Ibrutinib (IMBRUVICA)

Chronic lymphocytic leukemia

Mantle cell lymphoma  

Marginal zone lymphoma  

Waldenstrom’s macroglobulinemia

Chronic lymphocytic leukemia

• Dose – Oral: 420mg daily continuously until disease progression or unacceptable toxicity  
• Given as monotherapy or in combination with venetoclax

Mantle cell lymphoma

• Dose – Oral: 560mg daily continuously until disease progression or unacceptable toxicity  

Marginal zone lymphoma

• Dose – Oral: 560mg daily continuously until disease progression or unacceptable toxicity  

Waldenstrom’s macroglobulinemia

• Dose – Oral: 420mg daily continuously until disease progression or unacceptable toxicity  
• Given as monotherapy or in combination with rituximab

Available as 140 mg hard gelatin capsules. Capsules should NOT be opened. Store at room temperature.

Bruton’s Tyrosine Kinase Inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as possible on the same day of the missed dose and return to the scheduled time the next day. Patient should not take an extra dose to make up for a missed dose.

Common: Anemia, Neutropenia, Thrombocytopenia, Diarrhea, Infections, Hyperuricemia, Hemorrhage, Musculoskeletal pain.

Less Common: Atrial fibrillation/flutter, Ventricular tachyarrhythmia, Hepatitis B reactivation, Pneumonia, Sepsis, Subdural hematoma, Secondary malignant neoplasm, Non-melanoma skin cancer, Progressive multifocal leukoencephalopathy.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, bilirubin, ALT, PTT, INR, HBsAg, HBcoreAb.

During treatment: CBC & differential, bilirubin, ALT.

If clinically indicated: Baseline ECG should be arranged if patient has cardiac risk factors such as hypertension, diabetes mellitus, pre-existing arrythmias or history of heart failure.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Serious hemorrhagic events, including fatal events, have been reported in patients with hematologic malignancies. Consider the risks and benefits of antithrombotic agents when co-administered with Ibrutinib.  Monitor all patients for signs of bleeding.
• Fatal and serious cardiac arrhythmias and cardiac failure have occurred in patients treated with ibrutinib.  A baseline ECG is recommended for patients with cardiac risk factors.

BC Cancer. BC Cancer Drug Manual.  Ibrutinib.  Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Ibrutinib_monograph.pdf. Updated January  1, 2024. Accessed January 22, 2024.

Lexicomp. Ibrutinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/4831102?cesid=4VtNYhFVs3G&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dibrutinib%26t%3Dname%26acs%3Dfalse%26acq%3Dibrutinib . Updated January 19, 2024. Accessed January 31, 2024.

Cancer Care Ontario. Ibrutinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44366. Updated February  2023. Accessed January 22, 2024

Janssen Inc. IMBRUVICA® Product Monograph. Toronto, Ontario. Updated May 28, 2021.