MULTIPLE MYELOMA KNOWLEDGE CENTER

What are Velcade side effects?

Velcade side effects vary from patient to patient and may be influenced by the current stage of a patient’s myeloma.

The most common possible side effects of Velcade® (bortezomib, Takeda Oncology) include:

  • Nausea, diarrhea, constipation, or vomiting
  • Low platelet counts, also referred to as thrombocytopenia
  • Low numbers of white blood cells known as neutrophils, a condition known as neutropenia
  • Peripheral neuropathy or nerve pain
  • Fatigue
  • Anemia, or low numbers of red blood cells
  • Low numbers of all types of white blood cells, including lymphocytes
  • Rash
  • Fever
  • Loss of appetite

Serious side effects that have been reported with Velcade include:

  • Peripheral neuropathy
  • Low blood pressure
  • Heart problems
  • Lung problems
  • Liver problems
  • A rare, reversible brain condition called posterior reversible encephalopathy syndrome (PRES)
  • Nausea, diarrhea, constipation, or vomiting
  • Low numbers of neutrophils or platelets
  • Tumor lysis syndrome

Note that if you are taking Velcade in combination with other anti-myeloma agents you may experience different side effects.

Also, let your doctor know if you are taking medication for diabetes, as Velcade can affect your blood glucose levels. Your doctor may ask you to closely monitor your blood glucose levels and may adjust the dose of your diabetes medicine while you are being treated with Velcade.

How are side effects of Velcade managed?

Side effects of Velcade can often be managed with other medications, increasing the amount of fluids, reducing the dose of Velcade, or stopping Velcade treatment temporarily until symptoms resolve.

If you develop peripheral neuropathy, your doctor may adjust your Velcade dose.

Side effects of Velcade can often be managed with other medications, increasing the amount of fluids, reducing the dose of Velcade, or stopping Velcade treatment temporarily until symptoms resolve.

If you develop peripheral neuropathy, your doctor may adjust your Velcade dose.

If a patient develops peripheral neuropathy, certain medications that decrease neuropathic pain (such as Neurontin® [gabapentin], Elavil® [amitriptyline], Cymbalta® [duloxetine], or Lyrica® [pregabalin]) may be beneficial. In addition, certain soothing creams, such as cocoa butter, may be helpful. A number of centers have developed approaches for managing neuropathy that include these measures, as well as incorporating:

  • Vitamins, such as high-dose multi-B complex vitamins, vitamin E, and essential fatty acids (fish oil, flaxseed oil, and/or evening primrose oil)
  • Amino acids, such as acetyl L-carnitine and alpha-lipoic acid
  • Minerals (magnesium or potassium) or tonic water for muscle cramping

However, always consult with your doctor before taking any supplements or medications. Also, the use of supplements on the day of Velcade administration is not recommended as lab studies have suggested there may be a blunting of Velcade effects, although clinically this has not been shown.

Prompt dose reduction and a change in the schedule of Velcade administration are essential in managing peripheral neuropathy should it develop.

Can anything be done to lessen the development of peripheral neuropathy?

Preventing the development of side effects, when possible, is an important goal of therapy. For example, once-weekly Velcade dosing is used more frequently because it has been associated with fewer side effects.

Subcutaneous administration of Velcade may also lessen the development of peripheral neuropathy.