Verapamil and Acalabrutinib

[fish61]

Do not even think of trying to use them both at the same time .. it is almost midnight and I just finished looking up interactions , now I can sleep better knowing what is wrong with my body .... will fill in the details tomorrow.

[PlanetaryKim]

oh, I see. It's a moderate cyp3a inhibitor. I have had problems with things in that category with ibrutinib - specifically echinacea and/or CBD. Would need to reduce or suspend my ibrutinib to not have bad interaction from heightened ibrutinib (afib, bleeding, bruising).

[fish61 in reply to PlanetaryKim]

CBD ??? Say it isn’t so .... I use CBD oil daily ... you say it is a problem with Ibrutinib ... Does anyone have experience with Acalabrutinib and CBD oil or cream ???I thought I had the problem solved by eliminating the Verapamil 36 hours ago ... I was also led to believe that CBD oil had no side effects or interactions ...

[PlanetaryKim in reply to fish61]

CBD is listed as a strong CYP3a4 inhibitor somewhere. I will see if I can find the link. I have posted about this before. So that puts it in same category as grapefruit, if we are taking a drug metabolied by cyp3a4 - which unfortunately includes iburitnib, acalaburtinib and venetoclax.

The only reason I know this is because I was having some bizarre effects that felt like ibrutinib poisoning/overdose when I was applying a tiny amount of CBD cream to my cheek. I could hardly believe enough would absorb transdermally to have this effect. But I was noticing bruising, easy bleeding, then heart arrhythmias - all of which would happen if I took too much ibrutinib over several days.

So my advice would be: monitor yourself. If you are not noticing anything that looks like excess acalabrutinib effect, then you may not be having a problem.

Also... when you remove a cyp3a4 inhibitor from your diet/body (whether its grapefruit, echinacea, CBD, whatever)... it takes 4-7 days before the body is able to restore the normal level of CYP3a4. So you could experience overdose effects from your daily acalabrutinib dose until then.

Acalabrutinib may be less likely to cause this problem than ibrutinib because its side effects profile is supposed to be lower to begin with.

I have gotten to point where if I need to take echinacea 3-4 days to ward off a cold.. I will cut my ibrutinib in half or skip a day altogether. I makes a difference. (But I am almost done with ibrutinib. Will have to decide what to do with venetoclax in that situation.)

[fish61 in reply to PlanetaryKim]

got to reread and digest this ,, thanks ,, was not aware about the cream

[dvd1955 in reply to PlanetaryKim]

Could it be this? ebmconsult.com/articles/med...

[AussieNeil Partner Administrator in reply to fish61]

See this post about CBD/marijuana drug interactions:

healthunlocked.com/cllsuppo...

Any substance that has an effect on our body function is subject to drug interactions, because of overlapping absorption and elimination pathways. Further, if a substance has more than one effect, then for some people, the second effect can be an unwanted side effect.

Neil

[fish61 in reply to AussieNeil]

Thanks for the input Aussie Neil ... glad you are doing better ,, last time i saw you, you were in the middle of a line of Koalas getting on a chopper away from the fires ...

[dvd1955]

When the pharmacist at my oncologist's office saw that I was on Verapamil, she reduced the dosage of Ibrutinib that I was going to start taking. I still had a severe side effect and was off the Ibrutinib after just 6 weeks. That was five months ago and my lab results are still good enough that I have not been put on any kind of treatment. My WBC count has been very stable at between 17 and 20, but my platelets are dropping, so I suspect I will be starting some type of treatment before long. Next bloodwork is in May.