Drug Interaction Report

Amiodarone and Ibrutinib: Interaction Details

A pharmacist-reviewed analysis of the Amiodarone and Ibrutinib interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Amiodarone

Nexterone Pacerone
+

Ibrutinib

Imbruvica Imbruvica®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 141 documented Amiodarone interactions, 26 are rated moderate — including this one.
Onset
unspecified
Evidence
probable
Severity
Moderate

What happens

Increased ibrutinib exposure and risk of atrial fibrillation

Interaction Deep Dive

Concurrent use of amiodarone (a CYP3A and CYP2D6 inhibitor)2with ibrutinib (a CYP3A and CYP2D6 substrate) 1may result in increased ibrutinib exposure and risk of atrial fibrillation. Monitor for signs and symptoms of atrial fibrillation, including rapid pulse, dizziness, lightheadedness, or shortness of breath. For heart rate control in patients experiencing atrial fibrillation, administer beta blockers 34 and consider the use of calcium channel blockers or digoxin 4, or temporarily withhold or reduce the dosage of ibrutinib 43.

Why it happens (mechanism)

Inhibition of CYP3A and CYP2D6-mediated metabolism of ibrutinib

Common questions

Can I take Amiodarone and Ibrutinib together?

Increased ibrutinib exposure and risk of atrial fibrillation Always confirm with your pharmacist or prescriber before making any change.

How serious is the Amiodarone and Ibrutinib interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "probable". Good supporting evidence, though not definitively proven.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Amiodarone or Ibrutinib need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (4)

  1. Product Information: IMBRUVICA(R) oral capsules, oral tablets, oral suspension, ibrutinib oral capsules, oral tablets, oral suspension. Pharmacyclics LLC (per FDA), South San Francisco, CA, 2023. DailyMed
  2. Product Information: NEXTERONE intravenous injection, amiodarone HCl intravenous injection. Baxter Healthcare Corporation (per FDA), Deerfield, IL, 2021. DailyMed
  3. Khalid S, Yasar S, Khalid A, et al: Management of atrial fibrillation in patients on ibrutinib: a Cleveland Clinic experience. Cureus 2018; 10(5):e2701. PubMed
  4. Ganatra S, Sharma A, Shah S, et al: Ibrutinib-associated atrial fibrillation. JACC Clin Electrophysiol 2018; 4(12):1491-1500. DOI
Was this write-up helpful?
Amiodarone

Keep reading about Amiodarone

All Amiodarone interactions (141)
Also serious with: Deuruxolitinib Colchicine Ketoconazole Topical Galantamine
Ibrutinib

Keep reading about Ibrutinib

All Ibrutinib interactions (149) Ibrutinib drug information
Also serious with: Bacillus Of Calmette And Guerin Vaccine, Live Ensitrelvir Levoketoconazole Dengue Tetravalent Vaccine, Live
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Amiodarone + Activated Charcoal American Hellebore Arsenic Beer Cesium Ephedra Grapefruit Siberian Cocklebur + 202 more
Ibrutinib + Activated Charcoal Danshen Grapefruit Piracetam St. John's Wort Acacia Rigidula Aconite Adrafinil + 274 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.