Juices, Fluid Options

[Zappymom12]

What juices can you drink on Ibrutinib? My husband has a problem with 1% milk especially at night. He can drink water and tolerates ginger ale. Thank you so much

[PlanetaryKim]

No grapefruit juice and no pomegranate juice, if on Ibrutinib. Other juices okay, as far as I know. I drink many other juices - especially orange juice. Cannot have Seville oranges (marmalade oranges) when on ibrutinib. But Seville oranges are never juiced. And other oranges are okay (except for blood oranges, which are also a no-go). Limes are also a no-go apparently, but not lemons. (I guess I better stop buying limes!)

The problem with drug interactions and some citrus fruit depends on whether the citrus fruit contains furanocoumarins, according to this article: usatoday.com/story/news/nat... Furanocoumarins inhibit the liver/gut enzyme CYP3A4, which is required to metabolize ibrutinib and many other drugs.

kim

[BeckyLUSA in reply to PlanetaryKim]

Hey Kim, Was wondering about the prohibition of blood oranges and limes? Have not heard about this. My trial doctor okayed all but Seville oranges and pomegranates. I regularly use limes and blood oranges without issue. Have had no problem with liver enzymes since the beginning of trial. Thanks,

Becky

[PlanetaryKim in reply to BeckyLUSA]

It wouldn't be your liver enzymes (AST & ALT) that would exhibit the effect from limes or grapefruits. Basically any food or herb or another drug that inhibits CYP3A4 is a potentially a problem for anyone taking ibrutinib (or any other drug that is metabolised via CYP3A4). Grapefruit may be a stronger cyp3a4 inhibitor than limes. I don't know. But in the article link I posted, limes were included. And elsewhere I have read that blood oranges are also cyp3a4 inhibitors. The consequences of consuming a cyp3a4 inhibitor when on ibrutinib is that you would have a higher amount of ibrutinib in your body than planned, since it is not being metabolized and excreted at normal rate - essentially an overdose to some degree, which may or may not be serious.

[BeckyLUSA in reply to PlanetaryKim]

Thanks. Will discuss this at my next appt.

[PlanetaryKim in reply to BeckyLUSA]

Pharmacists are also really good people to discuss it with. Cytochrome P450 interactions are their language. I have more than once asked pharmacists these questions - to help me on herbal supplements like curcumin and whether it is a cyp3a4 inhibitor or inducer. Pharmacists are actually better equipped to answer these questions than doctors.

[Traudel in reply to PlanetaryKim]

Hello Kim,

Hope only you are doing alright. Have not seen any posts from you, surely everything is OK.

I am concerned about taking IB with Orange/or Blood Orange juice, freshly squeezed.

Why not Blood Oranges? There are a lot of different opinions?

Appreciate,

Traudel

[PlanetaryKim in reply to Traudel]

Hi Traudel. I'm good. You can always see all of my posts (and my replies to other people's posts) by clicking on my picture by my name. That takes you to my profile page where my posts are listed. If you click "replies" on my profile page, you will see any comments I have made on other posts too.

As for grapefruit, seville oranges, blood oranges and a few other citrus fruit,,, the problem apparently is their level of furanocoumarins. If that chemical is present in a food, or if it is too high, it will inhibit the enzyme needed to break down ibrutinib. And if our body cannot break the ibrutinib to eliminate it, then each day's dose will be added to the previous days. It will lead to a high level of ibrutinib in our body - essentially an overdose.

Some citrus has more furanocoumarins than others. so we can't eat seville oranges, but we can eat valencia oraganges. can't eat limes but can eat lemons. at least this is what I have read.

how are you doing?

[Traudel in reply to PlanetaryKim]

Hello Kim,

Good to hear you are doing well.

Yesterdays blood result had been a touch better, so my Hematologist does not like to change anything for right now. I take a Bloodbuilder, Iron, over counter, brought up my RBC a touch. Actually have more stamina, have completed the sale of house in Scottsdale. Was amazed being able to do it. My love for golf and better condition let me to play again.

Very happy about it.

Looking for 2 weeks of total relaxation in Kona next week, return for good March 4th. Please let me know, if there could be a meeting in your area. Appreciate.

Now I understand, where I can find your posts, thank you and Good Night,

Traudel

[PlanetaryKim in reply to Traudel]

Enjoy Kona! And I will let you know about any meet-ups that are happening on Vancouver Island.

[Traudel in reply to PlanetaryKim]

Thank You, Kim, looking forward.

Stay well on your new path, enjoy your long weekend,

Traudel

[Zappymom12]

What drinks are ones that are agreeable? My husband can’t tolerate orange juice or milk. He’s losing a lot of weight rather quickly.

[PlanetaryKim in reply to Zappymom12]

If he can't tolerate milk, has he tried plant-based milks? almond milk, soy milk, rice dream, etc? Some people like those. And they contains some calories and protein.

[Zappymom12 in reply to PlanetaryKim]

Thanks Kim. I just found almond milk. I’m not very good at asking the right questions. He seems to tolerate hot peppermint tea today. Thank you so much.

[kathymac52 in reply to Zappymom12]

My husband lost 25 pounds as well......he did tolerate Ensure and Kefir and ginger ale and mint tea and sweetened almond milk and Boost. I increased his calorie intake with sauces, creamy soups, cheese, and small snacks and meals...He had such terrible mouth sores and developed a mouth infection after he burned his mouth on pizza....lots of water even when he said he had enough!! Thinking of you , and sending healing prayers your way....

[Zappymom12 in reply to kathymac52]

Thank you! This is the kind of answer I needed.