Ibrutinib with Fluvoxamine Interaction Details
Brand Names Associated with Ibrutinib
- Ibrutinib
- Imbruvica®
Brand Names Associated with Fluvoxamine
- Fluvoxamine
- Luvox®
- Luvox® CR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 27, 2023
Interaction Effect
Increased ibrutinib exposure
Interaction Summary
Coadministration of erythromycin (moderate CYP3A inhibitor) with ibrutinib in a pharmacokinetic study increased steady-state ibrutinib exposure by about 3-fold. If coadministration of ibrutinib with a moderate CYP3A inhibitor is required, closely monitor patient for ibrutinib toxicity and adjust dosage based on indication for ibrutinib use. For adults with B-cell malignancies, reduce ibrutinib to 280 mg/day. For patients with chronic graft versus host disease, begin with ibrutinib 420 mg/day (12 years or older) or 240 mg/m(2) (1 to less than 12 years). In all patients, modify the dose based on adverse reactions. After discontinuation of a CYP3A inhibitor, resume previous dose of ibrutinib.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of ibrutinib with a moderate CYP3A inhibitor requires close monitoring and ibrutinib dosage adjustment based on indication for ibrutinib use. For adults with B-cell malignancies, reduce ibrutinib to 280 mg/day and modify the dose as necessary for adverse reactions. For patients with chronic graft versus host disease, begin with ibrutinib 420 mg/day (12 years or older) or 240 mg/m(2) (1 to less than 12 years). In all patients, modify the dose based on adverse reactions. After discontinuation of a CYP3A inhibitor, resume previous dose of ibrutinib
Mechanism Of Interaction
Inhibition of CYP3A-mediated ibrutinib metabolism
Literature Reports
A) Coadministration of multiple doses of erythromycin (moderate CYP3A inhibitor) with ibrutinib increased steady-state ibrutinib Cmax by 3.4-fold and AUC by 3-fold .
Ibrutinib Overview
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Ibrutinib is used:
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to treat people with mantle cell lymphoma (MCL; a fast-growing cancer that begins in the cells of the immune system) who have already been treated with at least one other chemotherapy medication,
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to treat people with chronic lymphocytic leukemia (CLL; a type of cancer that begins in the white blood cells) and small lymphocytic lymphoma (SLL; a type of cancer that begins mostly in the lymph nodes),
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to treat people with Waldenstrom's macroglobulinemia (WM; a slow-growing cancer that begins in certain white blood cells in your bone marrow),
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to treat people with marginal zone lymphoma (MZL; a slow growing cancer that begins in a type of white blood cells that normally fights infection) who have already been treated with a certain type of chemotherapy medication,
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and to treat people with chronic graft vs host disease (cGVHD; a complication of hematopoietic stem-cell transplant [HSCT; a procedure that replaces diseased bone marrow with healthy bone marrow] that may start a while after the transplant and last for a long time) after being treated unsuccessfully with 1 or more medications.
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Ibrutinib is in a class of medications called kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.
Fluvoxamine Overview
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Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.