Velcade-Bortezomib

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Uses For This Medication

  • Bortezomib is used to treat adults with multiple myeloma and mantle cell lymphoma who have received at least one previous treatment.
  • Bortezomib is being studied for the treatment of other tumors and blood-based cancers, including certain types of leukemia (chronic myelogenous leukemia and acute lymphoblastic leukemia), myelodysplastic syndrome (MDS), certain types of non-Hodgkin’s lymphomas, prostate cancer, lung cancer, soft tissue sarcoma, breast cancer, and head and neck cancers.
  • This medication may also be given for other conditions as determined by your doctor.
 

How This Medication Works

Bortezomib is a chemotherapy medication that works by blocking the normal function of certain cell proteins, helping to slow the growth and spread of cancer cells.  

Benefits Of This Medication

In patients with multiple myeloma who have received at least one previous treatment, bortezomib has been shown to improve blood markers for the disease and to lengthen the lives of some patients. Who Should Not Take This Medication You should not take this medication if you:
  • Are allergic to bortezomib, boron or mannitol
 

Precautions To Be Aware Of Before Taking This Medication

Activity related precautions

This medication can lower your blood pressure and may cause fatigue, dizziness, light-headedness, fainting, double vision, or blurred vision. Use caution or avoid operating machinery, including driving a car, following treatment with this medication. If you are taking any medication(s) that lower your blood pressure, the dose of these medications may need to be adjusted by your doctor.  

Blood related precautions

  • This medication may temporarily reduce the number of platelets in your blood. This can increase your risk of bleeding. Contact your doctor or healthcare provider if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. If your platelet levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a platelet transfusion, and/or that you take medication to help increase the number of platelets in your blood. To lower your chance of bleeding, do not use aspirin, aspirin-containing medications, or aspirin-like medications(for example ibuprofen, naproxen). Use caution with sharp objects like razors and nail cutters, and avoid activities that can cause cuts, bumps, and bruises.
  • This medication may temporarily lower the number of red cells in your blood. This can increase your risk of anemia. If your red blood cell level becomes low, you may feel tired and weak. If your red blood cell level becomes too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a red blood cell transfusion, and/or you receive a medication to help increase the red cells in your blood.
  • Occasionally, this medication may temporarily reduce the number of germ fighting white blood cells in your blood. This can increase your risk of infection. Contact your doctor or healthcare provider promptly if you develop any signs of an infection such as fever, painful urination, chills, or a sore throat that doesn’t go away. If your white blood cell levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed and/or you receive medication to increase the number of white cells in your blood. To lower your risk of infection, stay away from crowds and people with colds or other illnesses, wash your hands well and often, and brush and floss your teeth daily unless you have been told your platelets are low.
 

Gastrointestinal related precautions

This medication may cause nausea, vomiting, and/or diarrhea which can lead to dehydration. Eat small frequent meals, bland foods (for example bananas, rice, apples, toast), and drink plenty of water and fluids that contain electrolytes (e.g. Gatorade, Pedialyte) to avoid dehydration. Contact your doctor or healthcare provider if you have moderate to severe nausea, vomiting or diarrhea. These side effects can be treated with medications.  

Organ related precautions

  • Rarely, this medication can cause heart problems, including congestive heart failure. Your doctor or healthcare provider will check your heart regularly while you are on this medication to make sure that your heart is working properly. If you have any problems with your heart before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
  • This medication is broken down by enzymes (chemicals) in the liver and cleared from the body. In patients with severe liver disease, bortezomib may not break down normally which can lead to high levels of this medication in the body and a greater chance of side effects. If you have any liver problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
  • Rarely, this medication can cause changes in the ability of your liver and/or kidneys to work normally. Your doctor or healthcare provider will check your liver and kidneys regularly, usually through blood tests, while you are on this medication to make sure that they are both working properly. If you have any liver or kidney problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
 

Miscellaneous precautions

  • This medication can cause nerve problems in the hands and feet. Symptoms can include numbness, pain or a burning feeling in the feet or hands. Contact your doctor or healthcare provider if you experience new symptoms or if your symptoms get worse.
  • Rarely, this medication can cause tumor lysis syndrome (TLS). This occurs when chemotherapy medications rapidly kill large numbers of cancer cells and cause abnormal changes in your blood. Your doctor or healthcare provider will check your blood regularly through blood tests. In addition, if you experience symptoms such as muscle weakness, tingling on the lips, arms or legs, anxiety, cough, wheezing, chest tightness (shortness of breath), fatigue, increased nausea and/or vomiting, joint-pain, or a feeling of general discomfort, you should contact your doctor or healthcare provider.
  • Do not receive any immunizations (vaccinations) while on this medication without your doctor or healthcare provider’s approval. This medication can increase your risk of infection. For certain immunizations, you may develop the infection that the immunization is intended to prevent.
 

Patient specific precautions

  • It is not known if this medication is safe and effective in children.
  • Studies have shown that there is no difference in the incidence of side effects or the effectiveness of bortezomib in older patients (older than 65 years of age) compared with younger patients. However, older patients may be more sensitive to bortezomib.
 

