Ibrutinib and Anti-Inflammatory Medications

[Davidcara]

Wondering what is recommended for muscle type pain inflammation. Used to use ibuprofen, but no longer due to ibrutinib. Any recommendations will be checked with my MD before use. I have used bio freeze. Considering Voltaren creme but, not to sure about it’s safety profile.

[Newdawn Administrator]

I’ve had this issue David and eventually had to cease using Ibrutinib due to grade 3/4 arthralgia and myalgia. It is an issue not being able to take oral anti-inflammatories but I found Volterol gel fine to use on smaller areas. The systemic absorption of Voltaren Gel, which is 1% diclofenac sodium in a topical gel formulation, is three times less than oral diclofenac (5% vs. 15%, respectively).Obviously check this out with your specialist but I was allowed to use it due to its low systemic infiltration.

Be aware of your diet because some foods are notorious for causing and aggravating inflammation. Keeping a food diary to check against the worst days can be beneficial. Tomatoes surprisingly, are said to aggravate inflammation but I’m not totally convinced. I’m sure high carb and sugar does however.

Best wishes,

Newdawn

[Davidcara in reply to Newdawn]

Thanks New Dawn. Appreciate the insight.

[AnneHill in reply to Newdawn]

My blood sugar is too high. Im seeing the diabetic nurse tomorrow. I think there is a strong possibility that my pain and inflammation are agravated because of this. I will try the volteron gel. Its the price I am paying for the control of cll. Anne uk

[AnneHill]

My answer to muscle pain was swimming. I used the training pool which was warm and stretched well. Now covid has put a stop to that. I will go back when its safer.Ibrutinib has stopped the anti inflammatories and cod liver oil.

I hope your pain gets easier, Anne uk

[newyork8]

Please explain why you stopped Ibuprofen on Ibrutinib. Thanks

[Newdawn Administrator in reply to newyork8]

This may help to explain;

‘While using Imbruvica, it’s safe to take acetaminophen (Tylenol). However, you shouldn’t take ibuprofen (Advil, others). Ibuprofen may increase your risk for bleeding and raise your blood pressure. Imbruvica may also cause bleeding and increased blood pressure. (For more information, see the “Imbruvica side effects” section above.) So taking Imbruvica with ibuprofen may lead to serious bleeding or high blood pressure that can be harmful.

If you need a pain reliever while using Imbruvica but you can’t take acetaminophen, talk with your doctor. They can recommend other options.’

medicalnewstoday.com/articl...

Newdawn

[newyork8 in reply to Newdawn]

Thank you! This may apply to fish oil supplements as well then.

[Newdawn Administrator in reply to newyork8]

Yes it does newyork but check these issues out with your specialist because it’s clear some allow measured risk. I’ve yet to have any haematologist, GP or rheumatologist agree that I could take anti inflammatories whilst on ibrutinib.

Newdawn

[newyork8 in reply to Newdawn]

I understand that Ibrutinib is itself anti inflammatory but is it not the issue of increased bleeding risk that is the nexus. Oddly I don't recall any doc I have dealt with warn of Advil or NSAIDs in general with Ibr...and I've consulted with some of "the best". Maybe I missed it.

[Newdawn Administrator in reply to newyork8]

We have to rely on the medical advice we are given because we each have unique medical profiles and it’s clear some specialists are easier with these combinations than others. I’m on a clinical trial and had to cease ibrutinib use because of severe myalgia and arthralgia and being unable to use anti inflammatories whilst on it. This is a useful article on the subject.

cllsociety.org/2017/09/thin...

Just on a related issue newyork, I see from previous posts that you report a reduced eGFR and increased creatinine level. Did this not prompt your specialist to advise about reduce use of anti inflammatories? I have proteinuria and a nephrologist has been quite direct about me stopping or reducing use of anti inflammatories to a very low level. I have severe arthritis and it’s causing me some problems in managing pain.

Newdawn

[newyork8 in reply to Newdawn]

Not really. Going to a new nephrologist for full workup soon.

[210savannah]

I have been on Ibrutinib for over two years and have taken Diclofenac sodium the entire time with no issues. I was on the Diclofenac for osteoarthritis prior to my CLL diagnosis. Oncologist said to keep taking it and he would keep a close watch on my numbers. I have had no issues!

[danimal7777 in reply to 210savannah]

I have had exactly the same experience. I'm a regular diclofenac user, and both my oncologist and the oncology pharmacist agreed with my continued use of diclofenac.

[Davidcara]

Thanks everyone for your replies. Few years before starting treatment stopped taking ibuprofen due to worsening renal function. In addition, had some GI bleeding. Once starting ibrutinib heard no anti-inflammatory medication. I think I might have also read this on Ibruvica website. Either way, no ibuprofen for me. I think I have heard on this forum ok for meloxicam because, uses a different metabolism pathway than ibrutinib. Either way, will need to check with MD. Thanks again for your comments.

[SofiaDeo in reply to Davidcara]

Just FYI, meloxicam may not interact with ibrutinib, but it Can affect kidney function. NSAIDs have to be monitored with any degree of renal dysfunction & used judiciously. My FIL used meloxicam & didn't hydrate properly, now he has more kidney problems than before. And there was familial history of kidney issues with his father failing to the point of dialysis. Here's a 2020 large university retrospective study regarding this:

kidney360.asnjournals.org/c...

[lsutigers2018]

Back in the 70s at LSU we experienced with many of today's cures. Mostly cheap pot .