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Treatment Name: Ibrutinib (Imbruvica®)

Ibrutinib (Imbruvica®) is a Chemotherapy Regimen for Chronic Lymphocytic Leukemia (CLL)

How does ibrutinib work?
Ibrutinib is an oral chemotherapy medication designed to cause cancerous B-lymphocytes to leave the bone marrow and lymph nodes, and enter the bloodstream where they die more quickly. It does this by binding to and blocking the action of an enzyme within CLL cells known as Bruton's tyrosine kinase, otherwise known as BTK.

Goals of therapy:
Ibrutinib is taken to decrease the size of lymph nodes, decrease the size of an enlarged liver or spleen, or to increase the number of good cells made in the bone marrow. Patients may benefit from increased appetite, disappearance of swollen lymph nodes, and improvement in normal blood cell counts. Ibrutinib is commonly taken to control symptoms from CLL or prevent CLL from progressing (getting worse). Ibrutinib is not commonly given with the goal of cure. The majority of patients who take ibrutinib have a response to the medication.


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Usual ibrutinib starting dose:

  • Ibrutinib 420 mg tablet (or three 140 mg capsules) by mouth once daily, every day of the week

Duration of therapy is indefinite, meaning that ibrutinib should be taken as long as it is working and side effects, if any, are tolerable.

Note: Individual doses may vary based upon your Doctor's recommendation, and drug availability. For patients who prefer capsules, ibrutinib may be taken as 420 mg (three 140 mg capsules) by mouth once daily, every day of the week. Typically, all 3 capsules are taken all at once, and around the same time of day.


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Side Effects

In clinical studies, the most commonly reported side effects with ibrutinib are shown here. Side effects sometimes have percentage ranges [example: 6 – 9% have abnormal heart rate] because they differed between clinical studies:

The percentage of patients that discontinued ibrutinib due to unacceptable side effects is low, roughly 4%. Most side effects resolve without having to hold therapy.

If atrial fibrillation develops after beginning therapy with ibrutinib, your doctor may advise that you continue ibrutinib therapy, or stop for a short time, or change ibrutinib to an alternative medication if you prefer. Ibrutinib-related atrial fibrillation can be managed via a number of different ways

Side effect videos Side Effect Videos
BleedingBleedingDiarrheaDiarrheaFatigue Fatigue PainPainBlood ClotsBlood ClotsNausea and VomitingNausea and Vomiting


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How often is monitoring needed?
Labs may be checked before treatment, weekly during the 1st month, then every other week during the 2nd month, and once monthly until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lactate dehydrogenase (LDH), magnesium, phosphorous, uric acid, plus any others your doctor may order. When ibrutinib is taken alone, it may cause lymphocytosis, which is a rise in the white blood cell (WBC) count.

Because ibrutinib can cause bruising or bleeding in up to 50% of patients, a baseline measurement of your body's blood clotting may be needed. These tests commonly include the PT (Prothrombin Time) and the aPTT (activated Partial Thromboplastin Time).

Tumor lysis syndrome may occur. Depending on baseline uric acid level and LDH level, the drug, allopurinol, may need to be taken for 7 to 28 days to help your kidneys eliminate uric acid.

How often is imaging needed?
Imaging may or may not be needed for patients with CLL. Imaging may help detect infection and may include: chest X-rays or CT scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.


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ChemoExperts Tips

  • Patients should contact their doctor immediately if they develop lightheadedness or feel their heart racing
  • Food increases absorption by 2-fold so it is best to take on an empty stomach to avoid an increase in side effects
  • Consider taking ibrutinib at bedtime since it may cause nausea. All three capsules should be taken at the same time
  • As ibrutinib may increase the risk of bleeding, it is important to tell the hematologist when you are having surgery or dental work and what type. They will then consider the risks versus benefits of temporarily holding ibrutinib therapy for up to 7 days pre and post-surgery or dental procedure. The length of time to hold ibrutinib will depend upon the type of surgery and the risk of bleeding
  • Talk to your healthcare provider before eating grapefruit or drinking grapefruit juice, Squirt, Fresca, Sundrop, or things that say “citrus blend” as these may increase the risk of side effects
  • High blood pressure may occur in patients taking ibrutinib. If the blood pressure increases, it often does so after about 4 months of taking ibrutinib. If you are already taking medications for blood pressure, the doses may need to be adjusted when adding ibrutinib, or changed to a different blood pressure medication if they interact with ibrutinib
  • Two out of three people (67%) taking ibrutinib for 6 - 12 months report fingernail changes such as splitting or cracking. Toenails may also become more brittle and it may take a few months longer to notice these changes. In addition, hair may change in texture in about one in four people (25%), and may be noticeable between 6 - 12 months after starting ibrutiinb. Some people have tried taking biotin (vitamin B7, an over-the-counter supplement) to help restore normal nail growth. Talk to your doctor before trying biotin for ibrutinib-related nail changes
  • Bring all of your pill bottles to every clinic visit! This will make it easier for your healthcare team to make sure that ibrutinib can be taken safely with every other medication you are currently taking
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • If you are having trouble paying for ibrutinib, there are many patient assistance programs available to help. Ask your doctor or pharmacist to help you with this before you run out of medication
  • Clinical trials may exist for CLL. Ask your doctor if any studies are currently enrolling in your area. If not, go to and type in “CLL” to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Ibrutinib (Imbruvica®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Ibrutinib (Imbruvica®). Depending upon your income, they may be able to help cover the cost of:

