Ibrutinib (Imbruvica)

Ibrutinib is a type of targeted cancer drug. It is also called Imbruvica.

You pronounce ibrutinib as i-broo-tih-nib.

You might have it as a treatment for:

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

How does ibrutinib work?

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 do 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 break, or chew the tablets. Take them at the same time each day.

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

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

How often do you have ibrutinib?

You take ibrutinib once a day.

You take it for as long as it is working, and the side effects aren't too bad. 

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.

Before treatment starts, you have a blood test to check for viruses such as hepatitis B, hepatitis C, HIV or cytomegalovirus (CMV) . This treatment can mean that your immune system  doesn't work as well as it normally does. So infection with these viruses can become active again if you’ve had them in the past. 

Side effects

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 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

You may have 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 heavy bleeding, such as heavier periods or blood in your poo or bleeding that you can’t stop from an injury. Call your advice line if you have any unusual bleeding. If you are losing a lot of blood call 999 or go straight to A&E.

You might have bleeding in other parts of your body, but this is rare. Your healthcare team will regularly check the level of platelets with blood tests. They will go through which symptoms to look out for when to contact someone.

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia. Less commonly it could be due to scarring of the lungs (interstial lung disease).

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

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

High blood pressure (hypertension)

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Diarrhoea or constipation

Tell your healthcare team 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. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Sore mouth 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Indigestion of heartburn 

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Skin and nail problems 

You may develop a skin rash.

Less common side effects include red skin and swollen red bumps (hives) on the skin. You may have nail problems which can cause your nails to break or separate from the nail bed.

Your doctor will check your skin and nails regularly through treatment.

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). 

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

High levels of creatinine in the blood

Your blood tests might show that you have high levels of a substance called creatinine.

Creatinine is a waste product made by the muscles. The kidneys remove this from our blood and get rid of it in our urine. You have blood tests to check the levels of creatinine.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 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. It can be life threatening.

• swelling of the sinuses which can cause pain, reduced sense of smell and blocked nose

• an increased risk of getting a skin cancer called non melanoma skin cancer such as basal cell cancer or squamous cell cancer

• an increase in the number of white blood cells that help fight off infections

• high levels of uric acid in the blood

• blurred vision

• weakness, numbness, tingling or pain in your hands or feet or other parts of your body

Rare side effects

These side effects happens in fewer than 1 in 100 people (fewer than 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

• breakdown of tumour cells (tumour lysis syndrome) which can cause high levels of certain chemicals in your body

• problems with the liver working properly (liver failure)

• a stroke or mini stroke

• a very high number of white blood cells in the bloodstream

• severe skin rash with blisters and peeling skin, particularly around the mouth, nose, eyes and genitals (Stevens-Johnson syndrome)

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 drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant 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. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

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.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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