Ibrutinib with Posaconazole Interaction Details
Brand Names Associated with Ibrutinib
- Ibrutinib
- Imbruvica®
Brand Names Associated with Posaconazole
- Noxafil PowderMix®
- Noxafil®
- Posaconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 27, 2023
Interaction Effect
Increased ibrutinib exposure
Interaction Summary
Based on pharmacokinetic simulations that predict an increase of ibrutinib exposure by as much as 10-fold, coadministration of ibrutinib with posaconazole requires close monitoring and ibrutinib dosage adjustment based on ibrutinib indication and posaconazole dosage. For adults with B-cell malignancies receiving posaconazole suspension 100 to 400 mg/day, reduce ibrutinib to 140 mg/day. For adults with B-cell malignancies receiving posaconazole suspension 600 to 800 mg/day, 300 mg/day IV, or delayed release 300 mg/day, reduce ibrutinib to 70 mg once daily. For patients aged 12 year or older, with chronic graft versus host disease (cGVHD) receiving posaconazole suspension 100 to 400 mg/day, reduce ibrutinib to 280 mg/day. For patients aged 12 year or older, with cGVHD receiving posaconazole suspension 600 to 800 mg/day, 300 mg/day IV, or delayed release 300 mg/day, reduce ibrutinib to 140 mg once daily. In adults and pediatric patients 12 year or older, modify the ibrutinib dose based on adverse reactions. For pediatric patients aged 1 to less than 12 years with cGVHD receiving any posaconazole dose, reduce ibrutinib to 80 mg/m(2) once daily. After discontinuation of posaconazole, resume previous dose of ibrutinib.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of ibrutinib with posaconazole requires ibrutinib dosage adjustment based on ibrutinib indication and posaconazole dosage. For adults with B-cell malignancies receiving posaconazole suspension 100 to 400 mg/day, reduce ibrutinib to 140 mg/day. For adults with B-cell malignancies receiving posaconazole suspension 600 to 800 mg/day, 300 mg/day IV, or delayed release 300 mg/day, reduce ibrutinib to 70 mg once daily. For patients aged 12 year or older, with chronic graft versus host disease (cGVHD) receiving posaconazole suspension 100 to 400 mg/day, reduce ibrutinib to 280 mg/day. For patients aged 12 year or older, with cGVHD receiving posaconazole suspension 600 to 800 mg/day, 300 mg/day IV, or delayed-release 300 mg/day, reduce ibrutinib to 140 mg once daily. In adults and pediatric patients 12 year or older, modify the ibrutinib dose based on adverse reactions. For pediatric patients aged 1 to less than 12 years with cGVHD receiving any posaconazole dose, reduce ibrutinib to 80 mg/m(2) once daily. After discontinuation of posaconazole, resume previous dose of ibrutinib.
Mechanism Of Interaction
Inhibition of CYP3A-mediated metabolism of ibrutinib
Literature Reports
A) Pharmacokinetic simulations under fed conditions suggest that posaconazole may increase ibrutinib AUC 7- to 10-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.
Posaconazole Overview
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Posaconazole is used to prevent serious fungal infections that can spread throughout the body in adults and children 2 years of age and older with a weakened ability to fight infection. Posaconazole delayed-release tablets are used to treat invasive aspergillosis (a serious fungal infection that begins in the lungs and spreads through the bloodstream to other organs) in adults and teenagers 13 years of age and older. Posaconazole oral suspension is also used to treat yeast infections of the mouth and throat including yeast infections in adults and teenagers 13 years of age and older that could not be treated successfully with other medications. Posaconazole is in a class of medications called azole antifungals. It works by slowing the growth of fungi that cause infection.
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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.