Bortezomib (Velcade, Boruzu)

Bortezomib at a glance

Bortezomib belongs to a group called proteasome inhibitors. Verified brands include Velcade and Boruzu; other products may contain the same active medicine. The brand name does not tell you the injection volume or how it must be prepared. Your pharmacy checks the exact formulation and route.

Treatment is given under the skin or into a vein by a healthcare professional. It is often part of a combination, so your calendar may include tablets, other injections and rest days. Common difficulties include tingling or numbness, tiredness, bowel changes and reduced blood counts.

Report new nerve symptoms early, even if they seem minor. Changing the dose or schedule may help protect daily activities. Do not wait until you cannot walk comfortably or fasten buttons. A treatment adjustment helps keep your care safe. Needing an adjustment is not your fault.

Keep your hospital's urgent number and an updated medicine list readily available. Before leaving each appointment, check the date of the next injection, blood test and review, and whether any home medicines have changed.

How bortezomib works

Cells continually make and recycle proteins. Proteasomes are part of the machinery that breaks down proteins no longer needed. Bortezomib interferes with this machinery, disrupting the balance inside susceptible cells and contributing to their death.

“Targeted” describes how the medicine works. It does not mean that healthy tissues are unaffected. Nerves, blood cells and other organs can also be affected, which is why symptom review and blood tests are essential throughout treatment.

Your specialist assesses benefit using the tests appropriate to your diagnosis, together with symptoms and examination. Depending on your situation, these may include blood or urine disease markers, scans or bone marrow assessment. Feeling better is encouraging, but neither the presence nor absence of side effects reliably measures how well treatment is working.

How your team decides whether it is suitable

The decision considers the exact diagnosis, previous treatment, general fitness, disease-related problems and other medicines. Bortezomib does not have a universal companion mutation test that every patient needs before starting. This statement concerns the reviewed prescribing information; diagnosis-specific investigations are still essential. Your specialist explains which investigations matter in your circumstances.

Tell the team about existing numbness, burning pain, weakness, diabetes, fainting, low blood pressure, heart or lung disease, liver problems and dialysis. Mention previous hepatitis B, shingles and reactions to medicines, including bortezomib or its ingredients. Severe existing neuropathy needs a careful assessment of likely benefit and harm. European information also excludes treatment during certain acute lung or pericardial conditions; the pericardium is the sac around the heart.

Discuss what treatment is intended to achieve and what would lead to a change. If travel, work, caregiving or mobility makes repeated visits difficult, raise this early so the calendar and support arrangements can be discussed safely.

Before treatment starts

Baseline assessment includes blood counts and relevant kidney, liver and blood chemistry tests. The team records your symptoms, blood pressure and medicines. They may examine sensation and strength so later changes can be recognised. Pregnancy testing is needed when applicable. European information recommends a chest X-ray before treatment to provide a baseline for later lung changes.

Ask whether you need antiviral tablets to reduce the chance of shingles. These are commonly considered with bortezomib and must be taken for the period prescribed. Hepatitis B testing and follow-up depend on your history and combination; this is particularly important when rituximab is included.

You may receive anti-sickness medicine, a bowel-care plan or measures to prevent tumour lysis syndrome, according to your risks. Not everyone needs the same supportive medicines. Bring any vitamins, herbal remedies and non-prescription products to the medicine review rather than assuming they are harmless.

Confirm the temperature threshold your hospital uses for urgent contact. Have a thermometer available and ask where to go outside clinic hours. Arrange transport after early visits if dizziness, weakness or the effects of other medicines may make driving unsafe.

How bortezomib is given

Injection route and appointment

A nurse may inject bortezomib under the skin of the abdomen or thigh, rotating sites and avoiding sore, bruised, reddened or hardened areas. Alternatively, the medicine is injected into a vein through suitable access. The labelled intravenous injection takes about three to five seconds; the whole visit is longer because of checks, preparation and any other treatment.

Some European Velcade presentations are for intravenous use only. Velcade powder requires preparation, whereas Boruzu is supplied as a liquid with route-specific preparation instructions. The concentrations used under the skin and into a vein differ. These are pharmacy and nursing checks, not instructions for self-injection. Bortezomib must never be injected into the spinal fluid.

During administration, tell the nurse immediately about itching, flushing, dizziness, swelling or breathing difficulty. Also report pain, swelling or leaking around an intravenous line. The team can assess and treat a reaction promptly.

Dose and calendar

A common starting dose is 1.3 mg per square metre of body surface area, calculated from height and weight. Your prescribed amount may differ because of the regimen, liver function, previous treatment or side effects. Moderate or severe liver impairment requires a lower starting dose. Kidney impairment alone does not usually require a starting-dose reduction; if you have dialysis, bortezomib is given afterwards.

