Adverse event potentially due to an interaction between ibrutinib and verapamil: a case report

Journal of Clinical Pharmacy and Therapeutics
E Lambert KuhnP Bilbault

Abstract

Ibrutinib is a recently approved oral anticancer agent with pharmacokinetics that is very sensitive to metabolic inhibition. We report a serious side effect of ibrutinib potentially attributable to interaction with the moderate CYP3A4 inhibitor verapamil. A patient with mantle cell lymphoma was admitted to our emergency department with severe diarrhoea. During a prescription review, the clinical pharmacist identified a potential drug interaction between ibrutinib and verapamil present in a branded combination product also containing trandolapril. Ibrutinib was discontinued for 5 days, and verapamil was stopped. Lercanidipine 10 mg daily was prescribed as an alternative antihypertensive drug. The patient was discharged after 3 days with symptomatic treatment for his diarrhoea. Three months later, the patient maintained control with ibrutinib and olmesartan, but without verapamil. This is the first description of a serious side effect of ibrutinib likely due to an interaction with the CYP3A4 inhibitor verapamil. Prescriptions of ibrutinib must be carefully checked to identify possible interactions with CYP3A4 inhibitors and patients monitored accordingly.

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Citations

Jun 17, 2016·Expert Opinion on Drug Metabolism & Toxicology·Fernando de AndrésPaolo Martelletti
Oct 22, 2016·ACS Chemical Biology·Adam R JohnsonWendy B Young
Nov 9, 2017·Basic & Clinical Pharmacology & Toxicology·Ren-Ai XuGuo-Xin Hu
Jul 27, 2018·Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners·Hira ShaikhSalman Fazal
Mar 8, 2018·Hematological Oncology·Giuseppe BorianiPier Luigi Zinzani
Aug 30, 2018·Drug Development and Industrial Pharmacy·Jian WenHong-Yu Zhou
Dec 20, 2017·Blood·Jennifer R Brown
Sep 13, 2020·Pharmaceutics·Dominique A GarrisonSharyn D Baker
Jun 11, 2021·Circulation Research·Matthew R FlemingJavid J Moslehi

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