Imbruvica
Imbruvica (ibrutinib) is an oral cancer medication used for certain leukemias, blood cancers, and blood cell conditions. It commonly causes diarrhea, tiredness, and easy bruising.
What is Imbruvica (ibrutinib)?
What is Imbruvica (ibrutinib) used for?
- Chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL) in adults
- Waldenström's macroglobulinemia (WM) in adults
- Chronic graft versus host disease (cGVHD) in adults and children 1 year and older
How Imbruvica (ibrutinib) works
Imbruvica (ibrutinib) is a kinase inhibitor. It blocks a protein in your body to help stop cancer cells from growing and multiplying.
Drug facts
Side effects of Imbruvica (ibrutinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Fatigue (Up to 80%)
- Low white blood cells (neutropenia), (Up to 66%)
- Bone or muscle pain (Up to 61%)
- Diarrhea (Up to 59%)
- Bruising (Up to 51%)
- Rash (Up to 49%)
- Upper respiratory tract infection (Up to 47%)
- High blood pressure (Up to 42%)
- Joint pain (Up to 41%)
- Nausea (Up to 40%)
- Headache (Up to 40%)
- Low platelet count (thrombocytopenia), (Up to 36%)
- Cough (Up to 32%)
- Bleeding (Up to 32%)
- Fever (Up to 30%)
- Mouth sores (Up to 29%)
- Muscle spasms (Up to 29%)
- Swelling in the body (Up to 28%)
- Infusion reactions (Up to 25%)
- Pneumonia (Up to 23%)
- Stomach pain (Up to 23%)
- Constipation (Up to 22%)
- Dizziness (Up to 21%)
- Vomiting (Up to 19%)
- Skin infection (Up to 18%)
- Low red blood cells (anemia), (Up to 17%)
Less Common Side Effects
- Indigestion
- Swelling of the sinuses
- Urinary tract infection
- Weakness
- Low potassium levels
- Fast heart rate
- Trouble sleeping
- Bronchitis
- Flu
- Sore throat
- Poor appetite
- Blurry vision
Imbruvica (ibrutinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious bleeding: blood in vomit, vomit that looks like coffee grounds, blood in your stool or black stools, pink or brown urine, more bruising, unexpected bleeding, bleeding that's severe or can't be controlled, dizziness, weakness, confusion, change in speech, sudden and severe headache, headache that lasts a long time
- Infections: fever, chills, weakness, confusion
- Heart problems: feeling like your heart is pounding, dizziness, fainting, trouble breathing, chest pain, swelling of your arms and legs
- New or worsening high blood pressure: headaches, changes to your vision, flushing, trouble breathing, chest pain
- Lower blood cell counts: infections, fever, dizziness, weakness, trouble breathing
- Cancers: new mole or spot on the skin, changes in existing moles, skin bleeding or itching, new symptoms
- Tumor lysis syndrome: dark urine, not urinating as much as usual, pain on either side of the lower back, racing heart, muscle cramps or spasms, numbness, nausea, vomiting, seizures
The following Imbruvica (ibrutinib) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Heart failure—shortness of breath, swelling of the ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Tumor lysis syndrome (TLS)—nausea, vomiting, diarrhea, decrease in the amount of urine, dark urine, unusual weakness or fatigue, confusion, muscle pain or cramps, fast or irregular heartbeat, joint pain
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bone, joint, or muscle pain
- Diarrhea
- Nausea
- Pain, redness, or swelling with sores inside the mouth or throat
Pros and cons of Imbruvica (ibrutinib)
Pros
- Oral medication
- Once-daily dosing
- One of the first-choice treatment options for CLL
- Safe to use in people with mild kidney problems; no dose adjustments needed
Cons
- Raises your risk for infections and serious bleeding events
- Must use birth control while taking, as it can harm an unborn baby
- Not a good option in people with severe liver problems
- Available as brand only, so it can be expensive
Pharmacist tips for Imbruvica (ibrutinib)
- Swallow Imbruvica (ibrutinib) capsules or tablets whole with a glass of water with or without food. Don't open, break, cut, crush, or chew the capsules or tablets.
- If using Imbruvica (ibrutinib) oral suspension, review the instructions for use to make sure you give the right dose to your child. Ask your child's provider if you have any further questions. Don't use it if the seal on the carton is broken or missing.
- Drink plenty of fluids to stay hydrated while taking Imbruvica (ibrutinib). A common side effect of this medication is diarrhea, which can lead to dehydration and raise your risk of serious complications.
- Follow up with your provider for monthly blood tests. Imbruvica (ibrutinib) can cause your blood cell counts to drop, so your provider will check these measurements to make sure they don't go too low.
- If you miss a dose of Imbruvica (ibrutinib), take it as soon as you remember that same day. Then take your next dose at your regularly scheduled time the next day. Never double up to make up for a missed dose since this could lead to side effects.
