Venetoclax is a BCL-2 (B - cell lymphoma 2) inhibitor which is prescribed for the treatment of a type of white blood cell cancer, chronic lymphocytic leukemia (CLL), in patients whose tumor cells lack a part of the 17th chromosome (a specific gene alteration known as 17p deletion). It is prescribed only for patients who received prior treatment for the cancer. Venetoclax mainly acts by inhibiting the action of the BCL-2 protein present in the cancer cells and kills the abnormal lymphocytes which are present in the blood and the bone marrow.
Venetoclax is contraindicated in patients who are allergic to the drug, with history of kidney or liver disease, conditions like gout where there is a high level of uric acid in the blood and during pregnancy and breast feeding. It should not be taken with grapefruit juice and some other drugs, which inhibit its breakdown.
Adult : The recommended dose is 20mg to be taken once daily for 7 days followed by a gradual increase in the dose every week to attain the maintenance dose of 400mg/day over a period of 5 weeks.
It comes in the form of a film coated tablet to be taken once daily, by mouth with meals and water.
• Avoid using the drug if you are planning to become pregnant or are already pregnant as the drug may harm the fetus. Lactating women should not use venetoclax as the drug may get excreted through breast milk.
• Do not drink grapefruit juice and do not use drugs which are CYP3A inhibitors with venetoclax as they may increase the risk of a serious condition known as Tumor Lysis Syndrome (TLS). This condition occurs when the drug causes fast and abnormal breakdown of cancer cells leading to kidney failure and other life threatening events. Drink excess of water while taking the drug to avoid TLS.
• Venetoclax requires regular monitoring of the blood cell counts as the drug might result in severe neutropenia (decreased neutrophil (white blood cells) count in the blood).
• Do not vaccinate the patient with live attenuated vaccines before, after or during the treatment with venetoclax as the drug is capable of reducing the effectiveness or safety of the vaccines.
• General: Fever, fatigue, peripheral edema (accumulation of excess fluid in the body that causes swelling), back pain and headache.
• Gastro-Intestinal: Diarrhea, nausea, vomiting and constipation.
• Respiratory: Severe cough, upper respiratory tract infections, pneumonia, chest pain, wheezing and breathing difficulties.
• Blood: Anemia, neutropenia (reduced white blood cell count) and reduced platelet count.
• Metabolic: Tumor lysis Syndrome, increased levels of potassium, phosphorus or uric acid in the blood and low levels of calcium.
• Reproductive system: Fertility problems.
• Do not take more than the recommended dose of the drug as overdose may result in drug toxicity and tumor lysis syndrome.
• Read the prescription leaflet carefully before taking the drug to avoid drug interactions.
• Do not take additional dose on the same day if venetoclax causes vomiting.
Venetoclax should be avoided with:
• Antifungal drugs like ketoconazole, itraconazole, fluconazole, voriconazole and posaconazole.
• Antibiotics like erythromycin, clarithromycin, azithromycin, ciprofloxacin.
• Cardiovascular drugs which are used in the treatment of heart diseases such as amiodarone, captopril, carvedilol, felodipine, quinidine, ranolazine.
These drugs increase the toxic side effects of venetoclax resulting in the risk of tumor lysis syndrome.
• Enzyme inducers like phenytoin, carbamazepine, rifampin, bosentan, efavirenz, etravirine, modafinil, nafcillin.
• These drugs reduce the concentration of venetoclax in the blood resulting in reduced effectiveness.
Warfarin: Venetoclax increases the concentration of warfarin in the blood. Therefore International Normalized Ratio (INR) has to be monitored closely in patients taking warfarin therapy.
P-glycoprotein substrates like everolimus, sirolimus and digoxin due to a possible interaction with venetoclax in the gastrointestinal tract.
Store the medicine in the original blister strip or container at or below a temperature of 30°C. Do not transfer the pack. Keep out of reach of the children.
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