Ibrance (Palbociclib)
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I wasn’t on PPIs nonstop, but even the four times in two years I have could have been a problem. I will say I’ve just started Xeloda, and she did tell me not to take them with Xeloda.
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Well that just adds to everything…. I’m taking the capsule Ibrance and my MO knew I am also taking omneprazole. So… guess what I won’t be taking anymore… Other than that, my first cycle seems to be going well except my MO hasn’t told me if he wants blood work now. So I guess I’m waiting until next week.
I’ve been trying to push out happy thoughts to everyone. And I’m working on the deep breathing.
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Apparently I can't dance. The ANC kept tanking even on the 75 so MO has switched me to Verzenio. I'm sort of upset about it, frustrating to stop and start so much and then switch. I'm tired of chaos. I'm noticing less fatigue off Ibrance, though. I've only been on the Verzenio 5 days, idk side effects for me yet.
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I was on omeprazole with Ibrance. If I remember correctly, you can take it but there has to be a time spacer in there.
As for xeloda, the parameters are a little bit stricter. I am on famotodine. Was told absolutely NOT to take omeprazole with that one.
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BevJen, that’s one I haven’t heard of. You know what’s really weird. I have GERD according to gastro, and I’ve never felt the burning of acid. I’ve never had any symptoms of it. I’m very thankful.
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KBL - you can have “silent GERD" where you don't notice it. I was shocked when I was diagnosed with it.
BevJen - I thought when Ibrance changed from capsules to pills that one of the changes was that it was compatible to be taken with omeprazole. I'll have to see if I can find it. However, if I understood the article that I most recently linked on here, it looks like AIs, Faslodex and some other drugs may have some issues being taken with PPIs. Maybe I am misunderstanding something
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Cowgal, it’s probably bad I’m appreciative it’s silent. It just means to me I can ignore it, which probably isn’t good, but I just can’t stand the thought of having to take more pills.
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I found this information on the Pfizer site for Ibrance TABLETS :
Drug Interactions:
In vitro data indicate that CYP3A and SULT enzyme SULT2A1 are mainly involved in the metabolism of palbociclib. Palbociclib is a weak time-dependent inhibitor of CYP3A following daily 125 mg dosing to steady state in humans. In vitro, palbociclib is not an inhibitor of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, and 2D6, and is not an inducer of CYP1A2, 2B6, 2C8, and 3A4 at clinically relevant concentrations.
CYP3A Inhibitors: Data from a drug interaction trial in healthy subjects (N=12) indicate that coadministration of multiple 200 mg daily doses of itraconazole with a single 125 mg IBRANCE dose increased palbociclib AUCINF and the Cmax by approximately 87% and 34%, respectively, relative to a single 125 mg IBRANCE dose given alone [see Drug Interactions (7.1)].
CYP3A Inducers: Data from a drug interaction trial in healthy subjects (N=15) indicate that coadministration of multiple 600 mg daily doses of rifampin, a strong CYP3A inducer, with a single 125 mg IBRANCE dose decreased palbociclib AUCINF and Cmax by 85% and 70%, respectively, relative to a single 125 mg IBRANCE dose given alone. Data from a drug interaction trial in healthy subjects (N=14) indicate that coadministration of multiple 400 mg daily doses of modafinil, a moderate CYP3A inducer, with a single 125 mg IBRANCE dose decreased palbociclib AUCINF and Cmax by 32% and 11%, respectively, relative to a single 125 mg IBRANCE dose given alone [see Drug Interactions (7.2)].
CYP3A Substrates: Palbociclib is a weak time-dependent inhibitor of CYP3A following daily 125 mg dosing to steady state in humans. In a drug interaction trial in healthy subjects (N=26), coadministration of midazolam with multiple doses of IBRANCE increased the midazolam AUCINF and the Cmax values by 61% and 37%, respectively, as compared to administration of midazolam alone [see Drug Interactions (7.3)].
