Imbruvica Dosages: Your GoodRx Guide

Not all cancers can be cured. But many people are able to experience long lives while living with cancer. Certain cancers grow very slowly and behave almost like a lifelong condition — such as diabetes or heart problems. Two of these types of cancers are chronic lymphocytic leukemia (CLL) and Waldenstrom macroglobulinemia (WM). These are both lymphomas, or cancers that affect white blood cells in your immune system.

If you’ll be receiving treatment for a long time, oral medications may be more convenient to take than medications given through a vein. Oral medications give you more flexibility by allowing you to take your treatment in the comfort of your own home. But convenience comes with increased responsibility — you still need to remember to take your medication (and take it correctly) for it to be most effective.

Imbruvica (ibrutinib) is an oral targeted medication that can treat CLL and WM. It interrupts signals that are involved in cell growth and destroys cancer cells in the immune system. It’s also used to treat another long-term condition that can happen after a bone marrow or stem cell transplant — chronic graft-versus-host disease (cGVHD). 

In either case, Imbruvica is taken for as long as it’s effective and tolerated. If you’ve been prescribed Imbruvica, this means you may take it for many years. Let’s review important pointers about Imbruvica dosages so you can get the greatest benefit out of your treatment.

What’s the typical Imbruvica dosage for adults?

The typical Imbruvica dosage is 420 mg once daily. You can take this as a single 420 mg tablet or three 140 mg capsules. It doesn’t matter if you take it with food, but you shouldn’t take it with grapefruit, grapefruit juice, or Seville oranges (found in marmalades). These three foods and beverages can raise blood levels of Imbruvica, increasing your chance of having side effects.

The tablets are available in three dosages: 140 mg, 280 mg, and 420 mg. It can be more convenient to take only one pill per day, but they do come in a blister pack that can be difficult to open.

The capsules are available in 70 mg and 140 mg dosages, so you’ll have to take more capsules to get to your target daily dose. Although the price of your medication depends on your insurance, Imbruvica capsules are often cheaper than the tablets. They also come in a pill bottle rather than a blister pack.

Regardless of whether you’re taking a capsule or tablet, you shouldn’t cut, crush, or chew them. You shouldn’t open the Imbruvica capsules, either. The powder inside Imbruvica capsules might be harmful to those in your household if they’re around it.

EXPERT PICKS: WHAT TO READ NEXT

• Non-Hodgkin vs. Hodgkin lymphomas: Learn about the different types of lymphomas, including differences in symptoms, treatment, and survival.

• Different oral dosage forms: Understand the differences in certain pill types, including ease of swallowing and shelf life, so you can pick an option that works best for you. Imbruvica comes in many oral formulations.

• The liver’s role in drug metabolism: Understand why the liver is so important for breaking down medications and what might happen if medications aren’t adjusted for liver problems.
  
  

What’s the typical Imbruvica dosage for children?

Imbruvica is only approved for cGVHD in children. It’s not approved for any lymphomas. 

For those ages 12 and older, the dose is still 420 mg daily. These adolescents and teens can take either the tablets or the capsules. For children younger than 12, the dose is based on body surface area — a calculation that takes height and weight into account. The specific dose is 240 mg/m² (up to a maximum of 420 mg) once daily. 

What’s more, since swallowing pills can be difficult for children, an oral suspension is available. If your child’s transplant team prescribes this 70 mg/mL liquid, there are some very specific instructions that come with the bottle to ensure your child gets an accurate dose. Here are some of the highlights:

• Bottle adapter: Each oral suspension bottle comes with an adapter to help you pull up an accurate dose without creating a mess — don’t remove this.

• Oral syringes: Only use the syringes that come with the medication. Using other syringes, household teaspoons, or dose cups can result in an incorrect dose.

• Expiration: The Imbruvica oral suspension expires 60 days after opening it — make sure to write this date down on the bottle as soon as you open it. You can leave the bottle at room temperature or refrigerate it.

• Pulling up the dose: Shake the bottle well before using the medication, and remove any air bubbles when pulling up the dose.

• Giving the dose to your child: Give the dose as soon as you pull it up from the bottle, and have your child drink some water after taking Imbruvica.

Are there any dosage adjustments for health conditions or drug interactions?

Yes. There are certain situations where you or your child might need a lower dose of Imbruvica.

Dosage for people with liver problems

Your liver does most of the work in breaking down Imbruvica so your body can get rid of it. But if you have liver problems, your body can’t break down Imbruvica efficiently. This can result in higher amounts of Imbruvica in your blood and lead to unwanted side effects.

You’ll likely need a lower dose of Imbruvica to account for this. But the specific dose adjustment depends on what you’re taking Imbruvica for and how severe your liver condition is. For CLL and WM, the dose is adjusted based on a scoring system that evaluates the severity of your liver condition. Dose adjustments are as follows:

• Mild severity: 140 mg daily

• Moderate severity: 70 mg daily

• Severe: Avoid altogether

For cGVHD, your Imbruvica dose will likely be adjusted based on bilirubin levels. Bilirubin is a substance that your body makes when it breaks down red blood cells. Normally, your liver is able to remove bilirubin from the body. But high bilirubin (measured with a blood test) can reveal potential liver problems. The table below outlines specific dose adjustments:

Dosage for certain drug interactions

Certain medications can slow Imbruvica’s breakdown. As with liver problems, this can result in increased Imbruvica side effects. There are varying Imbruvica dose adjustments based on the specific medication. Examples of these interacting medications include antifungals such as voriconazole (Vfend) and posaconazole (Noxafil).

On the flip side, there are also medications that can accelerate Imbruvica’s breakdown. These can decrease Imbruvica’s effectiveness. Examples of these types of medications include antibiotics such as rifampin (Rifadin) and anti-seizure medications such as carbamazepine (Tegretol).

Your pharmacist can check for drug interactions to determine if an Imbruvica dose adjustment is necessary.

Dosage based on side effects

Everyone responds to medications differently. If you experience intolerable side effects while taking Imbruvica, don’t be discouraged. Your healthcare team may be able to keep you going with Imbruvica by giving you a lower dose. Dose adjustments may be necessary for certain heart problems, such as abnormal heart rhythms and low blood counts.

What happens if you miss a dose of Imbruvica?

If you forget your dose of Imbruvica, take it as soon as you remember if it’s the same day. If a full day has passed, just skip that dose and take the next one at your normally scheduled time. Don’t take a double dose to make up for missed doses — this increases the risk of having side effects and can be dangerous.

What should you do if you take too much Imbruvica?

Taking too much Imbruvica can increase your chance of having unwanted side effects. Depending on the amount, too much Imbruvica can also be life-threatening.

If you take too much Imbruvica (even one extra pill), you should call your oncology or transplant team for guidance immediately. You can also contact Poison Control online or at 1-800-222-1222. Your care team or the representative at the Poison Control center can guide you toward next steps. This may include a trip to the closest ER so they can safely monitor you.

How to save on Imbruvica

There are ways to save on Imbruvica, which is only available as a brand-name medication at certain pharmacies. GoodRx can help you navigate between copay savings cards and patient assistance programs to save money on your prescription.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Imbruvica using a savings card from the manufacturer.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Imbruvica’s patient assistance program, which offers the medication free of charge for up to 1 year.

Why trust our experts?

Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Vanessa Carranza, PharmD

Vanessa Carranza, PharmD, is a pharmacist who has dedicated her career to the advancement of medical education for healthcare providers, patients, and caregivers, most notably in the oncology space.

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