortness of breath
- Nausea and vomiting
- Stomach pain
- Decreased appetite
- Mouth sores
- Fatigue or tiredness
- Muscle, joint, or bone pain
- Bruising or bleeding
- Rash
- Swelling of the legs and feet
Side effects not mentioned above may also occur. Notify your healthcare provider of any other unusual symptoms, as they may be able to tell you about ways to prevent or reduce certain side effects.
MANAGING COMMON SIDE EFFECTS
Some side effects are more common than others, many of which will go away after a short period of time after staying on the medication. It is important to talk to your healthcare provider to discuss if you might be able to manage side effects in the short term in order to stay on the therapy until your body has time to adjust to the new medication. Here are some possible ways to help manage some of the most common side effects of ibrutinib in consultation with your healthcare provider.
Diarrhea
- Increase your fluid intake.
- Take anti-diarrheal medications (such as Imodium) per package instructions.
- Eat a bland diet (such as bananas, rice, apples/applesauce, toast, or plain pasta).
Constipation
- Increase your fluid intake.
- Consume more foods that are high in fiber (such as vegetables and whole grain bread).
- Consider over-the-counter fiber supplements (such as Fibercon, Miralax, or Metamucil).
- Move around more, as walking and other forms of light exercise can help.
- Take over-the-counter stool softeners (such as Colace) to help soften bowel movements.
Fatigue or Tiredness
- Ensure you are eating a well-rounded diet that includes a balance of lean meats, fruits, vegetables, whole grains, and limited amounts of processed foods.
- Incorporate light types of exercise (such as walking).
- If you are able, take one short twenty-minute nap during the day. Frequent or longer naps during the day can affect the amount of sleep you are getting during the night and increase fatigue/tiredness.
Muscle, Joint, or Bone Pain
- Take acetaminophen (such as Tylenol) per package instructions.
- It is important to avoid taking anti-inflammatories (such as ibuprofen) for mild pain while taking ibrutinib due to the slightly increased risk of bleeding.
- Antihistamines (such as Allegra, Zyrtec, or Claritin) may help slightly with bone pain.
- Magnesium supplements may help muscle cramping.
- Gentle stretching and application of heat or ice to the affected area(s) can provide temporary relief.
- If you are experiencing more severe joint pain, your healthcare provider may prescribe a short course of steroids.
REASONS TO TALK TO YOUR HEALTHCARE PROVIDER
The presence of other medical problems may affect the use of ibrutinib. Make sure you share with your healthcare provider if you have any of the following conditions:
- Liver disease (ibrutinib should be avoided with severe liver impairment)
- Hepatitis
- Heart problems (including palpitations, fast or irregular heartbeat, dizziness, fainting, chest discomfort, or shortness of breath)
- High blood pressure (this medication may raise blood pressure)
- Recent or current infection
- Bleeding problems, or if you are on any blood thinning medication
- If you are pregnant or breastfeeding (or if you plan to become pregnant or breastfeed)
SPECIAL CONSIDERATIONS
- Ibrutinib can have a mild blood-thinning effect,
so aspirin and other anti-inflammatory pain medications (such as ibuprofen/Advil) may need
to be avoided. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently, be careful when using sharp objects, including razors and fingernail clippers. - Serious bacterial, viral, or fungal infections can occur while taking ibrutinib. But this can also occur in part from being immunocompromised due to having CLL or SLL. Avoid being near people who are sick and wash your hands often.
- If you have had hepatitis B before or carry the virus, talk with your doctor. This drug can cause the dormant virus to become reactivated and protective medication may be needed.
- There are several medications that interfere with the metabolism of ibrutinib and can cause toxic levels of the drug to build up in the blood, or that increase the breakdown of ibrutinib which can decrease the drug’s effectiveness. It is very important to tell your healthcare provider about all the medications you take, including prescription and over the counter medicines, vitamins, and herbal supplements (particularly in the case of ibrutinib you should not be on St. John’s Wort).
- Secondary cancers have been reported while taking the medication, but this is also a common finding associated with having CLL or SLL. Please be diligent about annual cancer screenings and wearing sun protection when outside in sunlight.
- You may be advised to briefly stop taking ibrutinib for dental or surgical procedures for several days before and after the procedure to minimize the risk of bleeding. Please let your CLL / SLL healthcare provider know about any planned procedures. Never hold or stop taking this medication without the supervision of your healthcare provider.
