Ibrutinib

Ibrutinib is a targeted therapy drug used to treat mantle cell lymphoma, Waldenstrom’s macroglobulinaemia and chronic lymphocytic leukaemia. It’s best to read this information with our general information about the type of cancer you have.

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

Like all targeted therapy drugs, ibrutinib can cause side effects , some of which can be serious. How targeted therapy affects people varies from person to person. Your healthcare team can talk to you more about this so that you know what to expect and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you have a temperature, feel unwell or have severe side effects. If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is ibrutinib?


How ibrutinib works

Ibrutinib is a type of targeted therapy drug called a tyrosine kinase inhibitor. It works by blocking (inhibiting) signals within cancer cells that make them grow and divide. This may help to stop or slow down the cancer growing.

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


When ibrutinib is given

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.


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. Don’t chew or open them up.

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

You usually keep taking ibrutinib every day for as long as it keeps the cancer under control. Your doctor may ask you to stop taking ibrutinib or take a lower dose because of side effects. Always follow your doctor’s advice.

There are some other important things to remember when taking your capsules:

  • 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.
  • Don’t eat grapefruit or Seville oranges (bitter oranges) while you’re 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.
  • Return any remaining capsules to the pharmacist if your treatment is stopped.


Possible side effects of ibrutinib

We explain the most common side effects of ibrutinib here. We haven’t included all the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.

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.

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 you have 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 shaky
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine a lot.

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.

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 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, or blood in your urine or stools (bowel movements).

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.

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.

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 can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Sore mouth and ulcers

Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.

Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.

Joint and muscle pain

You may have pain and stiffness in your joints, and sometimes in your muscles. Tell your doctor or nurse if this happens. They can prescribe painkillers and give you advice.

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.

Headaches

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

Eye problems

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

Skin changes

This treatment may affect your skin. It can cause a rash, which may be itchy. 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 or if they get worse. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

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

Raised levels of uric acid in the blood

Ibrutinib may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. Rarely this can cause chemical imbalances in the blood that affect the kidneys and the heart.

Your doctor will explain if you need treatment for this. You may have regular blood tests to check the uric acid levels.

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

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 and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

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

Doctors don’t yet know how this treatment may affect your fertility (the ability to become pregnant or father a child). If you are worried about this, talk to you doctor before treatment starts.

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 this treatment.