Gastric pH Elevating Medications: In a drug interaction trial in healthy subjects, coadministration of a single 125 mg IBRANCE tablet with multiple doses of the proton pump inhibitor (PPI) rabeprazole under overnight fasted conditions had no effect on the rate and extent of absorption of palbociclib when compared to a single 125 mg IBRANCE tablet administered alone. Given the reduced effect on gastric pH of H2-receptor antagonists and local antacids compared to PPIs, an effect of these classes of acid reducing agents on palbociclib exposure is not expected.
Letrozole: Data from a clinical trial in patients with breast cancer showed that there was no drug interaction between palbociclib and letrozole when the 2 drugs were coadministered.
Fulvestrant: Data from a clinical trial in patients with breast cancer showed that there was no clinically relevant drug interaction between palbociclib and fulvestrant when the 2 drugs were coadministered.
Goserelin: Data from a clinical trial in patients with breast cancer showed that there was no clinically relevant drug interaction between palbociclib and goserelin when the 2 drugs were coadministered.
Anastrozole or Exemestane: No clinical data are available to evaluate drug interactions between anastrozole or exemestane and palbociclib. A clinically significant drug interaction between anastrozole or exemestane and palbociclib is not expected based on analyses of the effects of anastrozole, exemestane and palbociclib on or by metabolic pathways or transporter systems.
Effect of Palbociclib on Transporters: In vitro evaluations indicated that palbociclib has a low potential to inhibit the activities of drug transporters organic anion transporter (OAT)1, OAT3, organic cation transporter (OCT)2, and organic anion transporting polypeptide (OATP)1B1, OATP1B3 at clinically relevant concentrations. In vitro, palbociclib has the potential to inhibit OCT1 at clinically relevant concentrations, as well as the potential to inhibit P-glycoprotein (P-gp) or breast cancer resistance protein (BCRP) in the gastrointestinal tract at the proposed dose.
Effect of Transporters on Palbociclib: Based on in vitro data, P-gp and BCRP mediated transport are unlikely to affect the extent of oral absorption of palbociclib at therapeutic doses.
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This is what I found on the Pfizer site for Ibrance CAPSULES:
Drug Interactions:
In vitro data indicate that CYP3A and SULT enzyme SULT2A1 are mainly involved in the metabolism of palbociclib. Palbociclib is a weak time-dependent inhibitor of CYP3A following daily 125 mg dosing to steady state in humans. In vitro, palbociclib is not an inhibitor of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, and 2D6, and is not an inducer of CYP1A2, 2B6, 2C8, and 3A4 at clinically relevant concentrations.
CYP3A Inhibitors: Data from a drug interaction trial in healthy subjects (N=12) indicate that coadministration of multiple 200 mg daily doses of itraconazole with a single 125 mg IBRANCE dose increased palbociclib AUCINF and the Cmax by approximately 87% and 34%, respectively, relative to a single 125 mg IBRANCE dose given alone [see Drug Interactions (7.1)].
CYP3A Inducers: Data from a drug interaction trial in healthy subjects (N=15) indicate that coadministration of multiple 600 mg daily doses of rifampin, a strong CYP3A inducer, with a single 125 mg IBRANCE dose decreased palbociclib AUCINF and Cmax by 85% and 70%, respectively, relative to a single 125 mg IBRANCE dose given alone. Data from a drug interaction trial in healthy subjects (N=14) indicate that coadministration of multiple 400 mg daily doses of modafinil, a moderate CYP3A inducer, with a single 125 mg IBRANCE dose decreased palbociclib AUCINF and Cmax by 32% and 11%, respectively, relative to a single 125 mg IBRANCE dose given alone [see Drug Interactions (7.2)].
CYP3A Substrates: Palbociclib is a weak time-dependent inhibitor of CYP3A following daily 125 mg dosing to steady state in humans. In a drug interaction trial in healthy subjects (N=26), coadministration of midazolam with multiple doses of IBRANCE increased the midazolam AUCINF and the Cmax values by 61% and 37%, respectively, as compared to administration of midazolam alone [see Drug Interactions (7.3)].
