Everyday life and lifestyle¶

Daily life can largely go on as before. The Swedish guideline's patient leaflet says: "För övrigt finns ingen anledning att du ska ändra på dina levnadsvanor" (otherwise there is no reason to change your habits). The sections below cover the things that do need attention.

Food, supplement and drug interactions¶

These interactions matter once a CLL drug is started. In the table, [SmPC] marks what the EU product information states and [I] marks our inference.

Item	Venetoclax	Ibrutinib	Acalabrutinib	Zanubrutinib	Pirtobrutinib (EU)
St John's wort	Contraindicated [SmPC]	Contraindicated [SmPC]	Avoid [SmPC]	Avoid (strong inducer) [SmPC]	Not named; "if possible avoid strong CYP3A inducers" [SmPC]
Grapefruit, Seville orange	Avoid (also starfruit) [SmPC]	Avoid; "must not be taken" with them [SmPC]	Not mentioned. Itraconazole raises exposure 5-fold, so avoiding them is a cheap precaution [I]	Counted as moderate inhibitors (→160 mg); "tell your doctor" [SmPC/leaflet]	Not mentioned; low CYP3A sensitivity [I]
Fish oil, vitamin E, flaxseed	Not mentioned	SmPC: fish oil and vitamin E "should be avoided"	Not mentioned	Leaflet lists them as bleeding risks	Leaflet lists them as bleeding risks
Proton-pump inhibitors, antacids	No effect [SmPC]	No restriction [SmPC]	Capsules: avoid PPIs; separate from H2 blockers and antacids. Tablets: no restriction [SmPC]	No effect [SmPC]	No effect [SmPC]
Strong CYP3A inhibitors (e.g. clarithromycin, itraconazole, posaconazole, voriconazole)	Contraindicated at start and during ramp-up; afterwards ≤100 mg/day [SmPC]	140 mg/day or pause ≤7 days [SmPC]	Avoid; pause the drug during short courses [SmPC]	80 mg/day [SmPC]	No dose change in the EU; the US label says reduce by 50 mg [SmPC]
Moderate CYP3A inhibitors (e.g. fluconazole, ciprofloxacin, erythromycin, diltiazem, verapamil)	Avoid at start and during ramp-up; afterwards cut the dose by ≥50% [SmPC]	280 mg/day [SmPC]	No change; monitor [SmPC]	160 mg/day [SmPC]	No change [SmPC]
Warfarin and other vitamin K antagonists	Monitor INR closely [SmPC]	Do not combine [SmPC]	Do not combine [SmPC]	Do not combine [SmPC]	"Not studied" [SmPC]
Pause around surgery	None stated	3–7 days before and after (instruction)	≥3 days (consider)	3–7 days (consider)	3–5 days (consider); US label 3–7

Sources: EU SmPCs for Venclyxto, Imbruvica, Calquence, Brukinsa and Jaypirca, all as of 7 October 2026; Jaypirca US label.

Common herbal supplements. Ginkgo, garlic, turmeric, ginseng, green tea and echinacea are named in none of these EU product information documents. Studies in healthy volunteers, using test drugs rather than CLL drugs, mostly show modest effects:

curcumin with piperine: no change in midazolam levels;
green tea catechins (800 mg EGCG): buspirone exposure +20%;
ginkgo: midazolam exposure −34%;
ginseng: midazolam exposure −34%;
garlic: saquinavir exposure −51%, the largest signal.

These compare with 3- to 24-fold changes from strong drug inhibitors (Volak 2013; Chow 2006; Piscitelli 2002). [I] The defensible advice is to disclose every supplement and to avoid St John's wort and concentrated extracts.

Painkillers on a BTK inhibitor. Avoid NSAIDs and ask which painkiller to use. The ibrutinib package leaflet lists NSAIDs such as ibuprofen and naproxen among drugs that raise bleeding risk, and an expert review advises people on ibrutinib against NSAIDs, fish oils, vitamin E and aspirin-containing products (Shatzel 2017, abstract only). [I] Extending the caution to the other BTK inhibitors is an inference from their shared bleeding warnings (Treatment landscape 2026).

Ask a pharmacist to check all medicines and supplements for interactions. In a Mayo Clinic series, 64% of people starting ibrutinib were already taking a potentially interacting medicine. The authors recommend a formal pharmacist medication review (Finnes 2017).

Blood thinners and heart-rhythm drugs are specialist decisions.

The Swedish guideline prefers a DOAC (direct oral anticoagulant) if anticoagulation is needed. Apixaban and rivaroxaban carry a low risk of interaction with BTK inhibitors; dabigatran carries more. A reduced dose such as apixaban 2.5 mg twice daily is a specialist judgement, not something to self-adjust (VP8.2 §12.1.4).
Verapamil, diltiazem and amiodarone interact with BTK inhibitors, so experts often prefer beta-blockers for rate control (Lipsky & Lamanna 2020).
Dual antiplatelet therapy (two antiplatelet drugs) needs a cardiologist's input.

