Imbruvica ibrutinib & ACE inhibitors

[sphexx]

I have just been told to stop my ramipril due to an interaction with ibrutinib having the risk of sudden cardiac death! I have been taking ibrutinib daily for 3/4 years with ramipril most of the time and obviously have not had this reaction so it may be very rare or not apply in my case. I have no other information about this. A quick Google turned up nothing.

[Newdawn Administrator]

Yes I understand patients on Ibrutinib who take Ace Inhibitors (the meds that primarily end in pril) are being contacted but I’d heard it was do with a possible adverse effect on blood pressure. I was contacted this morning but I haven’t been on Ibrutinib for quite some time now.

Doesn’t sound like you’ve been affected by this sphexx. Is your b/p regularly checked?

Newdawn

[sphexx in reply to Newdawn]

Yes I regularly check my BP . But I’ve had wildly varying (high) systolic readings predating ibrutinib though my average stays about the same.

[country76 in reply to sphexx]

When I was on Ibrutinib my systolic was in the 180-190's. I do have occasional abnormal heart beats however I always had them which I was told is normal. Of course, when the EKG was done it didn't happen.

[country76 in reply to Newdawn]

I wonder if it is true for Alacabrutinib?

[Newdawn Administrator in reply to country76]

I think you’d need to ask your Consultant on that one country.

Newdawn

[country76 in reply to Newdawn]

Thanks.

[Davidcara in reply to Newdawn]

Wondering if anyone an official statement or research paper, explaining this decision?

[annmcgowan]

Hi I have just received a letter from my haemotologist about this even though I am not on heart medication of any kind. He enclosed a list of medications not suitable to people on ibrutinib. I would speak to your specialist as it seems individuals on ibrutinib may need a change of medication.Ann

[zaax]

I had a call from my FLAIR specialist he said i have to come off perindopril, as it's now a no-no with Ibrutinib and I'm now on Candesartan

[Davidcara in reply to zaax]

Did the mention why you need to come off of it

[morepork]

I 'm waiting to see the published paper on this , and % of risk as I am on Ibrutinib AND one of the generic ACE inhibitors (enalapril) ; and have a good control of B/P with minimum dose.Had the whole cardio workup due to my occasional A/fib like slowing of heart rhythm and at the time I went onto my BTK the advice to GP's was not to prescribe Calcium Channel blockers for hypertension. If it's a long shot risk to take both together I'm not bothered.

[sphexx in reply to morepork]

It’s going to be a small risk I expect otherwise it would have shown up earlier given the nature of the claimed effect ie sudden death. That also makes it problematic to weigh the risk, it’s not like you can stop taking the drugs if the effect occurs — well of course you would actually stop taking them 😱. As I wrote earlier, I have no other information (eg published papers), just the notice from my haematologist.

[newyork8]

See if ARBs...telmisartan, losartan work for you. They are as good as ACE..I've been on for years with Ibrutinib no problem.

[Davidcara]

Has anyone heard what the interaction might be, and if there is an official reliable statement?

[sphexx]

I’m not sure what you would consider an “official” statement. Perhaps I didn’t make it clear in my OP that for me the instruction came from the Haematology department at the hospital I attend which is “official” enough for me :). I haven’t seen any reference to the work this is based on.My ibrutinib was prescribed by Prof. Peter Hillmen and he is ultimately responsible for the advice I received. “His clinical and research interests include chronic lymphocytic leukemia (CLL) and PNH. He is Chairman of the CLL trials subgroup of the National Cancer Research Institute (NCRI), with the responsibility of developing a portfolio of phase II and III studies in CLL for the UK. Dr. Hillmen is also the Chairman of the International PNH Interest Group. He is principal investigator of several national and international phase II and III trials for CLL and PNH.”

patientpower.info/bio/peter...

[sphexx in reply to sphexx]

It occurs to me, given the source, that it could be from unpublished results :(. Anyway, I definitely do *not* mean to be giving anyone advice! It could be that I fit some particular category at risk! Just a heads up.