Interaction of ibrutinib with pantoprazole…. ????

[ava1967ir]

Hi,, I have been taking ibrutinib for about 40 days, I have had stomach reflux and indigestion for about a week. The next visit with my oncologist hematologist is in two weeks.. Can I take pentoprazole and it does not interfere with ibrutinib?

[lankisterguy Volunteer]

Hi ava1967ir

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See: drugs.com/drug-interactions....

SNIP:" No interactions were found between Imbruvica and pantoprazole. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider."

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I believe there is an issue with Calquence / Acalabrutinib and the drugs that lower stomach acid, and a modified version is in development to avoid that problem

webmd.com/drugs/2/drug-1763...

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Len

[ava1967ir in reply to lankisterguy]

thanks for reply🌺

[SeymourB]

ava1967ir -

I think PPI's (proton pump inhibitors) like pantoprazole (drugs ending in -prazole) reduce the available ibrutinib:

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

The Concomitant Use of Tyrosine Kinase Inhibitors and Proton Pump Inhibitors: Prevalence, Predictors and Impact on Survival and Discontinuation of Therapy in Older Adults with Cancer.

"The concomitant use of tyrosine kinase inhibitors (TKI) and proton pump inhibitors (PPI) is a significant concern due to potential drug-drug interaction that reduces TKI absorption, thus potentially reducing effectiveness of TKI. "

So, it's not an interaction that causes an adverse effect, it just makes the ibrutinib less effective.

This is one of the reasons why there's a tablet form of Acalabrutinib now available in the U.S., and I hope soon in the rest of the world.

pharmacytimes.com/view/da-a...

Please ask your doctor for advice on this.

=seymour=

[ava1967ir in reply to SeymourB]

Hi, I live in Iran and unfortunately Acalabrutinib is not available in my country.

[AussieNeil Partner Administrator in reply to ava1967ir]

Ibrutinib doesn't have the same sensitivity as the acalabrutinib/Calquence capsule to PPI drugs, but here is what to do to reduce any effect. (I needed to do this when taking acalabrutinib.)

1. Take your ibrutinib whenever it suits you during your day

2. Take the pantoprazole 2 hours after the ibrutinib

This lets your stomach acidity increase for when you take your ibrutinib and time for ibrutinib to be absorbed before you again suppress your stomach acid.

Note: This isn't mentioned as a concern in the ibrutinib/Imbruvica prescribing information, but you can adopt this process to avoid any issue.

Neil

[Fwanni in reply to AussieNeil]

Hi Neil, with acalabr, can one take pantopranazole? Or alternative? I was on Ibrutnib over 3 years, also pantopranazole. Haemo advised me to stop Ibr 4 months ago - bone pain (reduced now), but no reference to pantopranazole, I continued with it...

Going to start acalabr shortly. Did you take an alternative to pantopranzole when on it?

Best...

[AussieNeil Partner Administrator in reply to Fwanni]

My specialist switched me from omeprazole to famotidine while I was on acalabrutinib.

Neil

[SeymourB in reply to AussieNeil]

AussieNeil -

How many times a day do you take the famotidine?

=seymour=

[AussieNeil Partner Administrator in reply to SeymourB]

I'm back on omeprazole after taking famotidine daily. In my opinion omeprazole is more effective. I'm actually taking 20mg every other day, as my gastroenterologist thinks I no longer need it based on how my oesophagus looked 10 years after stricture surgery during an endoscopy.

Neil

[Fwanni in reply to AussieNeil]

Did you stay on acalabrutnib long? Any unusual side affects? Did you do well on it? Different from Ibrutnib? We all react differently of course ; but good to understand. My lymphocites are rising after magnificent drop, stable for over 3 years on Ibrutnib. Off ibrut over 3 months..lymphocites now rising!. My haemo prescribed acalabr, maybe start next week if I can disregard its bad 'headaches' reports.

Haemo changed 3 weekly infusion of flebbogamma (unavailable?)to Privigen - I gather from nurses some people have v intense reaction to this? I dont know if it is related but having done so well, I now have flaring skin , bcc on my forehead, itch, heat...My body seems to be in a v reactive mode to Something?? Facial BCC spots have only flared since Privigen infusions commenced? Coincidence?

Endless tome...!

thankyou Neil for your valued insight.

F

[AussieNeil Partner Administrator in reply to Fwanni]

I had acalabrutinib plus venetoclax plus omeprazole, plus I've never had ibrutinib, so I can't make a comparison. The head to head comparison clinical trial ascopubs.org/doi/abs/10.120... showed acalabrutinib had the expected lower side effect profile. Given the trial sponsor you may understandably hold some degree of scepticism, but the results fit with that reported by most members reporting their switching experiences.

I achieved uMRD and my remission is holding 3 years later, so I'll be happy to repeat my treatment again if needed, but I'm hoping for a cure

Bad headaches, if you experience them oh, are generally quickly resolved by a caffeine drink, perhaps with acetaminophen (Tylenol, Panadol, APAP). This side effect is only usually temporary for two to three weeks.

There are quite a few suppliers of IgG for IVIG and SCIG. Switching suppliers usually solves any infusion reactions. I'd recommended switching to subcutaneous delivery if available.

Neil

[Fwanni in reply to AussieNeil]

Subcutaneous..interesting. I will indeed ask.

As before, Thankyou. (gur raimh maith aguit - in Irish)

[ava1967ir]

Neil ,Thanks for your help

[hhk50]

Yes - I take Pantoprazole, 40 mg, twice a day. Once before breakfast, and once before bed when I also take the Imbruvica.