Can Jaypirca (Pirtobrutinib) Cause Hallucinations?
Hallucinations are not a documented adverse effect of Jaypirca (pirtobrutinib) based on available clinical trial data and safety analyses. The most common adverse events associated with pirtobrutinib are fatigue, diarrhea, contusion, and neutropenia, with no reports of hallucinations in the published literature 1, 2.
Evidence from Clinical Trials
The BRUIN trial, which evaluated pirtobrutinib in 773 patients with B-cell malignancies, provides the most comprehensive safety data available:
- Most common adverse events included fatigue (20-32%), diarrhea (17-31%), and contusion (13%) 1, 2
- Grade 3 or higher events were primarily neutropenia (10%) 1
- Neuropsychiatric effects such as hallucinations were not reported among the adverse events 1, 2
- Extended exposure data (≥12 months of treatment in 326 patients) showed no emergence of new neuropsychiatric toxicity signals, including hallucinations 2
In the Richter transformation subgroup analysis of 82 patients, hallucinations were similarly not reported as an adverse event 3.
Comparison to Other BTK Inhibitors
While pirtobrutinib has not been associated with hallucinations, it is important to note that other medications in oncology can cause neuropsychiatric effects:
- Ibrutinib and other covalent BTK inhibitors have not been documented to cause hallucinations in the pharmacovigilance literature 4
- Other anticancer agents like topiramate (used in combination regimens) can cause hallucinations, but this is drug-specific, not a class effect 4, 5
Clinical Considerations
If a patient on pirtobrutinib develops hallucinations, investigate alternative causes:
- Medication review: Screen for anticholinergics, steroids, dopaminergic agents, benzodiazepines, and other psychoactive medications that commonly cause hallucinations 6, 7
- Metabolic derangements: Evaluate for electrolyte imbalances, hypoxia, sepsis, or poorly controlled pain 4
- Vision impairment: Assess for Charles Bonnet syndrome if any degree of vision loss exists 8, 7
- Concurrent malignancy effects: Consider CNS involvement, paraneoplastic syndromes, or delirium from underlying disease 4, 7
Bottom Line
Pirtobrutinib does not cause hallucinations based on current evidence from phase 1/2 trials involving over 700 patients with extended follow-up 1, 2, 3. If hallucinations occur in a patient taking pirtobrutinib, pursue alternative etiologies rather than attributing them to the medication.