# Caution: ibrutinib in patients with cardiac risk

Source: https://onco.cc/pairings/btki-ibrutinib-cardiac-caution/  
OnCo record `btki-ibrutinib-cardiac-caution` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Ibrutinib raises the risk of irregular heart rhythm, high blood pressure, and sudden cardiac events; second-generation BTK inhibitors are safer choices for patients with heart disease.

## Summary

This caution pairs ibrutinib with cardio-oncology: the first-generation BTK inhibitor raises the risk of atrial fibrillation, hypertension and ventricular arrhythmia or sudden cardiac death in chronic lymphocytic leukaemia patients, through off-target inhibition of CSK and TEC kinases in cardiomyocytes and the vasculature. Long-term ibrutinib data carry these signals, and the head-to-head phase 3 trials ELEVATE-RR and ALPINE showed markedly less atrial fibrillation with the second-generation inhibitors acalabrutinib and zanubrutinib, which are therefore safer choices for patients with heart disease; pharmacovigilance data agree. Anticoagulation for atrial fibrillation adds bleeding risk with any BTK inhibitor, so the cardiac and bleeding risks have to be weighed together.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Ibrutinib + Cardio-oncology
- Type: caution
- Rationale: Off-target inhibition of CSK and TEC in cardiomyocytes and vasculature.
- Evidence: Head-to-head phase 3 (ELEVATE-RR, ALPINE); pharmacovigilance.

## Sources

- ClinicalTrials.gov NCT03734016: ALPINE: https://clinicaltrials.gov/study/NCT03734016

## Connected records

- cancers: [Chronic lymphocytic leukaemia](https://onco.cc/cancers/cll/), [Chronic lymphocytic leukaemia, first treatment](https://onco.cc/cancers/cll-treatment-naive/)
- technologies: [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/)
- drugs: [Acalabrutinib](https://onco.cc/drugs/acalabrutinib/), [Ibrutinib](https://onco.cc/drugs/ibrutinib/), [Zanubrutinib](https://onco.cc/drugs/zanubrutinib/)
- trials: [ALPINE](https://onco.cc/trials/alpine/)

---
JSON: https://onco.cc/api/v1/entities/btki-ibrutinib-cardiac-caution.json