Imbruvica interactions: Alcohol, medications, and other factors

Here are some frequently asked questions about Imbruvica and possible interactions.

Is there an interaction between Imbruvica and coffee?

Imbruvica has not been specifically reported to interact with coffee. However, Imbruvica commonly causes diarrhea, and drinking coffee could worsen this side effect of Imbruvica. (For details about Imbruvica’s side effects, see this article.)

If you have other questions about Imbruvica and coffee, talk with your doctor or pharmacist.

What pain relievers can I take with ibrutinib?

If you need a pain reliever while taking Imbruvica, it’s usually considered safe to take acetaminophen (Tylenol). If you have more severe pain, it’s also usually safe to take opioid pain relievers such as codeine. Your doctor may also prescribe stronger opioids if you have severe pain while taking Imbruvica.

However, you should avoid taking anti-inflammatory pain relievers such as ibuprofen (Advil, Motrin) with Imbruvica, unless these are recommended by your doctor. Nonsteroidal anti-inflammatory drugs (NSAIDs) can raise your risk of bleeding with Imbruvica. For more information about this interaction, see the “Drug interactions in depth” section below.

If you have other questions about taking pain relievers with Imbruvica, talk with your doctor or pharmacist.

There aren’t any known interactions between Imbruvica and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Imbruvica treatment.

This is because drinking alcohol while taking the drug may worsen some of Imbruvica’s side effects. For example, you may experience:

• nausea
• vomiting
• diarrhea
• headache
• dizziness

If you consume alcohol during Imbruvica treatment, these side effects may be more likely to occur. If you have questions about drinking alcohol while taking Imbruvica, talk with your doctor.

Before you start treatment with Imbruvica, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Imbruvica interacts with supplements, herbs, or vitamins, see the “Imbruvica and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Imbruvica. Keep in mind that this table doesn’t include all drugs that may interact with Imbruvica. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Here’s a closer look at certain drug interactions of Imbruvica.

Certain antibiotics

Imbruvica can interact with certain antibiotics, which are drugs used to treat bacterial infections.

Interaction result: Taking certain antibiotics with Imbruvica can raise your risk of side effects from Imbruvica. (For details about Imbruvica’s side effects, see this article.)

Interaction explained: Certain antibiotics can slow down the action of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Imbruvica.

By slowing down this enzyme, these antibiotics can cause Imbruvica to build up in your body. Having a higher level of Imbruvica in your body is more likely to cause side effects.

Examples of antibiotic drugs: Here are some antibiotics that may interact with Imbruvica:

• ciprofloxacin (Cipro)
• clarithromycin (Biaxin)
• erythromycin (Erytab, others)

Steps you or your doctor may take: If you develop a bacterial infection while taking Imbruvica, your doctor will usually prescribe an antibiotic that doesn’t interact with Imbruvica.

If your doctor prescribes one of the antibiotics listed above with Imbruvica, they may reduce your Imbruvica dosage. Or they may have you pause Imbruvica treatment while you take the course of antibiotics. Be sure to follow your doctor’s instructions.

If you have questions about taking antibiotics with Imbruvica, talk with your doctor or pharmacist.

Certain seizure medications

Imbruvica can interact with certain seizure medications, which are used to treat seizure disorders such as epilepsy.

Interaction result: Taking Imbruvica with certain seizure medications can make Imbruvica less effective at treating your blood cell cancer or graft-versus-host disease.

Interaction explained: Certain seizure medications can speed up the action of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Imbruvica.

By speeding up this enzyme, these medications can lower the level of Imbruvica in your body. Having a lower level of Imbruvica in your body can make it less effective at treating your condition.

Examples of seizure medications: Here are some seizure medications that may interact with Imbruvica:

• carbamazepine (Tegretol, others)
• phenobarbital (Sezaby)
• phenytoin (Dilantin)

Steps you or your doctor may take: If you take one of these seizure medications, your doctor will likely avoid prescribing Imbruvica. They may recommend switching to a different seizure medication. Or they may prescribe a treatment other than Imbruvica.

NSAIDs

Imbruvica can interact with NSAIDs, which are a group of pain relievers that also reduce inflammation (swelling).

Interaction result: Taking an NSAID with Imbruvica can raise your risk of bleeding.

Interaction explained: NSAIDs and Imbruvica can both cause bleeding, including serious bleeding such as bleeding in your stomach or intestines. So you may have a higher risk of this side effect if you take these drugs together. (For details about Imbruvica’s side effects, see this article.)

Examples of NSAIDs: Here are some NSAIDs that may interact with Imbruvica:

• aspirin
• ibuprofen (Advil, Motrin)
• naproxen (Aleve, Naprosyn)

Steps you or your doctor may take: You should avoid taking NSAIDs with Imbruvica unless they are recommended by your doctor. Keep in mind that many over-the-counter pain relievers contain aspirin or ibuprofen. You should check with your doctor before taking these medications with Imbruvica.

If your doctor recommends taking Imbruvica and an NSAID together, tell your doctor if you have any unusual bleeding, such as nosebleeds or bleeding gums. Call your doctor right away if you have symptoms of more serious bleeding. These may include:

• coughing up blood
• blood in your urine
• black or tar-like stools
• vomiting blood or a substance like coffee grounds
• sudden or severe headache

If you have questions about taking Imbruvica with an NSAID, talk with your doctor or pharmacist.

