Velcade Disease Interactions

Acute development or exacerbation of congestive heart failure and new onset of decreased left ventricular ejection fraction have occurred during treatment with bortezomib, including in patients with no risk factors. Patients with risk factors for, or existing heart disease should be closely monitored. There have also been isolated cases of QT interval prolongation but causality has not been established.

Hypoglycemia and hyperglycemia was reported during clinical trials in diabetic patients in treatment with oral hypoglycemics and receiving bortezomib. Patients on oral antidiabetic agents may require close monitoring of their blood glucose levels and adjustment of the dose of their antidiabetic medication when using bortezomib.

Cases of acute liver failure and other hepatic reactions such as hepatitis, increases in liver enzymes, and hyperbilirubinemia have been reported in patients receiving bortezomib. Monitoring is recommended and caution should be used when using bortezomib in patients with hepatic impairment. The exposure of bortezomib is increased in patients with moderate and severe hepatic impairment, and starting dose should be reduced in those patients.

There was an incidence of 8% of hypotension in patients receiving bortezomib therapy. Caution should be used when treating patients with history of hypotension, syncope, dehydration, or taking antihypertensive medication.

Bortezomib can cause peripheral neuropathy that is predominantly sensory; however cases of severe sensory and motor peripheral neuropathy have been also reported. Patients with preexisting symptoms (numbness, pain or burning feeling in hands or feet) may experience worsening symptoms during treatment. Patients should be monitored for symptoms of neuropathy, and a dose adjustment might be required in those patients that experience them.

There have been reports of Acute Respiratory Distress Syndrome (ARDS) and acute diffuse infiltrative pulmonary disease of unknown etiology in patients receiving bortezomib. Additionally, there have been reports of pulmonary hypertension associated with bortezomib administration in the absence of left heart failure or significant pulmonary disease. Treatment interruption should be considered in the event of new or worsening cardiopulmonary symptoms until a comprehensive diagnostic evaluation is conducted. Caution should be exercised when using bortezomib in patients with cardiopulmonary pathologies.