In early February, it was discovered that due to my husband's low immune system from his leukemia, he had contracted a fungal infection called aspergillus. Since then, he has been on an antifungal medication called voricanazole, and they have cut his imbruvica back from three a day to one a day.
Before this happened, he was doing well on his imbruvica. Now, it seems like his numbers are changing and things are not going as well. Has anyone had any experience with these two drugs together?
This paper list it as a strong CYP34A4 inhibitor
Short term therapy (seven days or less) with a strong CYP3A4 inhibitor (i.e., ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin) is necessary, the clinician may carefully consider interrupting ibrutinib therapy during the duration of inhibitor usage based on risk versus benefit. Chronic therapy with strong CYP3A4 inhibitors should be avoided.
ncbi.nlm.nih.gov/pmc/articl...
~chris
my husband was on ibrutinib for 5 months prior to transplant, and had a tough fungal lung infection. because of the -azole and ibrutinib conflict, he had daily transfusions of ambisome- a version of amphotericin for just about the whole time. they tried backing that off to alternate days but the fungal infection surged again. ambisome kept it in check but didn't cure it.
once off ibrutinib, for transplant, he went on voriconazole. between vori and the new immune system that persistent fungal infection was cleared up by the time of his 100-day scans. hope the vori works as well for your husband! and he can resume his treatment.
we were given to understand that the -azole family made one's ibrutinib uptake less predictable and possibly too high, which jives with lowering his dose.
good wishes sent your way ~~~
Ok,I too have aspergillus, discovered during a lung section operation for lung cancer,in February . I also have had CLL since 1998 and have had chemo, and have been on Ibrutinib (420) mg since 2014 .Mistakenly, they gave me Voriconazole intravenously, while still on 420mg Ibrutinib,in hospital .When I went home two days later ,I was hallucinating and had insomnia. A week later I was off the Voriconazole , because of a negative test result for fungus and was ok for 2 months .During this whole time my CBC was very close to normal .
I then,in June I developed fungal pneumonia and went back on Voriconazole ,200 mg,for 30 days while reducing the Ibrutinib to140 mg .During that time on zole, I developed a sever rash on my forearms and had to stop the zole. It has been 10 days now and the rash is getting better ,my arms no longer look like raw hamburger .I continue on 140 mg of Ibrutinib and hope my cbc remains good ,it will be checked in September . I also receive a IGG infusion to boost my low immune numbers . It's a tricky balance and I still have fungal Pneumonia, but that Voriconazole is some nasty stuff .
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