Infection exposure in daily life¶

Wash your hands, especially around meals and after using the toilet.
Avoid people with active infections.
Avoid large crowds during the flu season, when susceptibility is high.
Do not isolate yourself. The Swedish guideline says advice must be balanced "så att patienter och närstående inte isolerar sig" (so that patients and families do not isolate themselves) (VP8.2 §18.5), and EHA notes that the risk of infection outdoors is "very limited".
A "neutropenic diet" did not reduce infections in a meta-analysis (RR 1.02) (Jamal 2026). Food precautions, such as avoiding unpasteurised dairy, apply during treatment.

Vaccination, immunoglobulin replacement and preventive antimicrobials are covered in Infections and vaccination.

Travel¶

No live vaccines: yellow fever and oral typhoid vaccines are excluded.
Order the European Health Insurance Card (EU-kortet) from Försäkringskassan.
Check that your travel insurance covers a known CLL diagnosis.
Carry enough medicine for the whole trip.
Hepatitis B vaccination is recommended for longer or repeated trips to Asia, Africa or South America (1177 travel checklist; FoHM hepatitis B).

Sun, skin and other cancers¶

Squamous and basal cell skin cancers are "5–10 gånger vanligare" (5–10 times more common) in CLL and often more aggressive; melanoma is also more common and has a worse prognosis (VP8.2 ch. 14).
In Denmark, the 10-year risk of any skin cancer was 13.5% vs 6.9% in matched controls (squamous cell carcinoma 4.7% vs 1.4%) (Drejøe 2026, abstract only).
Use daily UV protection, check your skin regularly, and have unclear lesions seen by a dermatologist.
[I] A baseline full-skin examination is reasonable.

Other cancers. Second cancers are about 1.6 times more common (SIR 1.63), and more so after treatment (van der Straten 2023). EHA advises taking part in population screening (III, B). Region Skåne runs cervical, colorectal and breast screening and organised prostate testing (OPT); eligibility details are not verified.

Smoking, alcohol, diet, weight and sleep¶

Smoking. Smoking does not cause CLL, but people with CLL have more lung cancer: a standardised incidence ratio of 1.61, rising to 2.22 under age 60 (Schöllkopf 2007). Sweden's quit line (Sluta-röka-linjen) is 020-84 00 00 (VP8.2 ch. 19).
Alcohol. During treatment, alcohol "kan öka risken för blödningar och infektioner" (can increase the risk of bleeding and infection) and can interact with drugs metabolised in the liver (VP8.2 ch. 19).
Diet and body weight. General Swedish dietary advice applies. No diet has been shown to slow CLL. EHA's phrase "a healthy diet without processed ingredients" is advice, not a tested intervention.
Fatigue and sleep. In a UK survey, 77% of people with CLL reported fatigue and 55% insomnia (Miles 2025). Pace activities and rest or nap when needed; staying active also reduces fatigue (VP8.2 patient leaflet; cancer rehabilitation guideline) [E]. Physical activity during treatment improves sleep, according to the Swedish guideline.

Vitamin D and other supplements¶

Vitamin D. Evidence is observational only. Insufficiency was associated with a shorter time to treatment (multivariable HR 1.47) (Shanafelt 2011). A retrospective cohort study linked supplement use to longer treatment-free survival, a design open to confounding (Tadmor 2024). EHA does not recommend routine supplements (III, C). [I] Checking for and correcting a deficiency under general guidance is reasonable; expecting it to delay CLL is not.
Green-tea extract (EGCG). The supporting data come from one single-arm trial at 2,000 mg twice daily (Shanafelt 2013). That dose is far above the 800 mg/day at which EFSA found raised liver enzymes (EFSA 2018). Avoid high-dose extracts. Ordinary brewed tea is generally considered safe at usual intakes.
Curcumin. Anecdotal and laboratory data only.

Physical activity¶

Physical activity is recommended for people with CLL as for anyone else, and all the relevant guidance encourages it [E]. The Swedish guideline says patients should be encouraged to stay physically active and continue their daily activities, whether or not they are treated; the treating doctor individualises the advice according to treatment intensity, infection susceptibility and blood counts (VP8.2 §18.6, §19.1.3). EHA 2026 "strongly advised" aerobic exercise, and the American College of Sports Medicine says every cancer survivor should "avoid inactivity" (ACSM 2019).

Specific precautions apply only in certain situations:

Infection or fever (≥38.0 °C). Pause and contact the clinic. The Swedish cancer rehabilitation guideline calls an ongoing infection an absolute contraindication to training (VP Cancerrehabilitering §9.2) [E].
Very low platelets or an enlarged spleen. With platelets well below about 50×10⁹/L, avoid contact, collision and high-fall-risk activities; this is convention, not outcome evidence (Elter 2009; Yang 2022). With an enlarged spleen, avoid collision activities and blows to the left upper abdomen until a clinician has assessed the spleen; [I] this is by analogy with mononucleosis, as there are no CLL data.
If treatment starts. On a BTK inhibitor, stop and get an ECG for new palpitations, an irregular pulse, fainting, chest pain or breathlessness during exercise, and get blood pressure controlled before strenuous exercise (SmPCs; ESC 2022). During the venetoclax ramp-up, drink 1.5–2 L a day from 2 days before the first dose and avoid dehydration from long exertion in heat or sauna, especially around dose increases (Venclyxto SmPC) [E].