Lisinopril/ Ace Inhibitors and Ibrutinib

[Davidcara]

Several weeks ago, it was mentioned on HU, that some people were told to stop Ace Inhibitors while on Ibrutinib. I am wondering if anyone found out what this was all about?

[lankisterguy Volunteer]

Hi Davidcara,

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There have been several mentions of problems between ACE inhibitors and Ibrutinib

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

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Here is a link to the 6 times Ace inhibitors were mentioned in all postings: healthunlocked.com/cllsuppo...

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You can read the past (unlocked) postings that mention Ace Inhibitors + Ibrutinib by pasting this string into a standard Google search box < site:healthunlocked.com/cllsupport Ace Inhibitors + Ibrutinib >

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Len

[Davidcara in reply to lankisterguy]

Yes but I have not seen any mention of what those problems may be. Except one mention of sudden death. Would like to see some actual facts or data, so I may be able to discuss with my MD. I did ask the pharmacist on Patient Power, and the response was no information.

[cllady01 Former Volunteer]

This linked article is in relation to SARS-CoV-2 Viral host and targets, mentioning Ibrutinib and ACE 2---a bit more weedy than I can handle, but it may be something that has been cited or spoken of

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

[RosettaClapp]

In the venetclax leaflet it says counter-indicated for ACE inhibitors but when I started on them I did ask and was told it was ok to carry on taking lisinopril

[ViPOR]

quite a while ago, I was on an Ibrutibib trial for my Follicular NHL and I was also on Lisinopril as my doc did not mention any problems. But that was quite a while ago and they may know more now.....

I did eventually get off the lisinopril as it was hard on my kidneys. So am now on Norvasc for B/p .

[hervec]

Bonjour There is a safety signal when using Ibrutinib+Rituximan ans ACE inhibitors

the EMA Pharmacovigilance Risk Assessment Committee

"new safety signal for use in combination with rituximab and ACE inhibitors"

" Imbruvica: new safety signal for use in combination with rituximab and ACE inhibitors

This DHPC aims to inform healthcare professionals about a new safety signal of sudden or cardiac death with Imbruvica (ibrutinib) when used in combination with rituximab and angiotensin-converting enzyme (ACE) inhibitors. The signal was recognized following a review of the findings of a clinical trial.

Imbruvica is a medicine for treating the blood cancers mantle cell lymphoma, chronic lymphocytic leukaemia (CLL) and Waldenström’s macroglobulinaemia (also known as lymphoplasmacytic lymphoma).

An interim analysis of the clinical trial suggested that the risk of sudden or cardiac death in patients on an ACE inhibitor when entering the study was increased in patients randomised to ibrutinib and rituximab, compared to those randomised to fludarabine, cyclophosphamide and rituximab.

While the PRAC is reviewing the signal, as a precautionary measure, for patients with CLL currently receiving ibrutinib plus rituximab together with an ACE inhibitor, the PRAC advises healthcare professionals to reconsider the treatment strategy.

For patients with CLL on ACE-inhibitors who have not yet started treatment with ibrutinib plus rituximab, the treatment strategy should be reconsidered before commencing ibrutinib."

ema.europa.eu/en/news/meeti...

Herve C

[Davidcara in reply to hervec]

Wow, thanks for the information Hervec. I submitted it to the LLS “Ask the Pharmacist “ for an opinion