Ibrutinib

Ibrutinib (Imbruvica®) is a targeted therapy drug used to treat:

  • mantle cell lymphoma
  • Waldenstrom’s macroglobulinaemia
  • chronic lymphocytic leukaemia (CLL).

It is best to read this information with our general information about targeted therapies and the type of cancer you have.

Ibrutinib is given as capsules and you usually have it as an outpatient. Your cancer doctor, nurse or pharmacist will tell you how often you will have it.

Like all targeted therapy drugs, ibrutinib can cause side effects. Some of the side effects can be serious, so it’s important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

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

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is ibrutinib (Imbruvica®)?

Ibrutinib (Imbruvica®) is used to treat:

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

Ibrutinib may only be available in some situations. Your cancer doctor can tell you if it's appropriate for you. Some people may be given it as part of a clinical trial.

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 is a type of drug called a tyrosine kinase inhibitor (TKI). Kinases are proteins in the body that control how the cells grow and divide.

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 targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How ibrutinib is given

Ibrutinib is given as capsules. It may be given in combination with other targeted therapy drugs and chemotherapy.

During treatment you usually see a cancer 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 capsules 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 capsules 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 capsules or tablets exactly as they have been explained to you. 

Ask your oncology team lots of questions about how the treatment will help. You can also ask what they can do to help make it more bearable.

Linda


Taking ibrutinib capsules

You take ibrutinib once a day. Try and take the capsules at the same time each day. Swallow the capsules whole with a glass of water. They should not be chewed, opened 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 capsules 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. Other things to remember about your capsules:

  • 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. 
  • Keep the capsules in the original package. 
  • Keep them safe and out of the sight and reach of children. 
  • If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
  • If your treatment is stopped return any unused capsules to the pharmacist.


Possible side effects of ibrutinib

We explain the most common side effects of ibrutinib here. We also include some less common side effects. You may get some of the side effects we mention, but you will not get them all.

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

Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you.

Your nurse will give you advice about managing side effects. After your treatment is over, side effects will usually start to improve. Always tell your doctor or nurse about the side effects you have.

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.

The nurses were always prepared to answer the phone 24 hours a day, if you had side effects that you didn’t understand or couldn’t cope with. They were really helpful.

Rob


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.

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.

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

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, or reduce the dose.

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

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

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 chemotherapy. 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

Ibrutinib may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.

Skin changes

This treatment 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.

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 fluid builds up. If your ankles and legs swell it can help to put your legs up on a foot stool or cushion.


Less common side effects of ibrutinib

Eye problems

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

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.

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’s important not to drive or operate machinery if you notice these effects.

Raised levels of uric acid (tumour lysis syndrome)

This drug 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 they may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints. This is called gout.

Your doctor may give you tablets called allopurinol (Zyloric®) to help prevent this. Drinking at least 2 litres (3.5 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

Other medicines

Ibrutinib may interact with several other types of medicines. This includes the herbal remedy St John’s wort. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. 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 father a child. 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.