Schedules may use once-weekly or twice-weekly injections with planned breaks. The reviewed prescribing schedules require at least 72 hours between consecutive doses. Do not assume that a different patient's calendar applies to you, or rearrange injections without the team.

Food does not determine absorption of an injected dose. Follow any separate instructions for tablets given alongside it, and ask whether another procedure at the visit requires fasting. Vomiting after an injection does not mean the dose has been lost and does not require another injection. Report repeated vomiting promptly.

Delays, storage and handling

If you miss a visit, contact the treatment unit to rearrange it. Never try to catch up doses yourself. Blood results, infection or nerve symptoms may lead to a planned delay, lower dose or less frequent schedule. Only the treating team decides when treatment can restart.

The pharmacy normally stores and prepares bortezomib. If you are asked to collect or transport a supply, obtain the exact product's written storage and transport instructions. Powder and liquid products have different handling requirements. Do not open vials, prepare syringes or dispose of unused treatment in household waste.

Monitoring and checking whether treatment is working

Blood counts are checked regularly. The US prescribing information specifically calls for a platelet count before each dose. Platelets help prevent bleeding; white cells help fight infection; red cells carry oxygen. Counts can fall during a cycle and recover during its break, so feeling well does not make a scheduled test unnecessary.

The team follows liver tests and other blood chemistry according to your situation. Kidney function and salts may need closer checks if there is dehydration or a risk of tumour lysis syndrome. People with diabetes may need more frequent glucose measurements because levels can become too low or too high.

At visits, describe sensation, pain, grip, walking and balance, as well as bowel habits, dizziness and breathing. Useful details include when a symptom began and what it prevents you doing. “I now drop cups” tells the team more than “a little tingling”.

Response tests and safety tests answer different questions. Ask when the next response assessment is planned and how results will be explained. A short delay for recovery can be appropriate even when treatment appears to be helping.

Common side effects and practical care

Tingling, numbness and nerve pain

Peripheral neuropathy can feel like pins and needles, burning, electric pain, unusual sensitivity or reduced feeling, often in hands or feet. Weakness can also occur. Tell the team promptly and before the next injection. Symptoms may improve with treatment changes, but recovery can take time and is not guaranteed.

Protect numb hands and feet from heat and injury. Wear supportive footwear, check your skin and reduce trip hazards. Ask about pain relief, physiotherapy or occupational support if symptoms interfere with sleep, walking or household tasks. Do not start high-dose supplements to treat neuropathy without advice.

Tiredness and low blood counts

Fatigue may reflect treatment, poor sleep, anaemia or other causes. Plan demanding tasks for better periods, accept help and combine rest with manageable activity. Report a marked change rather than assuming it is inevitable. New breathlessness, faintness or a racing heart needs assessment.

Low white cells increase infection risk and low platelets increase bleeding risk. Report unusual bruises, nosebleeds or bleeding gums. Seek urgent help for bleeding that is heavy or does not stop. Do not begin aspirin or anti-inflammatory painkillers without checking, and do not stop a prescribed blood thinner on your own.

Nausea, diarrhoea and constipation

Use prescribed anti-sickness treatment and take small, tolerable meals. Tell the team if vomiting prevents drinking or taking essential medicines. For diarrhoea, record frequency and follow your team's treatment plan. Fluid advice must account for kidney or heart problems; a fixed large fluid target is not suitable for everyone.

Constipation also deserves early attention. Ask about an appropriate laxative and activity or food changes. Severe abdominal pain, a swollen abdomen, repeated vomiting or inability to pass stool and wind needs urgent assessment because the bowel can stop moving normally. Do not simply add more laxatives in that situation.

Injection-site, skin and eye symptoms

An injection site may become tender or develop a red or darker patch. Show the nurse any persistent or worsening reaction before the next dose. Report a spreading rash, and obtain urgent assessment for blistering, peeling or sores involving the mouth or eyes.

Sore, watery or inflamed eyes and eyelid problems can occur. Ask before using medicated drops. Eye pain or a change in sight needs prompt assessment; sudden severe visual loss is an emergency.

Important side effects needing prompt assessment

Low blood pressure

Low blood pressure may cause dizziness when standing, faintness or collapse. Dehydration and blood-pressure medicines can contribute. Rise slowly and discuss recurrent symptoms; do not adjust your tablets independently. A collapse needs emergency help.

Heart and lung problems

Heart failure and serious lung problems can occur. Report new breathlessness, swelling or a persistent new cough promptly. Severe breathing difficulty or chest pain needs emergency assessment because several possible causes require rapid treatment.