Gastric pH Elevating Medications: In a drug interaction trial in healthy subjects, coadministration of a single 125 mg dose of IBRANCE with multiple doses of the proton pump inhibitor (PPI) rabeprazole under fed conditions decreased palbociclib Cmax by 41%, but had limited impact on AUCINF (13% decrease), when compared to a single dose of IBRANCE administered alone. Given the reduced effect on gastric pH of H2-receptor antagonists and local antacids compared to PPIs, the effect of these classes of acid-reducing agents on palbociclib exposure under fed conditions is expected to be minimal. Under fed conditions there is no clinically relevant effect of PPIs, H2-receptor antagonists, or local antacids on palbociclib exposure. In another healthy subject study, coadministration of a single dose of IBRANCE with multiple doses of the PPI rabeprazole under fasted conditions decreased palbociclib AUCINF and Cmax by 62% and 80%, respectively, when compared to a single dose of IBRANCE administered alone.
Letrozole: Data from a clinical trial in patients with breast cancer showed that there was no drug interaction between palbociclib and letrozole when the 2 drugs were coadministered.
Fulvestrant: Data from a clinical trial in patients with breast cancer showed that there was no clinically relevant drug interaction between palbociclib and fulvestrant when the 2 drugs were coadministered.
Goserelin: Data from a clinical trial in patients with breast cancer showed that there was no clinically relevant drug interaction between palbociclib and goserelin when the 2 drugs were coadministered.
Anastrozole or exemestane: No clinical data are available to evaluate drug interactions between anastrozole or exemestane and palbociclib. A clinically significant drug interaction between anastrozole or exemestane and palbociclib is not expected based on analyses of the effects of anastrozole, exemestane and palbociclib on or by metabolic pathways or transporter systems.
Effect of Palbociclib on Transporters: In vitro evaluations indicated that palbociclib has a low potential to inhibit the activities of drug transporters organic anion transporter (OAT)1, OAT3, organic cation transporter (OCT)2, and organic anion transporting polypeptide (OATP)1B1, OATP1B3 at clinically relevant concentrations. In vitro, palbociclib has the potential to inhibit OCT1 at clinically relevant concentrations, as well as the potential to inhibit P-glycoprotein (P-gp) or breast cancer resistance protein (BCRP) in the gastrointestinal tract at the proposed dose.
Effect of Transporters on Palbociclib: Based on in vitro data, P-gp and BCRP mediated transport are unlikely to affect the extent of oral absorption of palbociclib at therapeutic doses.
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Now with what is listed on the Pfizer site and what the recent articles talk about, are the articles talking about the tablets, the capsules or both? Are those of us reading the articles interpreting the findings wrong? I certainly think we need to get this figured out as GERD is serious and needs to be treated too. Perhaps if PPIs are bad then maybe there is a safer alternative.
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Cowgal,
I am no longer on Ibrance, so I haven't been watching this at all. I am, however, on neratinib and xeloda, so I watch that.
My comment about Ibrance and omeprazole was referring to when I first started Ibrance in 2019. Neither my doc nor her NP altered their advice at any point in my Ibrance adventure, but I wish you all luck in trying to figure this one out.
I have to take some sort of a PPI. My gastro told me that I am developing Barrett's esophagus when I had my last endoscopy and so even though I don't feel any effects of that 99% of the time, I assume I have to watch it. I did tell my oncologist this, but again, as we've all commented here before, the compartmentalization of medicine and the fact that we are all seeing so many doctors creates all sorts of issues for those of us who take a lot of meds. I often wonder why docs ask for med lists when half the time they just ignore them.
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I had a PET scan last week and received the results today. The old bone mets are improving and the mets to the lymph nodes in my chest are gone, but I have new bone mets in one hip and lower back. So I am staying on Ibrance but changing from Letrozole to Faslodex.
In 3 months I should have a CT scan, but since those don’t show the bones very well, he might order a bone scan to go with the CT scan.
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Hi KBL,
I do not post just read (mostly) We connected earlier because I have ILC Stage IV Denovo (2018) and it is in bones and intestine. I am on Ibrance and Faslodex since May. Was previously on Anastrozole. I follow you on here as not many it seems have it progress to intestinal areas. I just had a another Ct with barium and contrast. Stable results. As I was tolerating 75 mg pretty well, moved up to Ibrance 100mg. MO said lets try see if we can stay at stable or even better.
