Indications
Bortezomib is an anticancer medicine used to treat multiple myeloma (a cancer of plasma cells in the bone marrow) and mantle cell lymphoma (a type of non-Hodgkin lymphoma) in adults. It is usually given in combination with other medicines such as steroids and other anticancer drugs, under the care of a cancer specialist.
How It Works
Bortezomib is a proteasome inhibitor. Proteasomes are structures inside cells that break down proteins the cell no longer needs. Cancer cells, especially myeloma cells, depend heavily on them. Blocking proteasomes causes harmful proteins to build up inside the cancer cells, which stops them growing and makes them die.
Dosage and Administration
Bortezomib is given by a doctor or nurse as an injection under the skin or into a vein, usually twice a week or once a week in repeated treatment cycles. The dose is calculated by the specialist from body surface area and adjusted according to side effects, blood counts and nerve symptoms. Never self-inject unless trained and instructed.
Interactions
Strong CYP3A4 inhibitors (such as Ketoconazole, Ritonavir, Clarithromycin) may raise its levels, and strong inducers (such as Rifampicin, Carbamazepine, Phenytoin, St John’s Wort) may lower its effect. Blood pressure medicines may add to its blood-pressure-lowering effect. Diabetes medicines may need adjustment. Avoid green tea extract and high-dose vitamin C supplements unless your specialist agrees.
Contraindications
Do not use if you are allergic to Bortezomib, Boron or Mannitol, or if you have severe lung or heart conditions affecting the lining around the heart or lungs where the specialist advises against it. It must never be given into the spinal fluid (intrathecally); this can be fatal.
Side Effects
Common side effects include tingling, numbness or burning in the hands and feet (peripheral neuropathy), tiredness, nausea, diarrhoea or constipation, low platelets and other blood counts, fever, shingles reactivation, dizziness on standing and loss of appetite.
Get urgent medical help if you have a fever of 38°C or above, unusual bleeding or bruising, severe diarrhoea or vomiting, shortness of breath, chest pain, fainting, severe headache, confusion, seizures or changes in vision, or worsening numbness or weakness.
Pregnancy and Lactation
Bortezomib may harm an unborn baby. Women must use effective contraception during treatment and for 8 months afterwards, and men for 5 months afterwards. Do not breastfeed during treatment.
Precautions and Warnings
Regular blood tests and checks for nerve damage, blood pressure, heart and lung function are needed. Antiviral medicine is often given to prevent shingles. Drink enough fluids to avoid dehydration and low blood pressure. Tell your doctor about liver disease, diabetes, heart disease or nerve problems. Avoid driving if you feel dizzy or tired.
Overdose
Overdose is managed in hospital and can cause severe low blood pressure and low platelets. Treatment is supportive with close monitoring.
Therapeutic Class
Antineoplastic (proteasome inhibitor).
Storage
Hospital medicine: store as directed on the pack, protected from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.