Drug interactions
Diltiazem + Ibrutinib
Severity: Major
Diltiazem and Ibrutinib: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Diltiazem is a moderate CYP3A4 inhibitor and raises ibrutinib exposure. Higher ibrutinib levels increase the risk of bleeding, arrhythmias including atrial fibrillation, cytopenias and infection.
What this interaction means in plain words
Diltiazem and Ibrutinib can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Diltiazem belongs to Cardiovascular; Ibrutinib belongs to Oncology.
Why it happens
Inhibition of intestinal and hepatic CYP3A4 reduces first-pass and systemic clearance of ibrutinib.
What to do
Reduce the ibrutinib dose as directed by labeling for moderate CYP3A inhibitors and monitor for bleeding, cardiac rhythm and toxicity. Return to the usual ibrutinib dose after diltiazem is stopped.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Other interactions of Ibrutinib
- Abciximab + Ibrutinib Major
- Acetylsalicylic acid + Ibrutinib Major
- Alteplase + Ibrutinib Major
- Amobarbital + Ibrutinib Major
- Apalutamide + Ibrutinib Major
- Apixaban + Ibrutinib Major
Frequently asked questions
Can I take Diltiazem with Ibrutinib?
MediHelp rates the interaction as major. Diltiazem and Ibrutinib can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Diltiazem is a moderate CYP3A4 inhibitor and raises ibrutinib exposure. Higher ibrutinib levels increase the risk of bleeding, arrhythmias including atrial fibrillation, cytopenias and infection.
How serious is the interaction between Diltiazem and Ibrutinib?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the ibrutinib dose as directed by labeling for moderate CYP3A inhibitors and monitor for bleeding, cardiac rhythm and toxicity. Return to the usual ibrutinib dose after diltiazem is stopped.
What other medicines interact with Diltiazem?
MediHelp also lists interactions of Diltiazem with, for example, Flibanserin, Ivabradine, Lomitapide. The full list is on the Diltiazem page.
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