I saw your comment about GERD. Thought I would share my info on this diagnosis. My DH has "Silent Gerd". They identified this on an endoscopy that showed Barrett's Disease and early esophageal cancer. They prescribed Omeprazole which he took for a while but did not like the side effects or long term use causing acid to be drastically reduced.(we need some in our digestive system). I researched enzymes and found one that helped him. The doctors reluctantly agreed for him to try it. Has been 6 years since DX and so far so good.
To all trying to juggle everything that comes with this dreaded disease...I read your comments , feel the emotions and smile at all we can accomplish and endure.
I hope the best for you.
Bootsie
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Hi KBL,
I do not post just read (mostly) We connected earlier because I have ILC Stage IV Denovo (2018) and it is in bones and intestine. I am on Ibrance and Faslodex since May. Was previously on Anastrozole. I follow you on here as not many it seems have it progress to intestinal areas. I just had a another Ct with barium and contrast. Stable results. As I was tolerating 75 mg pretty well, moved up to Ibrance 100mg. MO said lets try see if we can stay at stable or even better.
I saw your comment about GERD. Thought I would share my info on this diagnosis. My DH has "Silent Gerd". They identified this on an endoscopy that showed Barrett's Disease and early esophageal cancer. They prescribed Omeprazole which he took for a while but did not like the side effects or long term use causing acid to be drastically reduced.(we need some in our digestive system). I researched enzymes and found one that helped him. The doctors reluctantly agreed for him to try it. Has been 6 years since DX and so far so good.
To all on this site trying to juggle everything that comes with this dreaded disease...I read your comments, feel the emotions and smile at all we can accomplish and endure even in the worst times.
I hope the best for all of us.
Bootsie
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Bootsie - Which enzyme worked for your husband? Has your husband had another endoscopy since using the enzyme.
BevJen - Yes, the compartmentalization of medicine is frustrating! You posted that with your current medicine that you had to stop omeprazole. Did they put you on something else instead?
GoKale4320 - Hopefully, the Faslodex will help you get the rest of the cancer gone and get you to NEAD! Please join us on the Faslodex thread too.
MKestrel - Sorry, you have to move on from Ibrance. I hope you have success with your new medication.
Everyone - Please be careful if you plan to get off of a PPI and consult with your doctor first.
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Heard from my MO today and he apologized for not connecting the omeprazole and ibrance. So I’m off the omeprazole. I have an endoscopy on Friday so I guess I can talk to the GI doc to see what else I can do. Thanks for the information cowgal! I’m glad to have seen this in my first cycle and not to have continued on with counterproductive medication.
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Katyblu - Glad it was helpful. I am still confused by it all though. It looks like the tablet is safe with PPIs but not the capsule...at least I think that is how to interpret this. Hopefully, someone that knows more than I will jump in. Let us know what your doctor says to do instead of the PPI.
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Cowgal,
I was put on famotodine which is the prescription form of one of the OTC PPIs -- but I can never remember which one. Besides, so long as I have the prescription it's cheaper than buying it OTC. The pharmacist for my breast center was the one who caught this -- amazingly, Puma, the drug manufacturer, has a nursing line and one of the nurses told me omeprazole was fine so long as I took it at least two hours apart from my neratinib tabs.
Another example of how we have to often "doctor" ourselves. It's quite scary, isn't it?
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Just looked it up -- famotodine is Pepcid, and it has a different drug action than a PPI -- it's something called a histimine blocker.
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Bootsie7, I’m so glad you’re stable. That’s awesome.
I’d also like to know the enzyme your husband took. I’m glad it helped. Thank you for letting me know
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Cowgal ..yes my DH has had multiple endoscopies since diagnosis in 2015. Our gastrointestinal doctor is excellent. He did a mucosal resection and was doing endoscopies every 4 months with scraping of the Barretts but it became less and less. His last one was a year ago so he will be having it in November this year. He is so fortunate it was found early.
