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Ibrutinib (Imbruvica)

Ibrutinib is a type of targeted cancer drug. It is a treatment for:

  • mantel cell lymphoma
  • chronic lymphocytic leukaemia (CLL)
  • Waldenstrom's macroglobulinaemia

How ibrutinib works

Ibrutinib is a type of cancer growth blocker called a tyrosine kinase inhibitor (TKI).

Tyrosine kinase inhibitors block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing. 

How you have ibrutinib

You have ibrutinib as tablets that you swallow.

You take the tablets whole with a full glass of water. You should not open, break, or chew the tablets. Take them at the same time each day.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have ibrutinib

You take ibrutinib once a day. How many tablets you have each day depends on your type of cancer.

You usually carry on taking ibrutinib if:

  • it is controlling the growth of your cancer
  • your side effects are not too severe

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs. 

Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

High blood pressure (hypertension)

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Skin rash

A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.

Joint or muscle pain

You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

You may also have muscle spasms during treatment.

Fluid build up in your hands and legs

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

This can be painful.

High temperature (fever)

If you get a high temperature, let your treatment team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • a severe infection (sepsis) which can cause difficulty breathing, high or low temperature and a skin rash – see your doctor immediately if this happens
  • a bladder infection which can cause pain when you pass urine
  • swelling of the sinuses which can cause pain, reduced sense of smell and blocked nose
  • an increase in risk of getting a skin cancer called non melanoma skin cancer, basal cell carcinoma or squamous cell carcinoma
  • an increase in the number of white blood cells that help fight off infections
  • high levels of uric acid and other substances in the blood due to the breakdown of tumour cells (tumour lysis syndrome) – this can cause swelling in the joints of your foot (gout), diarrhoea, muscle cramps, weakness, nausea and vomiting
  • dizziness - don’t drive or operate machinery if you have this
  • blurred vision
  • skin problems such as redness of the skin and swollen red bumps (hives)
  • nail problems which can cause your nails to break or separate from the nail bed
  • weakness, numbness, tingling or pain in your hands or feet or other parts of your body
  • irregular and fast heart rate causing shortness of breath and light headedness

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • an allergic skin reaction which includes a swollen face, lip, mouth, tongue or throat
  • inflammation underneath the skin
  • liver failure and infection of the liver caused by a virus (hepatitis B) if you have had this infection before
  • internal bleeding in the brain which can cause confusion, headaches, slurred speech, or feeling faint
  • severe fungal infections
  • loss of blood flow to the brain (stroke)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Do not take ibrutinib with grapefruit or Seville oranges (bitter oranges) – this includes eating them, drinking the juice or taking a supplement that might contain them. This is because it can increase the amount of ibrutinib in your blood.

Taking fish oil, vitamin E or flaxseed may increase your risk of bleeding.

Lactose intolerance

This drug contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Having immunisations 

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
27 Mar 2020
Next review due: 
27 Mar 2023
  • Electonic Medicines compendium

    Accessed March 2020

  • Ibrutininb for treating Waldenstrom's macroglobulineamia technology appraisal document (TA491)

    National Institute for Health and Care Excellence (NICE) 2017 

  • Ibrutinib for treating relapsed or refractory mantle cell lymphoma technology appraisal guideline (TA502)

    National Institue for Health and Care Excellence (NICE) 2018

  • Ibrutinib for previously treated chronic lymphocytic and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation

    National Institute for Health and Care Excellence (NICE) 2017

  • Immunisations for infectious disease: Chapter 6: general contraindications for vaccination

    Public Health England

    First published: March 2013 and regularly updated on the Gov.UK website

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