Pain Meds and Ibrutinib

[Davidcara]

Wondering if anyone knows of safe non opioid pain medication while on ibrutinib. Especially an anti-inflammatory

[AussieNeil Administrator]

From drugs.com/ppa/ibrutinib.html

Drug Interactions

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): Ibrutinib may enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Monitor therapy

Taking Paracetamol/Acetimenophen (marketing names Tylenol/Panadol/APAP) is fine.

[Smith123456 in reply to AussieNeil]

acetaminiophen is not anti inflammatory

[kathymac52 in reply to Smith123456]

My husband was told only Tylenol, and to treat pain with ice or heat...(depends on where/what your pain is.....)

[AussieNeil Administrator in reply to Smith123456]

You are strictly correct, but as Kathymac says, it "depends on where/what your pain is." Per the NHS "For pain associated with inflammation, such as back pain or headaches, paracetamol and anti-inflammatory painkillers work best."

nhs.uk/live-well/healthy-bo...

Not long after I started on Acalabrutinib, I had excruciating pain from an inflamed muscle in the back of my head compressing a nerve. I gained better relief from paracetamol than I did from prescribed high strength opiods. After the paracetamol wore off, it was agony waiting until I could take the next dose of paracetamol. A nurse commented that paracetamol is under rated for pain relief.

[Davidcara in reply to AussieNeil]

Thanks Neil, Have you heard of melixocam.

[AussieNeil Administrator in reply to Davidcara]

No, but I note it is a NSAID.

[Davidcara in reply to AussieNeil]

I read some articles that said does not affect platelets

[Davidcara in reply to Davidcara]

ncbi.nlm.nih.gov/pmc/articl...

[Davidcara in reply to Davidcara]

About half way done. Would need to talk to my specialist about this. Playing it safe with tylenol. Thanks everyone for your comments.

[AussieNeil Administrator in reply to Davidcara]

From that NIH listed reference:"Use of non-selective NSAIDs in conjunction with ibrutinib has been shown to increase the risk of both minor and major bleeding and should therefore be avoided.[14, 22] Celecoxib, the only available COX-2 selective NSAID, has been shown to have no effect on platelet function, and therefore should not further increase the risk of bleeding associated with ibrutinib.[67] Likewise, meloxicam has minimal to no effects on platelets.[68] Selective serotonin reuptake inhibitors (SSRI) do have some documented antiplatelet effects and increased risk for bleeding;[69] via similar mechanisms, serotonin-norepinephrine reuptake inhibitors (SNRIs) used for neuropathic pain may be just as likely to cause bleeding, although current clinical data is conflicting.[70] Acceptable analgesics with no major adverse platelet effects include acetaminophen and opioids, as well as anti-epileptic drugs such as gabapentin, pregabalin, and tricyclic antidepressants."

Does the Tylenol help?

[AussieNeil Administrator in reply to Davidcara]

Given the concern is the potential interaction with Ibrutinib in particular via CYP 3A4, per this PubMed reference: pubmed.ncbi.nlm.nih.gov/103... "The predominant P-450 enzyme involved in meloxicam metabolism is CYP 2C9, with a minor contribution of CYP 3A4.", the drugs.com recommendation to "Monitor therapy" seems appropriate, but you need to check with your specialist or a knowedeable pharmacist. I couldn't find Melixocam/Mobic mentioned in the the drug interaction databases mentioned in this post:

healthunlocked.com/cllsuppo....

Have you spoken to a hospital pharmacist?

[bkoffman CLL CURE Hero]

NSAIDs may increase bleeding risk. Acetaminophen which is good for pain but not inflammation should be fine as well as opioids if appropriate.

[Hidden in reply to bkoffman]

I know I can't take anything but Tylenol as far as OTC pain relief. But I also take Tramadol 50 mg. when I need it, a Rx medication.

[bkoffman CLL CURE Hero in reply to Hidden]

Good plan. Tramadol is a mild opioid.

[Hidden in reply to bkoffman]

True. That's what my Family Doctor told me and she prescribed it. I only take one a day. If I need something for pain later in the day I just take a Tylenol.

[bkoffman CLL CURE Hero in reply to Hidden]

Sounds like a good plan.

[Cllsller]

I find that taking 2 ibuprofen and 2 Tylenol helps severe pain.(or alternating) I had knee replacement surgery and it worked for me.(I am on Imbruvica)

[Hidden in reply to Cllsller]

I was told not to take ibuprofen while on Imbruvica.

[Cllsller in reply to Hidden]

I wasn’t. I take it for all the joint pain that I have thanks to the Imbruvica! This is so confusing. The combination of Motrin and Tylenol has really helped me. Also, I highly recommend taking marijuana edibles. Fortunately I live in Colorado so it is easy to get.

I sincerely wish you well.

Dorothy Star, 71, cll and sll since 2005.

[Hidden in reply to Cllsller]

If your oncologist told you to take it, then, it's between you and your Dr.

[Cllsller in reply to Hidden]

Of course it is

[AussieNeil Administrator in reply to Cllsller]

If you highly recommend taking marijuana edibles, you missed this post: healthunlocked.com/cllsuppo... which concludes that cannabis may encourage the movement of CLL cells from the blood into the nodes, spleen and bone marrow, where they propagate and interfere with blood cell production

Neil

[Cllsller in reply to AussieNeil]

Thank you. My doctors never told me that and they are all aware of the fact that I have been taking edibles. Will check again with them next week. Thanks

[Cllsller in reply to AussieNeil]

Thank you. Again all of docs know about this and none of them told me anything about this. Thank you.

[Cllsller in reply to AussieNeil]

Can you send this report to Brian Koffman? I have tried but cannot figure out how to do it. Thanks so much.

Dorothy Star

[AussieNeil Administrator in reply to Cllsller]

Just ask Dr bkoffman to respond with his thoughts about the article referenced in this post healthunlocked.com/cllsuppo... mentioned above

[Cllsller in reply to AussieNeil]

Thanks but I have tried to send it and it won’t go through. Do you know his exact e-mail address?

[AussieNeil Administrator in reply to Cllsller]

No need to email Dr Koffman. I've tagged him using @ bkoffman (indicated by his username in blue), so he will receive an email notification: support.healthunlocked.com/...

[Cllsller in reply to AussieNeil]

Thanks so much.

[Zia2 in reply to Hidden]

Me too

[studebaker]

I am on Acalabrutinib and since I also have Fibromyalgia and Osteoarthritis my doctor and AstraZeneca allowed me to take Celebrex for pain when needed.

Dana

[Davidcara]

Thank you CLL Pharm

[Hidden]

Thanks. I'll try to remember to do that when I see my oncologist this month.

[Hidden]

I bookmarked your page. Will check it out later!! Thanks.

[NoClew]

I've been using the anti-inflammatory Voltaren gel while on Acalabrutinib with the approval of my team. Results have been very good for me, and I'm sure the massage helps as you rub it in, too. Knees, IT bands, Achilles tendon, shoulders/traps. I have not had any stomach issues as I did with oral NSAIDs, so it seems very little gets into your system. Available now without prescription. $$ but worth it for me. Hope you find something that works for you.