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Velcade Warnings and Precautions

There are serious and potentially life-threatening problems that can occur with Velcade, so it is important to be aware of any signs of these complications. For example, this medication can cause heart problems or liver failure, so it is important to call your healthcare provider immediately if you develop any warnings signs of these problems. Other Velcade safety precautions apply to women who are pregnant or nursing.

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to receiving Velcade® (bortezomib) if you have:
  • Kidney disease, such as kidney failure (renal failure)
  • Numbness, tingling, or burning sensations of the hands or feet (peripheral neuropathy)
  • Liver disease, such as hepatitis, cirrhosis, or liver failure
  • Heart disease
  • Low blood pressure
  • A history of fainting
  • Dehydration or if you do not drink enough fluids throughout the day
  • Ever had a herpes infection
  • Any allergies, including to foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Specific Precautions and Warnings With Velcade

Some warnings and precautions to be aware of prior to receiving this medication include the following:
  • Velcade can reduce blood levels of white blood cells and platelets, increasing the risk for infections and bleeding problems. You will need regular blood tests to monitor your cell counts during treatment, at least before each dose. Blood cell counts usually return to near normal during treatment breaks, which are part of the Velcade dosage regimen.
If your blood cell counts are too low, your healthcare provider may lower your dose or temporarily stop treatment. If the number of platelets in your blood becomes too low, you may need a blood transfusion.
  • Velcade can cause peripheral neuropathy, which is nerve damage that causes numbness, tingling, burning, or painful sensations in the hands or feet. It can also cause muscle weakness. Peripheral neuropathy can be serious. Therefore, let your healthcare provider know if you experience any of the these symptoms. You may need a lower dose or a break in treatment. In some cases, it may be necessary to permanently stop using the medicine.
  • You may experience low blood pressure (hypotension) during treatment, which could cause you to become dizzy or faint, especially upon rising. You may have a higher risk for hypotension if you become dehydrated. Therefore, make sure to drink plenty of fluids during treatment. Let your healthcare provider know if you believe you are dehydrated, or if you experience any dizziness, lightheadedness, or fainting.
  • Because of the potential for dizziness, you should not drive or operate heavy machinery until you know how this medicine affects you.
  • Velcade contains boron and mannitol. More specifically, it is a form of modified boronic acid, and mannitol, an inactive ingredient, is used to reconstitute Velcade powder. Tell your healthcare provider if you are allergic to either of these ingredients.
  • Velcade can potentially cause or worsen heart problems. Your healthcare provider may choose to closely monitor your heart if you have heart disease or if you are at risk for it. Let your healthcare provider know if you experience any signs of heart problems during treatment, such as:
    • Shortness of breath
    • Chest pain
    • An abnormal heartbeat
    • Swelling of the hands, legs, ankles, or feet.
  • There have been reports of lung problems, including lung infections, occurring in people receiving Velcade. Let your healthcare provider know if you experience any signs of lung problems, such as:
    • Shortness of breath
    • Cough
    • Difficulty breathing.
  • This medication has been associated with a rare brain condition known as reversible posterior leukoencephalopathy syndrome (RPLS). People who develop this condition should not continue Velcade treatment. Let your healthcare provider know if you develop any signs of RPLS, such as:
  • Many people will experience stomach and intestinal side effects from Velcade, including nausea, vomiting, diarrhea, and constipation. Talk to your healthcare provider about ways to manage or help prevent these problems. He or she may recommend you take other medicines, such as antinausea or antidiarrheal products.
  • Like other chemotherapy medicines, Velcade can cause tumor lysis syndrome. This potentially life-threatening complication occurs when the breakdown of dying cancer cells leads to metabolic and electrolyte problems. People who have many tumors, or who have more advanced cancer, are at a higher risk for tumor lysis syndrome. Your healthcare provider will monitor you for this condition using blood and urine tests, and treat you for it if it occurs.
  • There have been reports of liver failure occurring in people who were receiving Velcade in combination with several other medicines, as well as in people who had other serious medical problems. Let your healthcare provider know if you develop yellowing of the skin or whites of the eyes (jaundice), as this could be a sign of liver problems. People with moderate or severe liver disease should be started on a lower Velcade dosage and closely monitored during treatment for any liver problems.
  • This medicine may increase blood glucose (blood sugar) levels. If you have diabetes, your healthcare provider may ask you to check your blood sugar levels more often. You may need a different dose of your diabetes medicines during treatment.
  • Velcade is a pregnancy Category D medication, which means it may harm an unborn child (see Velcade and Pregnancy).
  • It is unknown whether this medicine passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to receiving the drug (see Velcade and Breastfeeding).
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