KBL & Cowgal.....The enzyme we use is GI-ENCAP by Thorne. We just feel it has helped and better than long term PPI use.
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Thank you, bootsie7. I will talk to my oncologist about it.
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Thank you Bootsie7. My husband has ordered himself some. He doesn’t want to take omeprazole so GI-ENCAP is worth a try.
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RK2020...Hope it will help your husband. My MO but knew nothing about it so no answer there. We have a pharmacist friend who researched it for us and said it was OK. Also my Integrative Doctor agreed.
Bev Jen...I find I always have to "doctor" myself on many occasions. Have to be your own advocate. I take supplements (Integrative recommended) to help keep my blood counts up. My regular MO just said doesn't know anything about them. (sigh)
I started Faslodex end of May and added Ibrance in June.
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I went in for my Faslodex shot this morning and discussed with the nurse that I had read that certain foods and supplements shouldn't be consumed when taking either Letrozole or Ibrance, and I wondered if this was the reason I had progression and had I not done that, I wouldn't have had to switch to Faslodex. I had read that Reishi mushroom, citrus fruit, Strontium, Tumeric supplement shouldn't be taken with Ibrance or Letrozole. So she went to ask the MO, and came back to say that since supplements are not tested by FDA, that I should stop all supplements for a month until I can discuss it with the MO. This upset me, and I said that I may as well throw out everything I have been doing. I had given up meat and dairy because they are inflammatory. She said that I don't have inflammatory cancer so I can eat inflammatory foods. She said that my condition is simply because I have too much estrogen. I thought reducing animal foods would help my liver metabolize the estrogen better. So I reduced animal foods and increased dark leafy greens and cruciferous vegetables.
I am just rather angry that the doctor just expects me to simply take the medicine and rely only on the meds. I also told her that if I only rely on the medicine, eventually it becomes toxic, but she said that one of her patients has been coming in for faslodex shots for 15 years and perhaps she is on something else, too.
What are your thoughts on Estrogen positive BC, what fuels it, what helps it?
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Hi All -
GoKale, since your scan showed a decrease in some areas I think it's a good thing that your MO is swiching the hormone med and not dumping Ibrance right now. When starting fulvestrant, they give patients two doses in the first month - I will tell you that by the second dose I had a significant decrease in my symptoms so I feel like it is a powerful hormone blocking/degrading drug. I also have a lot less joint pain on it compared to the years I was on femara.
I share in this frustration with you and others who were posting yesterday about drug interactions and the lack of info we may receive. Scary as HECK that we have to "doctor" and research so much on our own, which is another reason I appreciate this forum so very much. RE supplements, my oncologist is not a fan of most supplements. I was taking a tumeric/black pepper supplement when I had my stage IV recurrence and she told me to stop that immediately, her opinion is that tumeric supplements have estrogenic qualities - however she said I am fine to add actual tumeric to foods (eat curry, add to salad dressing etc). Not that it matters, she happens to be east Indian and loves tumeric. I have read on here other women who have oncologists that are fine with tumeric supplements, so I don't know what to say about that. I recently asked her about turkey tail mushroom supplements and she told me no. She wants me on calcium, viatmin D and a multi vitamin. I also take advil pm often at night and she is fine with that. My cancer has been very responsive to I/F. I have learned on here that breast cancer morphs and at some point I/F will stop working. As long as I am on it and stable or NEAD I am not adding anything to my supplements or over the counter meds without checking with her. I was told no grapefruit while on Ibrance, no mention of other citrus to avoid such as lime but I will check next appt ( i ocassionally have a squeeze of fresh lime on a taco or in a vodka/soda cocktail). Editing to add, no pomegranate juice while on Ibrance.
KatyBlu - how you doin?!
MKestral - sorry you are switching off of Ibrance to Verzenio. It is supposed to be a great drug and I hope you have many years on it with better WBC and minimal side effects.
SF-Cakes - As I am also on the west coast, 11am is a hard time for me to join the MBC zoom call, although the one time I did I really appreciated it!
