Atorvastatin and Ibrutinib?

[RobertCLL]

I asked the group about a month ago if it was OK to take Atorvastatin and Ibrutinib, several members came back and said they have been on the combination.

However, my Haematologist has advised and I quote:

"There may be an interaction and should not be given to prevent high cholesterol and if your cholesterol is high and GP wants to start you on medication to start you on a different one but of his choice. "

I did say that my GP is probably not the best person to advise as he/she is not an expert in CLL and possible interactions.

Drugs.com says no interaction.

Any suggestions as to what I do next?

[PaulaS Volunteer]

Hi Robert, thanks for asking this. I'm on Ibrutinib and have also recently started on Atorvastatin, so will be interested in any replies you get.

I haven't had any noticeable side effects since starting the statin, but of course things can be going on that I'm not aware of.

Did your haematologist give you any idea of what sort of interaction might occur? Eg would the statin make a difference to absorption levels of Ibrutinib? Would Ibrutinib inhibit absorption of the statin?

I take the statin at a different time of day to the Ibrutinib, I wonder if that avoids any interaction?

Paula

[RobertCLL in reply to PaulaS]

Paula

I was told that metabolism of Ibrutinib can be decreased with Atorvastatin.

[PaulaS Volunteer in reply to RobertCLL]

Thanks Robert. It's very helpful to know that.

[Classicaljazz in reply to PaulaS]

Calling the Imbruvica customer support and asking to speak with a company pharmacist may be helpful. You could check your Imbruvica website online for contact info for UK or other locations. For the USA:

Support is just a phone call away.

Find your dedicated IMBRUVICA® By Your Side Ambassador by calling 1-888-YourSide (1-888-968-7743).

Contact information:

Pharmacyclics LLC, an AbbVie Company, and Janssen Biotech, Inc., partner to develop and commercialize IMBRUVICA® (ibrutinib) for oncology and other serious diseases in the United States.

Pharmacyclics LLC

999 East Arques Avenue

Sunnyvale, CA 94085

Phone: [phone]

pharmacyclics.com

Janssen Biotech, Inc.

800 Ridgeview Drive

Horsham, PA 19044

janssenbiotech.com

Medical Information Inquiries

For medical information about IMBRUVICA®, or to report a possible adverse event or product quality complaint, please contact Pharmacyclics Medical Information by using one of the following two methods:

Phone: [phone]

Select Option 2 for Medical Information Inquiries

Select Option 3 for Reporting of Possible Adverse Events or Product Quality Complaints

E-mail: [e-mail] 

[PaulaS Volunteer in reply to Classicaljazz]

Thanks Classicaljazz. I'm in the UK but must try and follow things up.

[Skyshark]

From the wiki: Atorvastatin as a substrate for the CYP3A4 isozyme, it has shown susceptibility to inhibitors and inducers of CYP3A4 to produce increased or decreased plasma concentrations, respectively.

BTKi drugs are affected by CYP3A4 inhibitors, showing an increased dose concentration.

Supposition: If both are competing for available CYP3A4 they could act as inhibitor to each other, increasing the plasma dose concentration of both.

[RobertCLL]

Thank you. So it does mean that Atorvastatin and Ibrutinib COULD affect each other. Still not sure what I should do next in getting this resolved!

[AussieNeil Partner Administrator in reply to RobertCLL]

This is where I find that having access to a hospital pharmacist, who has experience in dispensing drugs for people with CLL and knows about potential interactions is invaluable. If you can talk with someone like this, they might be able to advise how to take both drugs in their full strength, such as one in the morning and the other in the evening, if both are taken in one dose daily. That's fortuitously the case with these medications, but not for most other BTKi medications. Otherwise, the pharmacist could confer with your prescribing doctors, to determine the primary and secondary drug priority, reducing the dose of the less critical drug. I'd expect that this would probably be the Atorvastatin.

Per Mayo Clinic Drugs and Supplements

Atorvastatin (Oral Route) mayoclinic.org/drugs-supple...

"Tell your doctor if you regularly drink grapefruit juice. Drinking large amounts of grapefruit juice (more than 1.2 liters each day) while you take this medicine may increase your risk of muscle injury and could result in kidney problems."

Which is what you'd expect for medications susceptible to CYP3A4 inhibitors as Skyshark previously noted.

It's surprising drugs.com doesn't report an interaction, but of note, it does point out that the side effects of both drugs can be worsened if you drink grapefruit juice.

drugs.com/interactions-chec...

