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ibuprofen (Neurofen) contra-indicated with imatinib.

Contrasting Effects of Diclofenac and Ibuprofen on Active Imatinib Uptake Into Leukaemic Cells
Br J Cancer. 2012 May 1;1061772-1778, J Wang, TP Hughes,
CH Kok, VA Saunders, A Frede, K Groot-Obbink, M Osborn,
AA Somogyi, RJ D'Andrea, DL White

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ibuprofen should be avoided in combination with imatinib

This analysis of the effects of NSAIDs on uptake of imatinib in CML cell lines determined that leukemic cell response may be influenced by an interaction between certain NSAIDs and imatinib, some with positive impact (diclofenac), others (ibuprofen) negative.

Abstract

Background:
The human organic cation transporter-1 (OCT-1) is the primary active protein for imatinib uptake into target BCR-ABL-positive cells. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used by chronic myeloid leukaemia (CML) patients on imatinib to manage musculoskeletal complaints.

Methods:
Here we investigated the impact of NSAIDs on functional activity of the OCT-1 (OCT-1 activity; OA) in CML cells.

Results:
Although ten of twelve NSAIDs tested had no significant impact on OA (P>0.05), we observed increased OA (27% increase in K562; 22% increase in KU812 cells, P<0.05) and reduced IC50imatinib when treated with diclofenac. Co-incubation with imatinib and diclofenac resulted in a significantly lower viable cell number compared with imatinib alone. In contrast, ibuprofen led to a significant decrease in OA, an increase in IC50imatinib and thus reduced the cytotoxicity of imatinib. In primary CML samples, diclofenac significantly increased OA, particularly in patients with low OA (<4 ng per 200 000 cells), and significantly decreased IC50imatinib. Ibuprofen induced significant decreases in OA in CML samples and healthy donors.

Conclusion:
On the basis of the expected impact of these two drugs on OA, ibuprofen should be avoided in combination with imatinib. Further studies are warranted regarding the potential benefit of diclofenac to improve OA in a clinical setting.

Translational Therapeutics
British Journal of Cancer 106, 1772-1778 (22 May 2012) | doi:10.1038/bjc.2012.173

One question. I've been suffering with Sciatica for quite a while now and had been taking Ibuprofen, which workes really well. So if I can't take this, what other strong pain killers can I take?

great info about ibuprofen. thanks.

Hi Dennis... if you read the link it tells you why you shouldn't take this particular NSAID- the other one mentioned in the article actually increases the uptake of imatinib- so side effects would be more prevalent with that one. BUT the reason why I alerted everyone to ibuprofen is because it negatively affects the uptake of imatinib. Of course this is highly undesirable as it would mean that you might be getting a sub-optimal response.
However, if your bcr/abl % is at a low level - i.e your PCR results are at 3 log or even less then you might be OK to carry on taking ibuprofen.

Other painkillers might be OK -though I am not sure it is a good idea to take any of them in the longer term.
I suggest you bring this article to the attention of your consultant and ask for advice on other forms of pain relief.

Sciatica is very painful I know- maybe you could try another method to deal with this. I have friends who have tried acupuncture and/or manipulation by a chiropractor for this condition, with success

I hope this is helpful,
Sandy.

This is very useful. I'm taking naproxen rather that paracetamol with Imaninib - but I know naproxen is also a NSAID. What would be best for headaches/muscles aches/bone pain accompanying imatinib treatment? I was told that I shouldn't take paracetamol - but I have also read reacently that moderate doses concurrently should not presentan interaction problem with imaninib.

What do folk on imaninib generally take for headaches/muscles aches/bone pain?

Thanks

Brian

I know this is an older post, but thought it worth stating that, when I linked to a more detailed report of the study, Naproxen was one of the NSAIDs included in the experiment. However, it did not have significant effect on the uptake of Imatinib, so it was not targeted for further study. I am recently diagnosed with CML (1 1/2 months), am on 400mg Imatinib(generic by Apotex, Canada), and have recently developed mild to moderate joint pain. Surprisingly, the doctor's assistant advised taking Ibuprofen for occasional relief. I asked about Naproxen, and he said that would be fine, too. I am very interested in optimal response, so I have been searching for answers. Most cautions with NSAIDs seem to be about increasing bleeding risks due to low platelet counts. At this time, my platelets are not low. We will see if anything changes. I'm curious, has anyone had joint pain subside over time? I'm hoping for that to be the case, as it is irritable. 

Also, the more detailed article stated that this uptake phenomenon is unique to Imatinib. Sprycel and Nilotinib work through a different method than the OCT-1 pathway of Imatinib, which was the pathway studied.

Going back to a slightly earlier part of this thread, I went to my GP with sciatica a bit over a year ago.  Apart from pain-killers, she suggested that the best treatments were likely to be physio and/or Pilates.  I've been going to Pilates once a week since then, and have not felt as much as a twinge in my back for at least the last 9 months.  I was lucky enough to find a very good teacher and a small class, so there is plenty of individual support, but I would recommend anyone with back pain to give Pilates a try.

Olivia

Matt, I had some joint and bone pain when I started taking imatinib (over 10 years ago). It did die down over 3-4 months. I have used both ibuprofen and paracetamol occasionally over the last 0 years. At one stage I was prescribed high does paracetamol by a GP who didn't know about the imatinib interaction - I didn't use it. I used ibuprofen (after I had got to MMR) to help with sprains and strains, and don't believe it caused me any issues. 

Its interesting that there may be a very good reason to avoid ibuprofen with imatinib.  When I was first diagnosed and treated I had the cramps and bone pain that we all seem to get.  My consultant advised (in 2009) against ibuprofen primarily because of my reflux issues (discussed in other threads), the fact that imatinib makes that worse, and the further fact that ibuprofen would only add to that.  On the other hand, it was a bit Catch 22 because paracetemol combined with imatinib could cause liver issues (unlikely if you keep to the doses but nevertheless, the liver is involved with both).

When I had a further discussion with another consultant, in the context of colds etc. he said "I would just continue as you always have on that" - though I confess I tended to aim for paracetmol based cold medication for the reasons above, and still do in my current TFR status off imatinib. Even though the ibuprofen based ones work much better for me...

Richard