October/PinkTober/Puketober - so much dislike for this. How I loath the various food products, many with huge amounts of corn syrup and other bad ingredients bathed in pink, sports teams in pink socks etc etc. It was very unnerving back in 2008. I also have shocked unknowing cashiers when I told them at 44 I had already donated time, tissue and tears to the cause.
RK2020 - hope rads are ok and you are counting down towards the finish line. I remember back in 2009 when I hit 1/2 way, for some reason I started crying while in the rads body cast thing under la machina (this was breast radiation). I was afraid to breath, let alone sob so just had tears streaming down the sides of my face. The techs were so concerned that I was experiencing extra pain - my burns were painful BUT it wasn't that, it was the reality that I was only 1/2 way done. Such a surreal experience we all share.
RRabbit - I have been listening to Annie Lennox, Little Bird a lot and just love it - added it to my itunes library and will always think of you when I hear it!
KBL, Candy, BevJen and others who have switched it up but still say hi - hope you are all doing well on your new tx! It is always good to hear from you!
I officially kicked off Pumpkin Roll season early. My friend's son, who I mentioned has Hodgkin's lymphoma stage 3 is really suffering during chemo. We have attended a xmas eve potluck with this family for 14 years so since he was a wee lad. He LOVES the pumpkin roll so I made it for him and delivered it this Wednesday. I didn't know it, but it was his 16th birthday on Wednesday! Perfect timing:) So far, I have gifted 2 and have two ready to frost.
My birthday is April 1st and someone on bc.org mentioned they celebrate 6 month birthdays now - so I am taking a short trip with my high school best friend this weekend, heading to see my daughter in Chicago! Initially, invited my husband but he had plans he couldn't change so thought "GIRLS TRIP!!!" TREAT YO'SELF! If I was tech savvy I would insert a GIF of Tom and Donna of Parks and Recreation on their Treat Yo'Self day.
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GoKale,
Here is a link to a topic on drug interactions with ibrance and letrozole. https://community.breastcancer.org/forum/8/topics/...
I understand your frustration about the conflicting information out there on taking supplements. I don't think there is a standard even among the Naturopathic doctors. I go to a Integrative Cancer center and my Cancer center Naturopathic doctor told me not to take cucumin. The Naturopathic doctor I see outside of the cancer center who specializes in treating cancer patients prescribed curcumin to address the inflammation caused by Letrozole. I'm just not comfortable taking it so I don't. I don't know if you see a Naturopathic doc, but there are blood tests they can order to see how much estrogen your body is producing. My insurance covered the cost and I have it checked every 3 months..
I do a lot of my own research on PubMed.
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Hi, Aprilgirl1. I appreciate the shout out. I’m on day 4 of Xeloda and had first fulvestrant shot September 20th. So far so good. I’ll continue to post here and read for sure. Have a great trip.
GoKale, I’m sorry for what you’re going through. I hope you can stay on your supplements. I haven’t changed my eating habits at all throughout, and I’m a pretty picky eater. I don’t get the nutrients I’m sure I need because I’m so picky.
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Hey Aprilgirl1! Thanks for thinking of me. I’m doing okay, mood is a little better these last few days. Had my halfway through the cycle blood work done early this week. My MO says my neutrophils have decreased a little but everything else looks good. More blood work on Monday. Next week I get to sit down with the cancer nurse (I think), so I have lots of questions regarding diet, nutrition, supplements, etc…
Sending happy thoughts!
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Thanks for mentioning me Aprilgirl. I am 1 month into Lynparza. I just got my next bottle per UPS. Still nausea and fatigue. I guess I could have called MO and lowered dose, but I have not yet. I did look online at how the dose reductions go. I am on 600mg per day--- 2 150mg tablets twice a day. The stated dose reduction on the Lynparza website says down to 500mg a day, then 400mg a day. I would need some 100mg tablets to do this. I do not have those. And I cannot find any documentation of PFS on the lowered doses. I want to stay on the routine dose if I can so the drug works at its best. I know with Ibrance they say the PFS is comparable with the 125mg, 100mg, and 75mg. I don't know about Lynparza. I see my MO the end of October. I do not have my next scan appt yet. I will just see if I can tolerate the side effects a little longer.
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