Stopping Imbruvica before going to the dentist

[AshGS]

Good day to all.

Why shall I stop Imbruvica before going to the dentist to clean the gum? Is it for fear of bleeding?For how long before going?

Why it is also recommended to stop it after treatment for few days?

Thanks much!

[AussieNeil Administrator]

BTK inhibitors like Imbruvuca/ibrutinib reduce the effectiveness of clotting, because of an off target effect on platelets. So yes, you are at increased risk of bleeding unless you stop taking your BTKi treatment for long enough before surgery for the drug to leave your system.

Likewise, if you recommence taking Imbruvica too soon after your surgery, your wound may not have time to begin the healing process and bleeding could restart.

Neil

[AshGS in reply to AussieNeil]

Thanks much dear for your clarifications. Iguess three days prior the surgery are enough?

[lankisterguy Volunteer]

Hi AshGS

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I asked my CLL expert and dentist, and was advised that if the dental procedure was not expected to bleed noticeably, I would not need to pause treatment.

And fortunately I don't have significant scale or plaque, so the dental hygienist is alerted about the bleeding risk and requested to be very cautious & conservative with the tools & hygiene procedures.

If I need an extraction or deep cleaning, then pausing BTKs and using prophylactic antibiotics - including Chlorhexidine dental rinse is recommended.

-

Len

[stevesmith1964]

I don't stop acalabrutinib for general dental cleaning, but do stop for 10 days and take additional antibiotics if I am have treatment like a filling etc.

[Leo71]

my husband was advised to stop acalabrutinib and to take antibiotics before a deep clean and below the gum scale because the dentist expected to release bacteria

[mrsjsmith]

I think the excellent advice I was given by my dental surgery was to see the hygienist every three months. One of the things I keep to religiously. Antibiotics for any invasive work.

Colette

[BeckyLUSA]

Like most everything else with CLL, this can be different with each of us. I have been on Ibrutinib 5+ years and have only come off of it for port placement and hip replacement. My hygienist knows about my CLL. I do not have a history of bleeding and my specialist said not necessary. I would check with your specialist.

[lebo222]

I will give my personal opinion on this isssue although my profession as an Oral and Maxillofacial Facial Surgeon and CLL patient give me a unique perspective. For the minimally invasive procedures such as dental prophylaxis and restorative ( filling/ crowns) I fell the need for drug holiday is not indicated. The incidence /severity of bacterimia from these procedures are quite low. From a surgical standpoint the incidence is higher and prophylactic antibiotics would be utilized in my clinical practice. As is true in all of medicine it is very difficult to have a one size fits all approach. I personally request most current labs to to evaluate each patients status. Take home is make sure your provider understands the lab data to weigh the pros and cons of a drug holiday. The bleeding issue in the oral cavity is much more easily managed than surgery at other less accessible surgical sites post op. Hope this helps. BEST TO ALL.

Lee

[AshGS in reply to lebo222]

thanks much for a very comprehensive reply

[Kingfish6]

Hi. Does doc recommend this? Never mentioned to me & dentist / oral surgeon pulling wisdom teeth had no concern about bleedinng. The concern was more toward infection & priming with amoxocillin both due to CLL & hip replacement.