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
• 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
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• Danazol
• Darunavir
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• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Delavirdine
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• Duvelisib
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• Elbasvir; Grazoprevir
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• Encorafenib
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• Eptifibatide
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• 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
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• Loperamide; Simethicone
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• Netupitant, Fosnetupitant; Palonosetron
• Nevirapine
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• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole; Amoxicillin; Rifabutin
• Ozanimod
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• Phenobarbital
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• Ribociclib
• Ribociclib; Letrozole
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