Ibrutinib

How it works

It irreversibly inhibits BTK, blocking B-cell receptor signalling and thereby impairing malignant B-cell proliferation, survival and migration.

Prescribing in practice

• It increases the risk of bleeding and of atrial fibrillation, so assess cardiovascular risk and exercise caution with concomitant anticoagulants and antiplatelets.
• It is a CYP3A substrate, so co-administration with strong CYP3A inhibitors or inducers requires dose adjustment or avoidance.
• Consider holding therapy peri-operatively because of bleeding risk and monitor for infections and hypertension.

Monitoring

Monitor full blood count, cardiac rhythm and blood pressure, and remain alert for bleeding and infection throughout treatment.

Counselling the patient

• Report any unusual bruising or bleeding, palpitations, breathlessness or signs of infection.
• Take it consistently and avoid grapefruit and Seville oranges, which can raise drug levels.
• Tell your team before any surgery or dental procedure.

Evidence & guidelines

Ibrutinib is recommended by NICE for chronic lymphocytic leukaemia and other B-cell malignancies on the basis of randomised trials such as RESONATE.