10 Imbruvica Side Effects and How to Manage Them

GoodRx Health

Imbruvica (ibrutinib) is an oral cancer medication with several uses. It's FDA approved to treat adults living with chronic lymphocytic leukemia / small lymphocytic lymphoma or Waldenström's macroglobulinemia. It's also approved to treat chronic graft-versus-host disease in adults and children ages 1 and older.

Imbruvica is beneficial for these conditions because it's a Bruton's tyrosine kinase (BTK) inhibitor. It targets and blocks BTK proteins that help certain cancer cells survive.

Although Imbruvica works in a targeted manner, it can still cause side effects. Some side effects are common and mild, but others can be serious and life-threatening.

Imbruvica side effects at a glance

If you're new to Imbruvica, it's good to know what to expect. This occasionally comes down to navigating risks and side effects.

Common Imbruvica side effects include:

• Fatigue

• Low white blood cells

• Low platelets or red blood cells

• Bone or muscle pain

• Diarrhea

• Bruising

• Rash

• Upper respiratory tract infection

• High blood pressure

• Nausea

• Headache

• Cough

Rare but serious Imbruvica side effects include:

• Bleeding problems

• Severe infection

• Heart problems

• Dangerously high blood pressure

• New, unrelated cancers

• Liver problems

• Tumor lysis syndrome

Below, we'll review 10 noteworthy Imbruvica side effects and what you can do to manage them.

1. Fatigue

Fatigue is a common side effect of Imbruvica. In clinical studies, up to 57% of people who took Imbruvica by itself reported feeling fatigued at some point. Imbruvica lowers blood cell counts in the body, so this may contribute to these symptoms.

To manage low energy while taking Imbruvica, carve out purposeful time to rest. Allow yourself to get plenty of sleep, and take naps during the day as needed. Also, try to plan your day to complete activities when you have the most energy, and ask friends or family for help. And it makes a big difference to eat a balanced diet and stay well hydrated when you can - even if it sounds like cliché advice.

Light exercise, like yoga or walking, may further boost your energy.

2. Low blood cell counts

Imbruvica can cause blood cell counts to drop, including white blood cells, red blood cells, and platelets. A healthcare professional should monitor your blood cell counts monthly to watch for your blood cell counts getting too low.

Low white blood cells, which play an important role in immune health, can raise your risk of infection. To lower this risk, wash your hands frequently and avoid crowds or other people who are sick. Wearing a mask in busy places is a good idea too.

Low red blood cell counts and low platelets can make you feel tired and bruise or bleed more easily.

3. Bone and muscle pain

Bone and muscle pain are common Imbruvica side effects. They're most intense when you first start taking Imbruvica and usually get better over time.

You may be tempted to try over-the-counter (OTC) pain relievers for relatively mild or moderate bone or muscle pain. But it's recommended to check in with a healthcare professional before doing so. Imbruvica raises your risk of bleeding, so it's ideal to avoid ibuprofen (Advil, Motrin) and other nonsteroidal anti-inflammatory drugs that may further raise your risk of bleeding. Acetaminophen (Tylenol) is likely a safer choice.

More severe pain calls for other interventions. If bone and muscle pain becomes hard to handle, a healthcare professional may recommend switching to a lower dose of the medication. If your pain still doesn't improve, they may recommend stopping Imbruvica altogether.

4. Diarrhea

Diarrhea is another common side effect. It happens in about half of people who take Imbruvica.

Diarrhea is usually mild and happens within the first 6 months of treatment. It tends to get better over time. But persistent or intense diarrhea raises your risk of dehydration.

If you develop diarrhea, try to stay hydrated by drinking plenty of clear fluids. And avoid foods that may make diarrhea worse, such as greasy or spicy foods. It also helps to avoid or minimize drinks containing alcohol or caffeine.

If diarrhea gets worse or becomes hard to manage, tell a healthcare professional. They can recommend OTC antidiarrheals, like loperamide (Imodium A-D), which may be safe for you to try.

5. Bruising or bleeding

Imbruvica can lower your platelets. This makes it easier for you to bruise or bleed.

Bruising and small red spots on the skin are the most common complication of low platelets. But bleeding can occasionally become serious and lead to brain or stomach bleeding. You're at a higher risk of bruising or bleeding while taking Imbruvica if you're also prescribed a blood thinner or an antiplatelet medication or you've had surgery recently.

Tell a healthcare professional if you find blood in your vomit, urine, or stool. These are signs of more serious bleeding.

6. Skin rashes

Imbruvica may cause skin rashes. In fact, about a quarter of people who took Imbruvica in clinical studies experienced a rash at some point.

The type of rash can vary. An Imbruvica rash may consist of small reddish-brown spots (petechiae), or it can be raised, solid bumps on the skin (papules). You may also feel itchy.

Depending on the severity of your symptoms, a healthcare professional will likely recommend lowering your dose of Imbruvica - or stopping it temporarily - to see if the rash improves. They may also recommend OTC medications, such as hydrocortisone or diphenhydramine (Benadryl), for itchiness relief in the meantime.

7. High blood pressure

Imbruvica can raise your blood pressure. Your risk of having high blood pressure goes up the longer you take Imbruvica.

You likely won't feel any different if you have high blood pressure. So make sure to attend your routine medical appointments so your healthcare team can monitor your blood pressure. If your blood pressure starts to rise while taking Imbruvica, a healthcare professional can prescribe blood pressure-lowering medications.

In rare cases, your blood pressure could rise very high. This is a medical emergency. Symptoms of very high blood pressure include:

• Chest pain

• Severe headaches

• Shortness of breath

• Trouble breathing

• Confusion

• Blurred vision

• Abnormal heart rhythm

• Numbness or weakness on one side of the body

If you experience any of these symptoms, call 911 or seek emergency medical attention. They may be signs of a hypertensive emergency.

8. Heart problems

Imbruvica can rarely cause serious heart problems, including heart failure or abnormal heart rhythms (atrial fibrillation).

If you have a history of atrial fibrillation, high blood pressure, or another heart condition, tell your healthcare team. They may need to monitor you more closely while you're taking Imbruvica.

What's more, tell your healthcare team right away if you feel faint or lightheaded, have sudden chest pain or shortness of breath, or develop a fast or inconsistent heartbeat. These may be symptoms of a serious heart condition that requires immediate medical attention.

9. Serious infection

Some people who take Imbruvica develop pneumonia and other serious infections. These infections can be life-threatening without prompt treatment. Serious infections are more likely to happen during the first few months of taking Imbruvica.

Always tell a healthcare professional if you develop a fever, chills, or a new or worsening cough while taking Imbruvica. They'll likely want to review your lab results and assess your symptoms. If necessary, they might prescribe antibiotics or other medications to combat the infection. You may need to stop taking Imbruvica temporarily too.

10. Liver injury

Imbruvica can rarely cause liver damage. Your healthcare team should monitor your liver health periodically through certain blood tests (called liver function tests).

If you develop liver damage from Imbruvica, a healthcare professional will likely recommend stopping the medication until the cause of your liver injury can be confirmed. If Imbruvica is the culprit, they may ask you to stop taking it and switch to an alternative medication.

Tell a healthcare professional right away if you experience any signs or symptoms of liver injury, such as stomach pain, yellow skin or eyes, or dark-colored urine.

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