Ibrutinib

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

  1. chronic lymphocytic leukemia (CLL)
  2. graft-versus-host disease (GVHD)
  3. macroglobulinemia
  4. mantle cell lymphoma (MCL)
  5. non-Hodgkin’s lymphoma (NHL)
  6. 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

  1. abdominal pain
  2. abdominal pain
  3. anaphylactic shock
  4. anemia
  5. anemia
  6. angioedema
  7. anorexia
  8. anorexia
  9. anxiety
  10. anxiety
  11. arthralgia
  12. arthralgia
  13. asthenia
  14. asthenia
  15. atrial fibrillation
  16. atrial flutter
  17. bleeding
  18. bleeding
  19. blurred vision
  20. chest pain (unspecified)
  21. chills
  22. cirrhosis
  23. conjunctivitis
  24. constipation
  25. constipation
  26. cough
  27. cough
  28. dehydration
  29. dehydration
  30. diarrhea
  31. diarrhea
  32. dizziness
  33. dizziness
  34. dyspepsia
  35. dyspnea
  36. dyspnea
  37. ecchymosis
  38. ecchymosis
  39. elevated hepatic enzymes
  40. elevated hepatic enzymes
  41. epistaxis
  42. fatigue
  43. fatigue
  44. fever
  45. fever
  46. gastroesophageal reflux
  47. GI bleeding
  48. headache
  49. headache
  50. hematuria
  51. hepatic failure
  52. hepatitis B exacerbation
  53. hyperbilirubinemia
  54. hyperbilirubinemia
  55. hypertension
  56. hypertension
  57. hyperuricemia
  58. hyperuricemia
  59. hypoalbuminemia
  60. hypokalemia
  61. hypokalemia
  62. infection
  63. infection
  64. influenza
  65. infusion-related reactions
  66. infusion-related reactions
  67. insomnia
  68. insomnia
  69. interstitial lung disease
  70. intracranial bleeding
  71. lacrimation
  72. leukoencephalopathy
  73. lymphocytosis
  74. muscle cramps
  75. muscle cramps
  76. musculoskeletal pain
  77. musculoskeletal pain
  78. nausea
  79. nausea
  80. neutropenia
  81. neutropenia
  82. new primary malignancy
  83. peripheral edema
  84. peripheral edema
  85. peripheral neuropathy
  86. peripheral neuropathy
  87. petechiae
  88. pharyngitis
  89. pruritus
  90. rash
  91. rash
  92. renal failure (unspecified)
  93. sinusitis
  94. sinusitis
  95. skin cancer
  96. Stevens-Johnson syndrome
  97. stomatitis
  98. stomatitis
  99. subdural hematoma
  100. syncope
  101. thrombocytopenia
  102. thrombocytopenia
  103. tumor lysis syndrome (TLS)
  104. urticaria
  105. ventricular fibrillation
  106. ventricular tachycardia
  107. visual impairment
  108. vomiting
  109. vomiting
  110. weight loss
  111. 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
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  • 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
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