Tumour lysis syndrome

Tumour lysis syndrome happens when many affected cells break down quickly, altering blood salts and potentially damaging the kidneys. Warning symptoms include reduced urine, marked weakness, cramps or an abnormal heartbeat. High-risk patients receive closer monitoring and preventive measures.

Liver injury and small-vessel clotting

Liver injury may cause yellow eyes or skin, dark urine, unusual nausea or upper abdominal pain. Another serious condition, thrombotic microangiopathy, involves tiny blood clots that can damage organs. Reduced urine, unexplained bruising, severe weakness or confusion needs urgent assessment rather than a home diagnosis.

Serious neurological problems

Rare neurological problems include posterior reversible encephalopathy syndrome, or PRES, which can cause severe headache, seizures, confusion and sight changes. Progressive multifocal leukoencephalopathy, or PML, a serious brain infection, has also been reported in people receiving bortezomib, often with other immune-suppressing treatments; the medicine's exact contribution is uncertain. New progressive problems with thinking, speech, vision, strength or coordination need urgent investigation. Sudden symptoms require emergency care.

Serious allergic skin reactions

Health Canada has identified a possible link between bortezomib and drug reaction with eosinophilia and systemic symptoms (DRESS). This allergic reaction can cause a rash with fever and affect internal organs. Seek urgent medical assessment for a new widespread rash with fever or feeling very unwell; do not wait for the next treatment visit. Breathing difficulty, collapse, or extensive blistering or peeling needs emergency care. Tell the oncology team before any further dose.

Other medicines, supplements and vaccinations

Some medicines alter the amount of bortezomib in the body. Important examples include certain antifungals or antivirals, rifampicin, some seizure medicines and St John's wort. Strong enzyme-inducing medicines can reduce its effect; strong inhibitors can increase toxicity. The pharmacist decides whether an alternative or closer monitoring is needed.

Include diabetes and blood-pressure medicines, blood thinners, painkillers, herbal preparations and supplements in the review. Do not stop essential treatment abruptly. If another clinician prescribes something new, tell them you are on bortezomib and ask the cancer pharmacist to check the combination.

Discuss vaccination timing with your team. Live vaccines may be unsuitable during immune-suppressing treatment. Non-live vaccines may be recommended, but response and timing depend on the treatment combination and blood recovery. An antiviral prescription and a shingles vaccination plan are separate decisions; neither should be changed without advice.

Everyday life during treatment

Keep a simple diary of injections, symptoms, bowel movements and any home blood-pressure or glucose readings requested. Bring it to appointments. A family member can help record changes, but report symptoms between visits when needed rather than saving everything for review.

Avoid driving or operating machinery when dizzy, faint, sleepy, weak or visually affected. Numb feet or impaired hand control can also affect safe driving. Discuss work adjustments if you handle hot objects, sharp tools or machinery.

Maintain food and fluid intake as your team advises, and ask for dietetic help if appetite or weight is falling. Wash hands regularly and avoid close contact with people who are unwell. Tell your dentist about treatment before procedures because blood counts and infection risk may affect timing.

Fatigue, pain and repeated visits can affect mood, relationships and independence. Ask for help with transport, symptom control, rehabilitation or emotional support. Reporting difficulties helps the team make treatment more manageable.

Fertility, pregnancy and breastfeeding

Bortezomib can harm an unborn baby. Discuss pregnancy prevention before treatment and contact the team promptly if pregnancy is suspected in you or a partner. Do not assume reduced fertility means pregnancy is impossible. Ask about sperm or egg preservation before starting if future parenthood matters to you.

The reviewed US information specifies effective contraception during treatment and for seven months afterwards for patients who can become pregnant, and four months afterwards for male patients with a partner who could become pregnant. European Velcade information specifies eight months and five months respectively. Your team should provide a written plan appropriate to the supplied product and all partner medicines; do not select the shorter interval yourself.

Do not breastfeed during treatment. US information specifies avoiding breastfeeding for two months after the last dose; European information requires stopping during treatment without specifying the same post-treatment interval. Confirm when restarting is safe, taking the entire regimen into account. If thalidomide is included, its separate pregnancy-prevention programme must also be followed.

After treatment finishes

Continue follow-up and prescribed protective medicines until your team advises otherwise. There is no single antiviral stopping date suitable for every bortezomib regimen. Maintain the agreed contraception and breastfeeding precautions after the last injection.

Nerve symptoms may persist and need ongoing treatment or rehabilitation. Report worsening symptoms, falls or problems with everyday tasks. Blood counts and other side effects also need time and, sometimes, further tests to recover. Ask which symptoms should still trigger the urgent line and how long that contact arrangement remains in place.

Keep a treatment summary listing bortezomib, partner medicines, dates, important reactions and any continuing monitoring. This helps other healthcare professionals interpret new symptoms and plan future care.

Frequently asked questions