Glivec and pain killers

I've been assured that paracetamol is OK.

Olivia

Every now and then, paracetamol or ibuprofen will be fine ... that's the message I was given by my doctors.

But habitual use os paracetamol especially is not great, as it's tough on the liver as are TKIs. My doctor gave me a box of codeine phosphate to use when needed as it is not tough on your liver, but I hardly ever take any.

A paracetamol once or twice every few weeks ought to be fine.

David. 

Avoid Ibuprofen-evidence now available

Hi Dennis,

In the light of available evidence your consultant appears to be entirely correct and up to date in suggesting that CML patients undergoing TKI therapy avoid the over the counter painkiller Ibuprofen. Evidence first came to light when a group of researchers from the University of Adelaide presented a poster paper at a recent  ASH (American Society of  Haematologists) conference.Their findings were written up in full in a paper  presented in  British Journal of Cancer (2012)  pp1-7: 106(11) entitled "Contrasting effects of diclofenac and ibuprofen on active imatinib uptake into leukaemic cells" authored by Wang,J et al ;I remember seeing a summary of this paper posted up by Sandy a little while ago but have not been able easily find it again.

The work goes back to a doctoral thesis undertaken by J Wang at the University of Adelaide titled "Investigating drugs that enhance imatinib uptake and factors which contribute to the functional activiity of OCT-1 CML cells".If you Google "cml ibuprofen diclofenac wang" you may be still able to access the thesis in full.. Basically the author started with the premise that CML patients often suffer from muscolo- skeletal side effects from the imatinib drug and in response take NSAIDS (Non steroidal anti inflammatories) such as paracetemol, ibuprofen, diclofenac, naproxen ,indomethacin and so on;the author considered 12 of these in total and there were significant results for  ibuprofen and diclofenac.in combination with imatinib. Diclofenac reduced the cyto toxicity of imatinib but most important of all ibuprofen affected and reduced the uptake of imatinib.It was suggested that the precise positive benefits of diclofenac might be subject to further investigation.

Diclofenac a generic which is prescription only  is often used for arthritis and is quite effective in counteracting bone pain as a consequence of CML but because it can cause sudden intestinal bleeding is now issued with take care warnings and should be taken with a proton pump inhibitor such as omneprazole-which in itself might interact with imatinib.I remember taking the original brand Arthrotec some 8 years ago now in the first six months of imatinib treatment when experiencing quite strong bone pain-this was when the TKI was clearing out the leukaemic cells from the bone marrow.It is now difficult to persuade GPs to prescribe the branded drug as opposed to generic diclofenac because of the cost..

So I dont know if any precise information exists on the interaction between other pain killers such as codeine phosphate and imatinib or co-draminol and imatinib.Codeine is an opiod and some indicate that it may be habit forming and addictive and it causes severe constipation in some patients.

On a general point very few GPs will be aware of the drug on drug interactions that surround TKIs so we as patients might wish to search some of the online drug checkers .In addition not all haematologists will be aware of the precise interactions either. At a recent appointment I took along the Haouala article from Blood on Drug Interactions with TKIs ..... which is the subject of another thread in Forum;out came the mobile phone to take a camera shot of the title and a comment of interesting!

So in conclusion I suggest it is all about whether we really need to take drugs that might interact with tkis and for how long and at what dose-even non imatinib users take risks with their liver toxicity when using high dose paracetemol long term.Aspirin in combination with dasatinib leads to lower platelet scores and a real risk of severe bleeding.I do not have a medical backround but on the basis of new and strong evidence I would avoid using ibuprofen in combination with any tki.

Trust this helps

johnw101

P.S The Wang thesis in its early pages has very useful summary on imatinib resistance-primary and acquired and a good summary of 2nd generation tkis