  • Ibrutinib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Ibrutinib (Imbruvica®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Ibrutinib (Imbruvica®)

Individual Drug Label Information

Ibrutinib (Imbruvica®)

  • Ibrutinib is available as an oral TABLET in 140 mg, 280 mg, 420 mg, and 560 mg strengths
  • Ibrutinib is available as an oral CAPSULE in 70 mg and 140 mg strengths
  • Ibrutinib should be swallowed whole. It is usually taken without food, at bedtime, and with a large glass of water 
  • Food increases ibrutinib absorption so it is best to take on an empty stomach to avoid an increase in side effects
  • If you miss a dose, take the dose as soon as possible on the same day, then return to the normal schedule. If already the next day, do not take extra doses. Wait until your next dose is due 
  • Dosage adjustments may be required if taken with certain medicines or if the liver is not working properly 
  • May interact with grapefruit or grapefruit juice, as well as medicines used to prevent clotting 
  • Store ibrutinib at room temperature 
General Ibrutinib (Imbruvica) Side Effects
  • Bruising or bleeding: patients taking other medicines that affect clotting or platelet count or platelet function may be at increased risk. Report any signs of bleeding immediately 
  • Diarrhea: drink plenty of fluids to prevent losing too much fluid (dehydration). Can often be treated using anti-diarrhea medicines 
  • Infection: patients should call their doctor if they experience a fever, chills, or other signs of infection 
  • Tiredness 
  • Bone pain 
  • Rash 
  • Water retention or swelling 
  • Muscle spasms 
  • Headache
  • Nausea or vomiting
  • Constipation
  • Abnormal heart rate, also known as atrial fibrillation may occur. Signs or symptoms include fast heart beat, dizziness, shortness of breath, chest discomfort, or feeling faint 
  • Rarely, new cancers such as skin cancer, have been diagnosed in people taking ibrutinib 
  • Click on the ibrutinib (Imbruvica) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleedingConstipationConstipationPainPain

See DailyMed package insert.

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1) Byrd JC, et al. Targeting BTK ibrutinib in relapsed chronic lymphocytic leukemia. N Engl J Med. 2013;369:32-42.

2) Bitar C, Farooqui MZ, Valdez J, et al. Hair and Nail Changes During Long-term Therapy With Ibrutinib for Chronic Lymphocytic Leukemia. JAMA Dermatol. 2016;152:698-701.

Created: November 28, 2015 Updated: July 4, 2018

What is Chronic Lymphocytic Leukemia (CLL)?

Chronic Lymphocytic Leukemia (CLL) is the most common type of leukemia diagnosed in adults. It is a cancer of the B-lymphocyte. In rare cases, CLL may be hereditary, but most causes are unknown. The stage of CLL can vary at diagnosis and throughout treatment. Stages of CLL include Rai stage 0, I, II, III, or IV. Many therapies are not curative, however, newer therapies are able to suppress the cancer for many months or even years.

As depicted in the picture, CLL may affect lymph nodes, the spleen, bone marrow, and the blood.

CLL may affect lymph nodes, the spleen, bone marrow, and the blood

Medications for CLL may include intravenous infusions, oral tablets or capsules, or a combination of IV and oral medications. Patients may be diagnosed with CLL without having any symptoms. Others may go to their doctor with symptoms of fatigue, a large spleen, or decreased appetite. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is Atrial Fibrillation?

Atrial fibrillation, or “Afib,” is when part of your heart, the atria, beats abnormally fast. A fast heart rate can sometimes be felt. This may be referred to as a palpitation. Afib can lead to low blood pressure, shortness of breath, lightheadedness or dizziness. It may also increase the risk of a blood clot forming. Blood clots may be life threatening, especially if they occur in the brain, lungs, or a blood vessel leading to the heart. If you develop these symptoms, seek emergency care immediately.

What is Lymphocytosis?

When B-lymphocytes increase in quantity in the bloodstream. Because lymphocytes are a type of white blood cell (WBC), the WBC count will increase as well. Lymphocytosis happens in about 80% of people taking Ibrutinib and usually does not cause any symptoms.

It is important to know that this is expected and NOT usually a sign that the disease is progressing. The WBC count usually reaches its highest level after 4 weeks, and then begins to go back down. Some patients achieve a normal WBC count within 6 months, whereas others may take more than a year before their WBC returns to normal. Lymphocytosis often occurs at the same time that lymph nodes shrink, the spleen size decreases, and other blood counts improve.

Sometimes an increased white blood cell count can suggest cancer growth. If concerned about your white blood cell count, talk to your doctor.

What is Tumor Lysis Syndrome?

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Usually the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs intravenous fluids (hydration) or medicines to help eliminate these substances and to prevent organ damage.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium

Ibrutinib-Related Atrial Fibrillation (Afib)

Click here for a proposed algorithm for managing ibrutinib-related afib