Imbruvica and Advil?

I've only been on Imbruvica for 2 months, and so far no problems. My question is, can I take Advil with this drug? I know I can't take any aspirin. Thanks for the help.

[Cllcanada Top Poster CURE Hero]

Advil (Ibuprofen) and aspirin are the same family of drugs called NSAIDs... best to get an opinion from your doctor...

~chris

[Hidden in reply to Cllcanada]

Thanks Found this site drugs.com/drug_interactions... and see it's a MAJOR interaction. To make sure I also called the Pharmacy that sends the Imbruvica every month and they told me all I can take is Tylenol.

[Justasheet1 in reply to Hidden]

Blunet,

Good catch but I'm not sure why you didn't ask your doc as Chris suggested?

Your doctor may know something particular to you that wouldn't show anywhere else.

Jeff

[Cllcanada Top Poster CURE Hero in reply to Justasheet1]

I'm really luke warm about drugs.com.... it is OK, but even as a patient I have found errors and omissions, so use it with caution...

Where your information comes from is getting increasingly important in the wild west of the internet.

A better source is the NIH, database DAILY MED, it is maintained and updated regularly

dailymed.nlm.nih.gov/dailym...

[Hidden in reply to Cllcanada]

I've been taking it for 5 years under MD Anderson supervision, so I went back through the several trials agreements I've signed off on over the years and can find no prohibition against ibruprofen or any other NSAID's. So out of curiosity I just downloaded Jansen's prescribing instructions and found nothing. Here is the link to it if you care to search for yourself; Patient Counseling begins on page 30 and Patient Information on page 32.

janssenmd.com/pdf/imbruvica...

Fwiw - I've been using ibruprofen (Advil), naproxen sodium (Aleve) and aspirin whenever I felt the need, and I have all three of those listed on my "current drug usage" chart which my oncologist can look at (if he cares; not sure he does) on every one of my every 3-month check-ups. Each of the doctors I've had -- O'Brien and now Wierda -- have at the time been MDA's lead investigator on ibrutinib trials and neither has ever commented on my NSAID use.

[Hidden in reply to Hidden]

But since the issue has been raised I will ask Dr. Wierda when I have my next check-up in July and post his response here.

[Hidden]

Thanks. I called the Pharmacist that supplies the Imbruvica - pharmacists know more about prescription drugs that doctors do. Got it sorted........Only Tylenol, nothing else.

[Mcpill]

The imbruvica patient information warns against NSAIDS. Since Imbruvica metabolizes in the liver, I would be cautious with tylenol which is known to damage the liver. It really is a problem finding something to take for pain and inflammation. I am 17p and have been on imbruvica for 13 months. Recently the swelling of ankles and feet has gotten much worse. I also have arthritis in the knees and hands. I had been taking Aleve without really thinking about it ( stupid of me!), but my counts have been good. I saw this post yesterday and read the literature. Not sure that there really is a solution. I have an appointment with my oncologist at the end of June and will follow up with him. Always something

[Hidden in reply to Mcpill]

How true!! I do get arthritis pain and headaches, etc. and always took Excedrin. So now that's out, and so is Advil which never worked well for me either. Tylenol actually does nothing for me for pain. Primary dr. said to take Tramadol, but I don't want to take a prescription pain reliever for simple pain. It's a small problem I know, but I don't want to take anything that will increase bleeding problems, which Imbruvica alone can cause. I do take Solaray Milk Thistle everyday to help my liver.

[Cllcanada Top Poster CURE Hero in reply to Hidden]

Bluenet

Does your CLL doctor know about Milk Thistle you are taking?

It is thought to interact with CYP 3A4, and so does Imbruvica (ibrutinib), so it might be cause for concern. The data appears to be somewhat conflicted, however.

Other supplements like St. John's Wort for example are contra indicated on Imbruvica (ibrutinib)

mskcc.org/cancer-care/integ...

[Hidden in reply to Cllcanada]

What is CYP 3A4? I'm very very new at all this! No, I don't take St. John's Wort. Pharmacist who supplies the Imbruvica told me milk thistle was OK, but I'll ask my doctor as well. And thanks for your help.

[AussieNeil Administrator in reply to Hidden]

You might want to rethink taking the milk thistle per this warning from Mayo Clinic: 'Milk thistle may cause allergic skin reactions, bloating, blood clots, collapse, constipation, decreased platelets, diarrhea, eczema, elevated liver enzymes....' (My emphasis)

mayoclinic.org/drugs-supple...