Pregnancy and Breastfeeding Precautions

  • This medication may cause fetal harm. When taking this medication, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant.
  • It is not known whether this medication is found or excreted in breast milk. Since many medications are excreted in breast milk and because this medication can cause serious harmful reactions in infants, breastfeeding should be avoided.
  • Many anti-cancer therapies can cause sterility. Notify your doctor or healthcare provider if you want to have children in the future.
 

Medication and Food Interactions

Before using this medication, tell your doctor or healthcare provider of all prescription or over-the-counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval. Possible interactions can occur with bortezomib and the following foods or medications:
  • Amiodarone (Cordarone)
  • Aprepitant (Emend)
  • Anti-viral medications used to treat HIV infection
  • Blood pressure medications
  • Carbamazepine
  • Clarithromycin (Biaxin)
  • Dexamethasone
  • Erythromycin
  • Fluconazole (Diflucan)
  • Floxetine (Prozac)
  • Fluvoxamine
  • Fluvastatin (Lescol)
  • Grapefruit or grapefruit juice
  • Imatinib mesylate (Gleevec)
  • Indinavir (Crixivan)
  • Isoniazid
  • Itraconazole (Sporanox)
  • Ketoconazole (Nizoral)
  • Lansoprazole (Prevacid)
  • Lovastatin
  • Nefazodone (Serzone)
  • Nelfinavir (Viracept)
  • Nitrofurantoin
  • Omeprazole
  • Oxcarbazepine (Trileptal)
  • Oral diabetes medications
  • Phenytoin (Dilantin)
  • Phenobarbital
  • Rifampin (Rifadin)
  • Rifabutin (Mycobutin)
  • Ritonavir (Norvir)
  • Saquinavir
  • Simvastatin (Zocor)
  • St.John’s wort
  • Topiramate (Topamax)
  • Voriconazole (Vfend)
NOTE: This list may not include all medications that can have interactions with bortezomib.  

Side Effects

  • The side effects associated with bortezomib listed below are taken from the manufacturer package insert.
  • All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
  • You should contact your doctor or healthcare provider if you experience any side effect(s) which don’t go away, worsen, are serious in nature, or are worrisome to you.
  • The incidence and type of side effects may vary depending on what type of cancer you have as well as whether bortezomib is being given alone or together with other chemotherapy medications. The side effects listed below are those reported in patients who were treated with bortezomib alone.
 

More common side effects

  • Feeling of general discomfort and weakness, tiredness (fatigue), fever
  • Nausea, vomiting, decreased appetite, diarrhea, constipation (see Precautions To Be Aware Of Before Taking This Medication)
  • Numbness, pain or a burning feeling in the feet or hands (see Precautions To Be Aware Of Before Taking This Medication)
  • Low platelet and/or red blood cell levels (see Warning and Precautions To Be Aware Of Before Taking This Medication)
 

Less common side effects

  • Difficulty sleeping, headache, chills, dizziness
  • Changes in ability to taste, indigestion, stomach pain
  • Retention of water in body tissues, dehydration
  • Low white blood cell levels (see Warning and Precautions To Be Aware Of Before Taking This Medication)
  • Anxiety
  • Low blood pressure (see Precautions To Be Aware Of Before Taking This Medication)
  • Blurred vision
  • Pain in joints or limbs, bone or muscle pain, cramps or back pain
  • Shortness of breath, cough, lung infections
  • Shingles, itching, rash
 

Rare side effects

This is not a complete list of the rare side effects reported with bortezomib. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert.
  • Blood clotting disorders
  • Abnormal heart rhythm (heart beat), heart attack, heart failure (see Precautions To Be Aware Of Before Taking This Medication)
  • Severe blood infection (sepsis)
  • Excess fluid in the lungs, coughing up blood, nose bleeds, blood clots in the lungs
  • Abnormal build-up of fluid in the stomach, bleeding of the stomach, swelling and sores in the mouth
  • Allergic reactions
  • Blood clots in the legs, stroke
  • Kidney problems (see Precautions To Be Aware Of Before Taking This Medication)
  • Tumor lysis syndrome (see Precautions To Be Aware Of Before Taking This Medication)
  • Hearing loss
  • Changes in liver function tests (see Precautions To Be Aware Of Before Taking This Medication)
  • Increase of pancreatic enzymes in the blood
  • Inflammation (irritation and swelling) of the colon caused by decreased blood flow. Can lead to infection. Symptoms include stomach pain, fever, vomiting, blood in the stool.
 

How To Take This Medication

  • This medication is usually given by injection into a vein (IV) by a healthcare professional. This medication can be given in different doses depending on your weight and your type of condition.
  • Antiemetics, which are medications to help prevent and control nausea and vomiting, may be given prior to bortezomib either by mouth (orally) or by injection into a vein (IV).
  • In the unlikely event of an overdose of this medication contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
 

Proper Storage

  • It is unlikely that you will need to store this medication. However, in the event that you do, the unopened containers should be stored at controlled room temperature. Keep in original package to protect from light.
  • Keep this medication out of the reach of children or pets.
  • Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.