Ibrutinib Brand Name– IMBRUVICA
What is Ibrutinib
Ibrutinib is an oral Bruton tyrosine kinase inhibitor approved for the treatment of adult patients with mantle cell lymphoma, chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), marginal zone lymphoma, Waldenstrom macroglobulinemia (WM), and chronic graft-versus-host disease.
It is used as single-agent therapy or as part of combination therapy with rituximab (for WM and CLL/SLL), rituximab plus bendamustine (for CLL/SLL), or obinutuzumab (for CLL/SLL).
Serious bleeding events have been reported with ibrutinib therapy, including intracranial bleeding, GI bleeding, and postprocedural hemorrhage.
Indications
- chronic lymphocytic leukemia (CLL)
- graft-versus-host disease (GVHD)
- macroglobulinemia
- mantle cell lymphoma (MCL)
- non-Hodgkin’s lymphoma (NHL)
- small lymphocytic lymphoma (SLL)
For the treatment of mantle cell lymphoma (MCL)
NOTE: Ibrutinib has been designated by the FDA as an orphan drug for the treatment of MCL.
Side Effects
- abdominal pain
- abdominal pain
- anaphylactic shock
- anemia
- anemia
- angioedema
- anorexia
- anorexia
- anxiety
- anxiety
- arthralgia
- arthralgia
- asthenia
- asthenia
- atrial fibrillation
- atrial flutter
- bleeding
- bleeding
- blurred vision
- chest pain (unspecified)
- chills
- cirrhosis
- conjunctivitis
- constipation
- constipation
- cough
- cough
- dehydration
- dehydration
- diarrhea
- diarrhea
- dizziness
- dizziness
- dyspepsia
- dyspnea
- dyspnea
- ecchymosis
- ecchymosis
- elevated hepatic enzymes
- elevated hepatic enzymes
- epistaxis
- fatigue
- fatigue
- fever
- fever
- gastroesophageal reflux
- GI bleeding
- headache
- headache
- hematuria
- hepatic failure
- hepatitis B exacerbation
- hyperbilirubinemia
- hyperbilirubinemia
- hypertension
- hypertension
- hyperuricemia
- hyperuricemia
- hypoalbuminemia
- hypokalemia
- hypokalemia
- infection
- infection
- influenza
- infusion-related reactions
- infusion-related reactions
- insomnia
- insomnia
- interstitial lung disease
- intracranial bleeding
- lacrimation
- leukoencephalopathy
- lymphocytosis
- muscle cramps
- muscle cramps
- musculoskeletal pain
- musculoskeletal pain
- nausea
- nausea
- neutropenia
- neutropenia
- new primary malignancy
- peripheral edema
- peripheral edema
- peripheral neuropathy
- peripheral neuropathy
- petechiae
- pharyngitis
- pruritus
- rash
- rash
- renal failure (unspecified)
- sinusitis
- sinusitis
- skin cancer
- Stevens-Johnson syndrome
- stomatitis
- stomatitis
- subdural hematoma
- syncope
- thrombocytopenia
- thrombocytopenia
- tumor lysis syndrome (TLS)
- urticaria
- ventricular fibrillation
- ventricular tachycardia
- visual impairment
- vomiting
- vomiting
- weight loss
- xerophthalmia
Monitoring Parameters
- blood pressure
- CBC with differential
- LFTs
- pregnancy testing
- serum creatinine/BUN
- serum electrolytes
- serum uric acid
Contraindications
- anemia
- anticoagulant therapy
- atrial fibrillation
- atrial flutter
- bleeding
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- contraception requirements
- dental work
- geriatric
- GI bleeding
- hematuria
- hepatic disease
- hypertension
- infection
- intracranial bleeding
- male-mediated teratogenicity
- neutropenia
- pregnancy
- pregnancy testing
- progressive multifocal leukoencephalopathy
- reproductive risk
- surgery
- syncope
- thrombocytopenia
- tumor lysis syndrome (TLS)
- ventricular arrhythmias
Interactions
- Abciximab
- Acetaminophen; Aspirin, ASA; Caffeine
- Alpelisib
- Amiodarone
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Anagrelide
- Antithrombin III
- Apalutamide
- Apixaban
- Aprepitant, Fosaprepitant
- Argatroban
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Betrixaban
- Bexarotene
- Bivalirudin
- Boceprevir
- Bosentan
- Brigatinib
- Carbamazepine
- Ceritinib
- Chloramphenicol
- Cilostazol
- Ciprofloxacin
- Clarithromycin
- Clopidogrel
- Clozapine
- Cobicistat
- Colchicine
- Colchicine; Probenecid
- Conivaptan
- Crizotinib
- Cyclosporine
- Dabigatran
- Dabrafenib
- Dalteparin
- Danaparoid
- Danazol
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Desirudin
- Dexamethasone
- Digoxin
- Diltiazem
- Dipyridamole
- Dronedarone
- Duvelisib
- Edoxaban
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Encorafenib
- Enoxaparin
- Enzalutamide
- Eptifibatide
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Etravirine
- Fedratinib
- Fluconazole
- Flutamide
- Fluvoxamine
- Fondaparinux
- Fosamprenavir
- Fosphenytoin
- grapefruit juice
- Heparin
- Idelalisib
- Imatinib
- Indinavir
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ivosidenib
- Ketoconazole
- Lapatinib
- Lefamulin
- Lepirudin
- Lesinurad
- Lesinurad; Allopurinol
- Letermovir
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lumacaftor; Ivacaftor
- Methotrexate
- Mifepristone
- Mitotane
- Modafinil
- Nafcillin
- Nefazodone
- Nelfinavir
- Netupitant, Fosnetupitant; Palonosetron
- Nevirapine
- Nilotinib
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Ozanimod
- Pazopanib
- Phenobarbital
- Phenytoin
- Posaconazole
- Prasugrel
- Primidone
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Rimegepant
- Ritonavir
- Rivaroxaban
- Saquinavir
- Sirolimus
- St. John’s Wort, Hypericum perforatum
- Talazoparib
- Telaprevir
- Telithromycin
- Telotristat Ethyl
- Temsirolimus
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tipranavir
- Tirofiban
- Tolvaptan
- Topotecan
- Trandolapril; Verapamil
- Tucatinib
- Ubrogepant
- Verapamil
- Voriconazole
- Warfarin
