Ibrutinib

Other Names: Imbruvica®

About This Drug

Ibrutinib is used to treat cancer and graft versus host disease (GVHD), a side effect from undergoing an allogeneic stem cell transplant. It is given orally (by mouth).

Possible Side Effects 

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you feel tired and weak (fatigue), and raise your risk of bleeding.
  • Abnormal bleeding - symptoms may be coughing up blood, throwing up blood (may look like coffee grounds), red or black tarry bowel movements, abnormally heavy menstrual flow, nosebleeds or any other unusual bleeding. 
  • Bruising 
  • Fever
  • Tiredness
  • Pneumonia
  • Nausea
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt. 
  • Loose bowel movements (diarrhea)
  • Bone, joint and muscle pain
  • Muscle spasms
  • Rash

Note: Each of the side effects above was reported in 20% or greater of patients treated with ibrutinib. Not all possible side effects are included above. 

Warnings and Precautions 

  • Severe abnormal bleeding which can very rarely be life-threatening
  • Severe bone marrow depression
  • Severe infections, including viral, bacterial and fungal, which can very rarely be life-threatening
  • Abnormal heart beat 
  • High blood pressure
  • This drug may raise your risk of getting a second cancer, such as non-melanoma skin cancer
  • Tumor lysis syndrome: This drug may act on the cancer cells very quickly. This may affect how your kidneys work. 

Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team. 

Important Information

  • You may need to hold ibrutinib for 3 to 7 days prior to some minor/major surgical procedures due to the risk of bleeding. Talk to your doctor and/or nurse for precautions you may need to take. Also, if you must have emergency surgery, tell the doctor that you are on ibrutinib.

How to Take Your Medication

  • Swallow the medicine whole with water at the same time each day. Do not open, break or chew it. 
  • Missed dose: If you miss a dose, take it as soon as you think about it that day. Do not take 2 doses at the same time or extra doses. 
  • If you vomit a dose, take your next dose at the regular time. Do not take 2 doses at the same time. 
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time. 
  • Storage: Store this medicine in the original container at room temperature. Discuss with your nurse or your doctor how to dispose of unused medicine. 

Treating Side Effects

  • Manage tiredness by pacing your activities for the day. 
  • Be sure to include periods of rest between energy-draining activities.
  • To decrease infection, wash your hands regularly. 
  • Avoid close contact with people who have a cold, the flu, or other infections.
  • Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever. 
  • To help decrease bleeding, use a soft toothbrush. Check with your nurse before using dental floss. 
  • Be very careful when using knives or tools.
  • Use and electric shaver instead of a razor.
  • Drink plenty of fluids (a minimum of right glasses per day is recommended).
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid). 
  • If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping.
  • Ask your nurse or doctor about medicine that can lessen or stop your diarrhea. 
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help stop or lessen these symptoms. 
  • Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or 1/2 teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime. 
  • If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat. 
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain. 
  • If you do get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you. 

Food and Drug Interactions

  • Do not eat grapefruit, Seville oranges, or drink grapefruit juice while taking this medicine. Grapefruit, Seville oranges, and grapefruit juice may raise the levels of ibrutinib in your body. This could make side effects worse. 
  • Avoid the use of St. John's Wort while taking ibrutinib as this may lower the levels of the drug in your body, which can make it less effective. 
  • Check with your doctor or pharmacist about all other prescription medicines and dietary supplements you are taking before starting this medicine as there are known drug interactions with ibrutinib. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplement to make sure that there are no interactions.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms: 

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • A headache that does not go away
  • Blurry vision or other changes in eyesight
  • Fatigue that interferes with your daily activities
  • Feeling dizzy or lightheaded
  • Coughing up blood
  • Easy bleeding or bruising 
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Loose bowel movements (diarrhea) 4 times a day or loose bowel movements with lack of strength or a feeling of being dizzy
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Blood in your urine, vomit (bright red or coffee-ground) and/or stools (bright red, or black/tarry)
  • Pain that does not go away or is not relieved by prescribed medicine
  • New rash and/or itching
  • Rash that is not relieved by prescribed medicines
  • Signs of tumor lysis: Confusion or agitation, decreased urine, nausea/vomiting, diarrhea, muscle cramping, numbness and/or tingling, seizures
  • If you think you may be pregnant or may have impregnated your partner

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 1 month after treatment. Men with female partners of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 1 month after your cancer treatment. Let your doctor know right away if you think you may be pregnant or may have impregnated your partner. 
  • Breastfeeding warning: It if not known if this drug passes into breast milk. For this reason, women should talk to their doctor about the risks and benefits of breast feeding during treatment with this drug because this drug may enter the breast milk and cause harm to a breast feeding baby. 
  • Fertility warning: Human fertility studies have not been done with this drug. Talk with your doctor or nurse if you plan on having children. Ask for information on sperm or egg banking. 

Revised: November 2017