What is ibrutinib (Imbruvica®)?

Ibrutinib (Imbruvica®) is used to treat:

Ibrutinib is sometimes used to treat other cancers. It is best to read this information with our general information about the type of cancer you have. 

Ibrutinib is a type of drug called a tyrosine kinase inhibitor (TKI) and belongs to a group of targeted therapy drugs known as cancer growth inhibitors. Kinases are proteins in the body that control how the cells grow and divide.

If a drug isn’t available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice.

Ibrutinib blocks the proteins (kinases) from sending signals to the cancer cells to grow. Blocking the signals causes the cells to die. This may help to stop or slow down the cancer growing.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How ibrutinib is given

You will be given ibrutinib as tablets. It may be given in combination with other targeted therapy drugs and chemotherapy.

During treatment you usually see a cance¬r doctor, a cancer nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level for you to have treatment.

You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your treatment. Your nurse will tell you when your treatment is likely to be ready. 

The nurse or pharmacist will give you the ibrutinib tablets to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given tablets of different strengths. 

You usually keep taking ibrutinib every day for as long as it keeps the cancer under control. 

Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your tablets exactly as they have been explained to you. 

Taking ibrutinib

You take ibrutinib once a day. Try and take the tablets at the same time each day. Swallow the tablets whole with a glass of water. They should not be chewed or crushed. 

Always take ibrutinib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.

If you forget a dose, take the tablets as soon as possible on the same day. Take the next dose at the usual time the next day. Never take a double dose to make up for the one you missed.

Your doctor may ask you to stop taking ibrutinib or take a lower dose because of side effects. Always follow your doctor’s advice. 

Here are some other things to remember about your tablets:

  • Do not eat grapefruit or Seville oranges (bitter oranges) while you are taking 
    ibrutinib. This can increase the amount of ibrutinib in your blood. This includes eating these fruits, drinking the juice or taking supplements that might contain them. 
  • Wash your hands after taking your tablets.
  • Other people should avoid direct contact with the tablets. 
  • Keep the tablets in the original package and at room temperature, away from heat and direct sunlight.
  • Keep the tablets safe and out of the sight and reach of children. 
  • If you are sick just after taking the tablets, contact the hospital. Do not take another dose.
  • If your treatment is stopped, return any unused tablets to the pharmacist. 

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them. 

If you have chemotherapy along with ibrutinib, some side effects may be worse. You may also have side effects not listed here. 

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve. 

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects of ibrutinib

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

Your doctor may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may reduce your dose or delay your treatment for a short time.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Bruising and bleeding

Ibrutinib can increase the risk of bleeding and reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes: 

  • nosebleeds
  • bleeding gums
  • blood spots or rashes on the skin.

Tell your doctor if you are taking any medicines that may affect bleeding. This includes aspirin, blood thinning tablets such as warfarin, or injections such as heparin or vitamin E.

Contact your doctor straight away if you have any heavy or unusual bleeding. This includes:

  • vomiting or coughing up blood
  • unexpected vaginal bleeding
  • blood in your urine or stools (poo).

If you need to have any surgery, your doctor may ask you to stop taking ibrutinib for a few days before and after your operation.

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Feeling sick

Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Muscle or joint pain

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Skin changes

Ibrutinib may affect your skin and can cause a rash. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. 

Rarely, ibrutinib can cause severe skin reactions. If your skin becomes painful, or you develop a severe rash or blisters, contact your hospital straight away. 

Nail changes

You may notice changes to your nails. They may become brittle and break easily. Wear gloves when washing dishes or using detergents to help protect your hands and nails. If the area around your nails becomes inflamed, tell your doctor straight away.

Build-up of fluid

You may put on weight or your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if you notice this. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Changes to your heartbeat

Ibrutinib may cause changes to your heartbeat. Let your doctor or nurse know if you notice your heartbeat is irregular or you feel more breathless than normal. They will check your heartbeat regularly.

Less common side effects

Blurred vision

Ibrutinib may cause blurry vision. Always tell your doctor or nurse if you notice any change in your vision. 

Effects on the nervous system

Ibrutinib can affect the nervous system. You may feel dizzy or unsteady.

Tell your doctor or nurse straight away if you notice this. They may make some changes to your treatment if it becomes a problem for you.

It is important not to drive or operate machinery if you notice these effects.

Very rarely, this treatment can cause a condition called PML (progressive multifocal leukoencephalopathy). Symptoms include:

  • difficulty speaking
  • difficulty walking
  • memory loss
  • confusion
  • changes in your eyesight.

Contact the hospital straight away if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects.

Increased risk of stroke

Ibrutinib may increase the risk of a mini stroke or stroke but this is not common. Contact a doctor straight away if you or someone else notices:

  • you are confused
  • you have difficulty speaking
  • drooping of the face
  • numbness or weakness on one side of your body.

Raised levels of uric acid (tumour lysis syndrome)

This treatment may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid but may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints, which is called gout.

Your doctor may give you tablets called allopurinol (Zyloric®) to help prevent this. Drinking at least 2 litres (3½ pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.

High blood pressure

Tell your doctor or nurse if you have ever had any problems with your blood pressure. You will have regular blood pressure checks when taking this drug. Let your doctor or nurse know if you have any headaches.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Second cancer

Ibrutinib can increase the risk of developing non-melanoma skin cancer (basal cell or squamous cell skin cancer). The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Raised levels of white blood cells

Leukaemia or lymphoma can cause very high levels of white blood cells in the blood. Ibrutinib can also cause this for the first few weeks of treatment. This is normal and not a sign that the cancer is getting worse. You will have regular blood tests while you are taking ibrutinib to check your levels.

Other information about ibrutinib

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Hepatitis B reactivation

If you have had Hepatitis B (a liver infection) in the past, this treatment can make it active again. Your doctor or nurse will talk to you about this and test you for Hepatitis B.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Lactose

This drug contains lactose. If you have a lactose intolerance, talk to your doctor before you start taking this treatment.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.