contraindications of BTKI and osteopenia/Osteoporosis drug?

[sunsetssr]

Does anyone in the active treatment of Lymphoma, with BTKI need treatment for osteoporosis or osteopenia has been warned by the Oncologist or a pharmacist about the contraindications and side effects of drugs used? Appreciate sharing your experience.

[GMa27]

I think I still took my Actonel during chemo. It was 3 months of treatment. But that was in 2018. Could be different now. What did ur endocrinologist & hematologist say? You can't go without osteoporosis meds rest of ur life.

[sunsetssr in reply to GMa27]

Thanks for the replay. I'm at the very early stage of researching for treatment of Ostopenia. The treatment is recommended by my Primary Physician who already consulted with the Endo. Specialist. I'm going to inform my Haemotologist about theis recomendation and see if she would agree. Thanks again for sharing your experience with me.

[mrsjsmith]

Hello,

I hope not because I am on Ibrutinib and started on Alendronic acid for osteoporosis at the beginning of the year. This medication was discussed with a bone specialist and my very experienced haematology pharmacist. The one thing I am aware of is very rare cases of bone necrosis with tooth extractions. Annoyingly I have a loose tooth that my dentist thinks is safer removed but this will be done in hospital and I have a pre assessment before that happens.

Where did you hear this.

[DoriZett in reply to mrsjsmith]

So sorry for the timing of your loose tooth. Just adding to the discussion on this topic: I was fortunate to be off CLL/SLL treatment/back in W&W when I had Reclast (Zoledronic acid) for osteopenia. I had a violent reaction to it and can no longer take meds to ward off osteoporosis. The advice from the docs "Don't Fall!" (and do light weights exercise over head if my arthritic cervical thoracic spine will allow 😉). Not ideal - but here I am. There is a suggested 1 year waiting period after the Reclast infusion before any deep dental work - like oral surgery/tooth extraction over concerns of jaw necrosis. Wouldn't you know - I developed two dental abscesses which required extraction - during that year of waiting. The decision was to keep knocking the infections back with antibiotics and let the year pass until they could be more safely extracted. Lots of antibiotics - also not ideal. CLL/SLL and simmering abscesses/infections just barely kept in check - also not ideal. I am sitting here with the stitches in my mouth from the 2nd tooth extraction. The first one 3 weeks ago seemed to heal well without any concerns of jaw necrosis. We CLL/SLLers have so much to be aware of and juggle - I want to shout out to all of us - good job being the best stewards of our health and educating ourselves (and helping each other on sites such as this). All the best to you.

[mrsjsmith in reply to DoriZett]

Sorry to hear about your problems, and totally agree about being aware of our health. There are are new treatments available, but luckily I was told I wasn’t severe enough to receive them. Hopefully I was aware of what the treatment involved, and luckily my amazing GP referred me to two different consultants before starting treatment. Sadly with teeth ( even though I go every 3 months ) problems suddenly appear 🙄

[sunsetssr in reply to mrsjsmith]

Thanks for the reply. I have read an article about it. Not sure how reliable was it. It also talked about supplement like vitamins and minerals we all take during cancer treatment which may cause conraindications.This need to be researched more carefully.One of the reliable resource is ONCOLINK.ORG or Livertax.com/NIH, for some accurate information.

[camper2]

I am in the same position as mrsjsmith (except I’m on Acalabrutinib and osteopenic 2.2 score). I am about to go for an assessment to have a tooth implant - we will see how that goes!

[lankisterguy Volunteer]

Hi sunsetssr,

-

You may be encountering what we call the "grapefruit" restriction. Many CLL drugs are sensitive to CYP3A inhibitors or inducers found in grapefruit and many common drugs for other conditions.

From a quick Google search it appears there are some osteoporosis drugs that cause a drug drug interaction and some that don't. Your pharmacist and the doctors involved have software tools that can sort out any issues and choose drugs that are safe when used together. Note: there is a similar issue with Paxlovid and with some dietary supplements like St. John's Wort.

See healthunlocked.com/cllsuppo...

pubs.acs.org/doi/10.1021/ac...

ncbi.nlm.nih.gov/books/NBK5...

-

Len

[mrsjsmith in reply to lankisterguy]

Thank you Len,

I just had a quick glance at the NHS website and it mentions telling consultants if you are on chemotherapy.

Regards

Colette

[sunsetssr in reply to lankisterguy]

Hi,great analogy of drug interaction and resources.. Thanks

[Zia2]

I was on Alendronate weekly while on brutinibs for 1.5 years. It was my CLL specialist in Chicago that insisted I treat my osteoporosis as well.

[sunsetssr in reply to Zia2]

Thanks for your reply. It is reassuring to know about your experince doing both treatment at the same time with no contrindication. Thanks again.

[bachplayer13]

I assume you cannot have any problems from this treatment. What about dental work? Have you had to have any hopefully not

[DoriZett]

😄

[annmcgowan]

Hi I am on ibrutinib. I have just had my 2nd zoleidinic infusion, for my bone condition. My haematologist was quite happy for me to have this. I haven’t discussed with my dentist as I don’t need treatment for my tests right now.

Ann

[sunsetssr in reply to annmcgowan]

Thanks for the reply. I'm sure my PCP has Zolendronic acid injection in mind for my treatment. Your experience with this drug while on ibrutinb is very helpful to me. Thanks again.

[annmcgowan]

Good luck.

Ann