The return search 'Solaray Milk Thistle bleeding platelets' had the Mayo clinic first and the fourth from the Foods for Living - Natural, Fresh, Organic, which largely echoed the Mayo Clinic warning for milk thistle.

I don't know how often you have your monitoring blood tests taken, but you might be interested to see whether your platelet count and liver function tests, ALP, ALT and AST change if you have say a two week break from taking milk thistle prior to your next test. You probably won't see a change, but why not use your blood tests to check if what you are taking could be causing effects you don't want?

Neil

[Hidden in reply to AussieNeil]

Thanks. I have blood tests on June 7th, so I'll stop the milk thistle and see what happens. Only have blood tests once a month. I'm in a rural area and the oncologists here are few, so I don't have many choices. I was glad to go on the Imbruvica though. So far no bad side effects but like I said I've only been on it for a month or so. You have so much knowledge! I've read a lot of your posts and you seem to know more than many doctors I've come across over the years.

[Mcpill in reply to Hidden]

I do not take any supplements. what with the Imbruvica I try not to take anything. tho, as I mentioned Aleve was helpful. I agree about Tramadol...not taking opioids unless pain becomes unbearable.

[Hidden in reply to Mcpill]

I do take Vitamin C, B complex, Vit. D, iron, and folic acid. Vitamin C helps me heal quickly.

[Cllcanada Top Poster CURE Hero in reply to Mcpill]

No NSAIDS on ibrutinib unless approved by your doctor.

What are NSAIDs?

en.m.wikipedia.org/wiki/Non...

[Mcpill in reply to Cllcanada]

Yes, I mentioned to my primary care doc and he said that NSAIDs are a definite no no. I discovered that in addition to thinning the blood, they cause inflammation which I was having a hard time with. He said to take only Tylenol, tho, I have always been wary of it. When I absolutely have to, I do now use it...and take only 2 a day. Hoping joint pain is another side effect that will disappear down the road. Thanks.

[Hidden in reply to Mcpill]

Mine said the same. So now I take nothing for pain. Tylenol never worked for me. I think I could take a boatload and it wouldn't even get rid of a minor headache, so............I'm stuck with pain when I get it and now I've strained my back. Tramadol does nothing either.

[Mcpill in reply to Hidden]

So sorry. I hope that it is a side effect that will go away soon.

[Emcee1 in reply to Hidden]

Wonder how a glass of wine would fare?

[judys411]

No not recommended nothing that thins the blood more

[Larry6440]

Consider yourself very fortunate. I've been on Imbruvica for 2 months and I have so much bone pain I want to crawl out of my skin. My oncologist told me the ONLY over the counter pain med you can take with Imbruvica is Tylenol. EVERY OTHER pain med is an unsaid. Nsaids thin your your blood and damage your liver if you take more than 3000 mg's in 24 hrs.

My oncologist has me on Oxycodone and Tyleno at this point. Tylenol makes the oxy work more efficiently. I have lower pain now. My first month on the high dose (420 mg's) was extremely painful.

[Hidden in reply to Larry6440]

True. I know how you feel. For the past two days my right ankle and top of my right foot is swollen and hurts, it's arthritis. I sat all day yesterday with ice packs on it to get the swelling down. Took Tylenol - which does nothing at all, and 1 Tramadol which also doesn't do much. Today it's my right foot, swelling is done some, but now I can hardly move my left hand it's stiff and very painful. If I could take Excedrin I'd be fine, but I can't, so I have to live with pain, or.......get addicted to opiods which I don't intend to do. Life is not much fun.

[Larry6440]

Getting old isn't for sissy's. The oxy plus tylenol work the best for me. Before my CLL diagnosis 4 yrs ago, the only pain med that worked for me was Motrin. Tylenol back then did nothing for me, now it works, go figure.

[Hidden in reply to Larry6440]

You're right. Who knows?? And I know one thing for sure..........Doctors don't "feel your pain"!! They barely listen and probably think you're just some old complainer. No, being old isn't for sissys, and it's too hard on the old!! When I was younger I always knew no matter what was wrong with me, it would pass, might take a week or so, but I'd be OK. Now, that is no longer the case and I know it.