Imbruvica may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Imbruvica.

Imbruvica interactions with supplements

Before you start treatment with Imbruvica, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Doctors will typically recommend you avoid taking St. John’s wort with Imbruvica. St. John’s wort is an herbal supplement that may be used to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Imbruvica.

By speeding up this enzyme, St. John’s wort can cause Imbruvica to break down more quickly. This may lead to a low level of Imbruvica in your system. If the level of Imbruvica in your system is too low, the drug may not work to treat your condition.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Imbruvica and vitamins

There are no specific reports of vitamins interacting with Imbruvica. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Imbruvica.

Imbruvica interactions with food

Grapefruit, grapefruit juice, and Seville oranges can interact with Imbruvica. Specifically, these fruits can stop your body from breaking down Imbruvica. This raises the level of Imbruvica in your body, which increases your risk of side effects from Imbruvica. (For details about Imbruvica’s side effects, see this article.)

Due to this risk, your doctor may recommend not consuming grapefruit, grapefruit juice, Seville oranges, and foods containing these fruits while taking the drug.

Imbruvica interactions with vaccines

Imbruvica may interact with live vaccines. A live vaccine contains live but weakened pieces of the virus or bacterium it’s meant to defend against. When your immune system is healthy, live vaccines usually won’t cause infection.

But Imbruvica (and the condition you take it for) can weaken your immune system. So if you get a live vaccine, your immune system may not be able to fight the virus or bacterium. This may cause you to become sick or develop symptoms of the illness the vaccine is meant to prevent.

Examples of live vaccines to avoid during Imbruvica treatment include:

• measles, mumps, rubella (MMR)
• chickenpox
• flu vaccine (nasal spray form)

Before starting Imbruvica, talk with your doctor or pharmacist about any vaccines you may need.

Imbruvica interactions with lab tests

Imbruvica isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

IMBRUVICA INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Imbruvica.

Using cannabis with Imbruvica may affect the amount of Imbruvica in your body. It could raise your risk of side effects from Imbruvica. (For details about Imbruvica’s side effects, see this article.) Or it could make the drug less effective at treating your condition.

Before you start treatment with Imbruvica, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Imbruvica. Before you take this drug, be sure to talk with your doctor about your health history. Imbruvica may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Imbruvica include:

• Liver problems: Your liver helps clear Imbruvica from your body. If you have liver problems, Imbruvica can build up in your body. This can raise your risk of side effects from the drug. (For details about Imbruvica’s side effects, see this article.) Due to this risk, your doctor may prescribe a dosage of Imbruvica that’s lower than usual. But if you have severe liver problems, your doctor may not prescribe this medication. You can ask them about other treatments that may be safer for you.
• Bleeding problems: Imbruvica can cause bleeding, which can be serious or even life threatening. If you have a condition that raises your risk of bleeding, such as hemophilia, low platelet count, or a stomach ulcer, you may have a higher risk of bleeding with Imbruvica. Talk with your doctor about whether Imbruvica is right for you.
• Recent or upcoming surgery: If you’ve recently had surgery, you may have a raised risk of bleeding with Imbruvica. Due to this risk, your doctor may recommend that you don’t start Imbruvica until a few days after your surgery. If you have any surgery planned during Imbruvica treatment, talk with your doctor beforehand. They may recommend pausing Imbruvica for a few days before and after your surgery.
• Infections: Imbruvica can raise your risk of infections. If you have an active infection or infections that keep coming back, your doctor may prescribe medication to treat this before you start taking Imbruvica.
• Heart problems: Imbruvica can cause heart failure and irregular heart rhythms. If you have a heart problem, you may have a higher risk of these side effects of Imbruvica. (For details about Imbruvica’s side effects, see this article.) Talk with your doctor about whether Imbruvica is right for you. If your doctor prescribes this medication, they’ll likely monitor your heart during treatment.
• High blood pressure: If you have high blood pressure, Imbruvica can make this worse. You may also have a higher risk of heart problems with Imbruvica (see just above). Your doctor will likely monitor your blood pressure and your heart while you’re taking Imbruvica.
• Heart disease risk factors: If you have risk factors for heart disease, such as diabetes, high cholesterol, or smoking, you may have a higher risk of heart problems with Imbruvica (see just above). Talk with your doctor about ways to reduce your risk.
• Allergic reaction: If you’ve had an allergic reaction to Imbruvica or any of its ingredients, your doctor will likely not prescribe Imbruvica. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s not known whether it’s safe to use Imbruvica while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Imbruvica may have on a child who is breastfed. Due to the risk of side effects, your doctor will likely recommend that you don’t breastfeed while taking Imbruvica and for 1 week after your last dose. If you’re breastfeeding or planning to, talk with your doctor before using Imbruvica. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: Imbruvica is likely not safe to use while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects) or pregnancy loss. If you’re pregnant or planning to become pregnant, tell your doctor before starting Imbruvica. They can advise you on the right treatment plan for you. If you’re able to become pregnant, you should use birth control while taking Imbruvica and for 1 month after your last dose. If you’re male and have a sexual partner who can become pregnant, you should use condoms while taking Imbruvica and for 1 month after your last dose.

You can take certain steps to help prevent interactions with Imbruvica. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Imbruvica label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Imbruvica doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Imbruvica by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.