Neil

[RobertCLL in reply to AussieNeil]

I have asked for a referral to the hospital pharmacists, but this was not acceptable to my Haematologist. I have made a call to my GP surgery today, with a view of them formally writing to the hospital for advice.

[mrsjsmith in reply to RobertCLL]

Robert is there not a pharmacist that works within the Haematology department ? My hospital has a brilliant one who is a mine of information.

The alternative is for someone to call the drug company directly and discuss.

Colette

[RobertCLL in reply to mrsjsmith]

Yes there is, but getting a conversation with the person, when you don't have a name is difficult. Will do some research.

[mrsjsmith in reply to RobertCLL]

Do you have a CNS to ask.

[RobertCLL in reply to mrsjsmith]

Yes, been in conversation wit CNS, but unable to help. The consultant said "that the the way", so she was following the instructions from high.

[mrsjsmith in reply to RobertCLL]

Sorry to hear they are making your life so difficult.

Colette

[RosettaClapp in reply to RobertCLL]

Maybe next time you go to your hospital just visit the. Pharmacy in person and ask to speak to the pharmacist? That is quite possible in my hospital

[Skyshark in reply to AussieNeil]

bnf.nice.org.uk/interaction...

UK NICE drug interaction checker which is what NHS pharmacist will use also shows no interactions.

[RobertCLL in reply to Skyshark]

Thank you. BTW, I see there are also a number of other modern targeted treatment that are listed with interactions.

[annmcgowan]

Hi Robert my haematologist said going on to statins would be good for me if I could tolerate them. I have started and so far no side effects and bloods have been great.

Ann

[Bowie1957]

I have been taking both for about 5 years and not had any issues!

[camper2]

Following this discussion with interest. Had a discussion yesterday regarding starting statins so this is pertinent.

Incidental, I knew my cholesterol was likely to be problematic, so I phoned the Hospital Pharmacist to ask if there were any statins I should ask my GP to avoid while on Acalabrutinib. The answer was no.

[RobertCLL in reply to camper2]

Interesting. I will try the same thing today.

[Mahunny]

I am taking Calquence & Atorvastatin. They put me on Atorvastatin before my diagnosis and reported that my A1c was also high (but not put on medication). Once I was diagnosed and started Calquence, my A1c returned to normal (I think my entire system was 'off' due to the undiagnosed CLL), so I was very keen to get off the Atorvastatin too hoping my cholesterol would be 'normal' w/out it. I had no interactions, but just didn't want to be on any pills I didn't HAVE to be on. Anyway, after 8 months of steady cholesterol numbers, my GP allowed me to go off Atorvastatin. However at my next blood panel, the cholesterol was back up, so I'm back on the Atorvastatin. All this is to say, that I haven't had any interactions and, well, if we need to be on certain medications (even if we hate the idea of it), we need to take them. I hope you find your answer - I did my little experiment and while it didn't pan out the way I wanted it to, I'm happy, functioning w/out any serious side effects, and living my life. Good luck to you! I'm in Los Angeles for reference.

[marianne12345]

I started taking Atorvastatin shortly after starting Venetoclax 10 years ago. The clinical trial nurse said there was an interaction with the two drugs and did not know what it was so contacted Abbvie. They decided that I was to reduce the dose of Atorvastatin by half from 20 ml to 10. I am still on both drugs. Like in your case Robert, Drugs.com showed no interaction. But when looking on Medscape it said "atorvastatin will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities." I also found this article "Statins enhance efficacy of venetoclax in blood cancers" ncbi.nlm.nih.gov/pmc/articl... . I'm not sure if this would apply to your situation with Atorvastatin and Ibrutinib but it reinforces how contradicting the drug interactions information can be.

[RobertCLL]

It has been proposed that I give it a go at half dose and see what happens! However, now waiting on my GP pharmacist to review interactions and advice.

[PaulaS Volunteer]

Hi Robert, It's all very complicated, trying to work out what's best. I'll be interested to hear what your GP pharmacist says.

For now, I've decided to reduce my Atorvastatin from 20 to 10 mg. My GP is happy for me to do that.

Paula

[hervec]

Bonjour

A solution I use, is no other pils 6 hours before and after ibrutinib. And as its better to take statin at the evening. I take ibrutinib a 9 am and statin at 9 pm.

Herve C

[RobertCLL in reply to hervec]

Hervec. That's a good idea to avoid any conflict.