- Avoid grapefruit, Seville oranges (commonly found in marmalades), and their juices. These foods can interact with Imbruvica (ibrutinib), raise the medication levels in your body, and raise your risk of side effects.
- Give your care team your most up-to-date list of medications and talk to them before starting any new medications, including prescription medications, over-the-counter products, and herbal supplements. Since Imbruvica (ibrutinib) can interact with many medications, your providers will need to make sure all your medications are safe for you to take. This might require dose adjustments to your medications, including Imbruvica (ibrutinib).
- Imbruvica (ibrutinib) shouldn't be used in pregnancy, since it can harm an unborn baby. Whether you're a female or male taking this medication, if you or your partner is of childbearing age, use reliable birth control during treatment and for 1 month after stopping the medication. Your partner can also use birth control during this time for extra precaution.
Common questions about Imbruvica (ibrutinib)
Imbruvica (ibrutinib) can be taken for many years. Continue to take this medication until your provider tells you to stop. Most people will continue to take Imbruvica (ibrutinib) until the side effects become too severe or their condition worsens.
Don't stop Imbruvica (ibrutinib), unless your provider has instructed you to do so. Stopping the medication early or taking a break from the medication can cause disease flare ups and can cause your condition to worsen. If you have a surgery scheduled, your provider might tell you to stop taking the medication a few days before and after your procedure due to the higher risk of bleeding. Your provider will monitor you closely in this situation.
It's best to avoid alcohol while taking Imbruvica (ibrutinib). This can help with diarrhea that you might experience during treatment. In addition, alcohol can damage the liver, which helps break down the medication in your body. Liver damage can raise medication levels in your body and raise your risk of side effects. This is also why people with severe liver problems should avoid Imbruvica (ibrutinib).
No, Imbruvica (ibrutinib) shouldn't be used in pregnancy, as it can harm an unborn baby. If you're female of childbearing age, you'll need to take a pregnancy test before you start Imbruvica (ibrutinib) to make sure you're not pregnant. In addition, whether you're a female or male taking Imbruvica (ibrutinib), if you or your partner is able to become pregnant, use reliable birth control during treatment and for 1 month after stopping the medication. Your partner can also use birth control during this time to prevent pregnancy as well.
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Risks and warnings for Imbruvica (ibrutinib)
Imbruvica (ibrutinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Bleeding
- Risk factors: Taking antiplatelet medications or blood thinners | Recent surgery
Imbruvica (ibrutinib) can cause many different bleeding-related side effects that can be serious. Bruising and red spots on the skin are most common, but serious brain and stomach bleeds have also been reported. The risk of major bleeding is higher if you're also taking antiplatelet medications or blood thinners. The risk for a serious bleed after surgery is also higher, so let your provider know if you have a procedure scheduled. They might tell you to stop your medication for a few days before and after your surgery. Contact your provider or get medical help right away if you experience blood in your vomit, urine, or stool, or a sudden and severe headache.
Infections
Some people taking Imbruvica (ibrutinib) have had serious, and sometimes fatal, infections. Wash your hands well with soap and warm water often to protect yourself from infections. Make sure to report any signs of an illness, especially fever and chills. If your risk for an infection is high, your provider might prescribe preventative medication.
Heart problems
- Risk factors: High blood pressure | Infection | History of irregular heart beat
Rarely, serious heart conditions, like abnormal heart rhythms and heart failure, have occurred in some people taking Imbruvica (ibrutinib). Make sure your provider knows your full medical history. They might monitor you more closely if you have a history of heart conditions or have ever had an irregular heart beat. Contact your provider right away if you ever faint, or have a fast heart beat, lightheadedness, chest pain, or sudden shortness of breath.
High blood pressure
About 20% of people in clinical studies taking Imbruvica (ibrutinib) had high blood pressure. Make sure you go to your regularly scheduled clinic visits so your provider can monitor your blood pressure. If your blood pressure starts to rise, your provider can prescribe blood pressure-lowering medications for you.
Risk of developing other cancers
Sometimes, Imbruvica (ibrutinib) can raise your risk for developing other cancers. The most common type of cancer was non-melanoma skin cancer. Wear protective clothing and sunscreen if you're going to be under direct sunlight.
Tumor lysis syndrome
- Risk factors: Higher tumor burden | Dehydration | Kidney damage
Rarely, Imbruvica (ibrutinib) causes tumor lysis syndrome, a condition that can be dangerous if not treated right away. This is more likely if you have a lot of cancerous cells (high tumor burden), are dehydrated, or have kidney damage. Talk to your provider right away if you experience dark urine, a racing heart, muscle cramps or spasms, numbness, nausea, or vomiting within the first week of taking Imbruvica (ibrutinib). You'll need to get appropriate care to prevent complications.
Imbruvica (ibrutinib) dosage
Typical dosage for Imbruvica (ibrutinib)
The typical dose is 420 mg by mouth once daily.
Your dose might differ if you have liver problems or are also taking certain medications that can interact with Imbruvica (ibrutinib).
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