Imbruvica (ibrutinib) is a prescription drug used to treat certain blood cancers in adults and graft-versus-host disease in adults and some children. Imbruvica can interact with some supplements and other medications, such as certain heart drugs and antibiotics.
Imbruvica comes in three oral forms: capsules, tablets, and a liquid suspension (a type of liquid mixture). The drug contains the active ingredient ibrutinib. To learn more about Imbruvica, see this in-depth article.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Before you start taking Imbruvica, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Imbruvica interacts with herbs or vitamins and supplements, see the “Are there other interactions with Imbruvica?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Imbruvica. Keep in mind that this table does not include all drugs that may interact with Imbruvica. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| certain antiandrogens | • apalutamide (Erleada) • enzalutamide (Xtandi) | can make Imbruvica less effective |
| certain antiarrhythmic drugs | • amiodarone (Pacerone) • dronedarone (Multaq) | can increase the risk of side effects from Imbruvica* |
| certain antibiotics | • clarithromycin • ciprofloxacin (Cipro) | can increase the risk of side effects from Imbruvica |
| certain antiepileptic drugs | • carbamazepine (Tegretol, others) • phenytoin (Dilantin) | can make Imbruvica less effective |
| certain antifungals | • ketoconazole • itraconazole | can increase the risk of side effects from Imbruvica |
| certain calcium channel blockers | • diltiazem (Cardizem, others) • verapamil (Verelan, others) | can increase the risk of side effects from Imbruvica |
| blood thinners | • warfarin (Jantoven) • apixaban (Eliquis) | can increase the risk of bleeding |
| nonsteroidal anti-inflammatory drugs (NSAIDs) | • aspirin • ibuprofen (Advil, Aleve) | can increase the risk of bleeding |
| cobicistat (Tybost) and combination drugs that contain it | • cobicistat/elvitegravir/emtricitabine/ tenofovir alafenamide fumarate(Genvoya) • cobicistat/darunavir/emtricitabine/ tenofovir alafenamide fumarate (Symtuza) | can increase the risk of side effects from Imbruvica |
| ritonavir (Norvir) and combination drugs that contain it | • nirmatrelvir/ritonavir (Paxlovid) • lopinavir/ritonavir (Kaletra) | can increase the risk of side effects from Imbruvica |
*To learn more about Imbruvica’s side effects, see this article.
Imbruvica is not known to interact with alcohol. But Imbruvica and alcohol can cause some similar side effects, such as fatigue and diarrhea. So you may be more likely to experience these side effects if you drink alcohol during your Imbruvica treatment.
If you have questions about consuming alcohol while using Imbruvica, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Imbruvica.
Interaction with certain calcium channel blockers
Imbruvica can interact with certain calcium channel blockers, which are used to treat high blood pressure, certain arrhythmias, and chest pain related to angina.
The following calcium channel blockers interact with Imbruvica:
- diltiazem (Cardizem, others)
- verapamil (Verelan, others)
What could happen
Diltiazem and verapamil can reduce the activity of certain enzymes that help remove Imbruvica from your body. This can increase the level of Imbruvica in your body, which raises your risk of side effects from Imbruvica, such as diarrhea and blood cell problems.
What you can do
If you take Imbruvica with diltiazem or verapamil, your doctor may prescribe a lower dosage of Imbruvica for you. You should not take a higher dose of either medication than your doctor prescribes.
If you have questions about taking Imbruvica with diltiazem or verapamil, talk with your doctor or pharmacist.
Interaction with certain antiepileptic drugs
Imbruvica can interact with certain antiepileptic drugs, which are used to treat epilepsy and other conditions.
The following antiepileptic medications interact with Imbruvica:
- carbamazepine (Tegretol, others)
- fosphenytoin
- phenytoin (Dilantin)
What could happen
The antiepileptics listed above can increase the activity of certain enzymes that help remove Imbruvica from your body. Increasing activity of these enzymes can lower the level of Imbruvica in your system, and Imbruvica may be less effective as a result.
What you can do
Due to this interaction, doctors typically avoid prescribing Imbruvica with carbamazepine, fosphenytoin, or phenytoin. Instead, they can suggest other antiepileptic medications to treat your condition that don’t have this interaction.
Interaction with certain antibiotics
Imbruvica can interact with certain antibiotics, which are used to treat bacterial infections.
Examples of antibiotic medications that can interact with Imbruvica include:
- clarithromycin
- ciprofloxacin (Cipro)
- erythromycin
What could happen
Certain antibiotics can lower the activity of certain enzymes that help remove Imbruvica from your body. This action can increase the level of Imbruvica in your body. As a result, taking Imbruvica with certain antibiotics can raise your risk of side effects from Imbruvica, such as diarrhea and blood cell problems.
What you can do
Doctors typically avoid prescribing certain antibiotics if you’re taking Imbruvica, unless there’s no other treatment for your infection. In that case, your doctor may either:
- have you temporarily stop taking Imbruvica until you complete your antibiotic course, and then have you resume taking Imbruvica
- temporarily lower your Imbruvica dosage until you finish taking the antibiotic, then resume your normal Imbruvica dosage
Imbruvica may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Imbruvica.
Does Imbruvica interact with supplements?
Before you start taking Imbruvica, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Imbruvica interactions with herbs
Imbruvica can interact with St. John’s wort, which is used to ease symptoms of depression and other conditions.
St. John’s wort can increase the activity of certain enzymes that help clear Imbruvica from your body. This action can lower the amount of Imbruvica in your system, which can make the drug less effective.
Because of this, your doctor will likely suggest you don’t take St. John’s wort while you’re taking Imbruvica. They can recommend other treatments that are safer to take with Imbruvica instead.
Imbruvica interactions with vitamins
There are currently no reports of Imbruvica interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Imbruvica.
Does Imbruvica interact with food?
Imbruvica can interact with grapefruit and grapefruit juice, as well as Seville oranges. These foods can lower the activity of certain enzymes that help remove Imbruvica from your body. Consuming them while taking Imbruvica can raise your risk of side effects from Imbruvica.
Because of this, your doctor will likely suggest you avoid consuming grapefruit, grapefruit juice, or Seville oranges during your Imbruvica treatment.
Does Imbruvica interact with vaccines?
You should talk with your doctor before receiving any vaccines during your Imbruvica treatment. Imbruvica and the condition you take it to treat (such as chronic lymphocytic leukemia) may make certain vaccines less effective for you.
If you need to receive a vaccine while taking Imbruvica, talk with your doctor first to make sure it’s safe.
Does Imbruvica interact with lab tests?
There are currently no reports of Imbruvica interacting with lab tests. If you have questions about having certain lab tests during your treatment with Imbruvica, talk with the healthcare professional ordering the test.
Does Imbruvica interact with cannabis or CBD?Cannabis(commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Imbruvica.
Using cannabis or cannabis products can increase the risk of side effects from Imbruvica. Cannabis and cannabis products can decrease the activity of a certain enzyme that breaks down Imbruvica after you take a dose.
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 states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Imbruvica. Before taking Imbruvica, talk with your doctor about your health history. They’ll determine whether Imbruvica is right for you.
Health conditions or other factors that might interact with Imbruvica include:
Bleeding problems: Taking Imbruvica can cause bleeding in some people. If you already have a bleeding problem, such as hemophilia, you may have a higher risk of this side effect. Your doctor can help determine if Imbruvica is safe for you to take.
High blood pressure, high cholesterol, diabetes, or other risk factors for heart disease: In rare cases, Imbruvica can cause heart-related side effects, including heart failure. You may have a higher risk of these side effects if you have risk factors for heart disease, such as high blood pressure. Your doctor can help determine if Imbruvica is safe for you to take.
Heart disease, arrhythmia, or other heart conditions: In rare cases, taking Imbruvica can cause heart-related side effects, including arrhythmia. If you have a heart condition, such as heart disease or an existing arrhythmia, taking Imbruvica could worsen your condition or cause new heart-related side effects. Your doctor can help determine whether Imbruvica is safe for you.
Liver problems: Your body depends on your liver to break down Imbruvica and help clear it from your body. If you have a liver problem, such as cirrhosis, Imbruvica levels can build up in your system. This can raise your risk of side effects from Imbruvica. If you have a liver problem, your doctor may prescribe a lower dosage of Imbruvica for you. But they likely won’t prescribe Imbruvica if you have a severe liver problem.
Smoke tobacco: Smoking tobacco raises your risk for heart disease. You may have a higher risk of heart-related side effects with Imbruvica if you smoke. Your doctor can help determine if Imbruvica is safe for you to take. They may want to discuss smoking cessation with you.
Recent or upcoming surgery: Taking Imbruvica can cause bleeding. If you have an upcoming surgery planned, your doctor may want to wait until after your surgery to prescribe Imbruvica for you. If you’ve recently had surgery, your doctor can determine when it’s safe to start treatment with Imbruvica.
Pregnancy: It’s likely not safe to take Imbruvica during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Imbruvica.
If you can 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. (Note: This article uses the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.)
Breastfeeding: Breastfeeding while taking Imbruvica is not recommended. It’s not known if the drug passes into breast milk and if so, whether it could cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to do so, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Imbruvica or any of its ingredients, your doctor will likely not prescribe Imbruvica. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Find answers to some frequently asked questions about Imbruvica and possible interactions.
What pain relievers can I take with Imbruvica?
Acetaminophen (Tylenol) is a pain reliever that isn’t known to interact with Imbruvica. However, acetaminophen has other interactions. Be sure to talk with your doctor or pharmacist before taking it, as it may interact with other medications you take besides Imbruvica or other medical conditions you have.
NSAIDs, such as aspirin, can cause bleeding. Imbruvica can also cause bleeding. Taking these medications together could raise your risk of this side effect. Talk with your doctor or pharmacist before using an NSAID while you’re taking Imbruvica.
To learn more about your options for pain relief while taking Imbruvica, talk with your doctor or pharmacist.
Can I drink coffee while taking Imbruvica?
Most likely, but it’s still best to check with your doctor first.
Diarrhea is a common side effect of Imbruvica. And coffee can cause or worsen diarrhea in some people. If you have diarrhea from taking Imbruvica, your doctor may suggest limiting or avoiding coffee.
If you have other questions about Imbruvica and drinking coffee, talk with your doctor.
Taking certain steps can help you avoid interactions with Imbruvica. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- other medications you take, as well as any vitamins, supplements, and herbs (they can also help you fill out a
medication list ) - what to do if you start taking a new drug during your Imbruvica treatment
It’s also important to understand Imbruvica’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Imbruvica exactly as prescribed can also help prevent interactions.
Disclaimer: Healthline 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.