Drugs Home > Precautions and Warnings With Bortezomib

If you have a history of fainting or have liver or kidney problems, let your healthcare provider know before beginning treatment with bortezomib. This medication can cause potentially dangerous and even life-threatening problems, such as nerve damage and heart problems. Warnings and precautions with bortezomib also apply to women who are pregnant, as this drug may harm an unborn child.

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to receiving bortezomib (Velcade®) if you have:
  • Kidney disease, such as kidney failure (renal failure)
  • Numbness, tingling, or burning sensations of the hands or feet (peripheral neuropathy)
  • Liver disease, such as hepatitis, cirrhosis, or liver failure
  • Heart disease
  • Low blood pressure
  • A history of fainting
  • Dehydration or if you do not drink enough fluids throughout the day
  • Ever had a herpes infection
  • Any allergies, including to foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Specific Bortezomib Precautions and Warnings

Some warnings and precautions to be aware of prior to receiving this medication include the following:
  • Bortezomib can reduce blood levels of white blood cells and platelets, increasing the risk for infections and bleeding problems. You will need regular blood tests to monitor your blood cell counts during treatment, at least before each dose. Blood cell counts usually return to near normal during treatment breaks, which are part of the treatment regimen.
If your blood cell counts are too low, your healthcare provider may lower your dose or temporarily stop treatment. If the number of platelets in your blood becomes too low, you may need a blood transfusion.
  • Bortezomib can cause peripheral neuropathy, which is nerve damage that causes numbness, tingling, burning, or painful sensations in the hands or feet. It can also cause muscle weakness. Peripheral neuropathy can be serious. Therefore, let your healthcare provider know if you experience any of these symptoms. You may need a lower dose or a break in treatment. In some cases, it may be necessary to permanently stop using the medicine.
  • You may experience low blood pressure (hypotension) during treatment, which could cause you to become dizzy or faint, especially upon rising. You may have a higher risk for hypotension if you become dehydrated. Therefore, make sure to drink plenty of fluids during treatment. Let your healthcare provider know if you believe you are dehydrated, or if you experience any dizziness, lightheadedness, or fainting.
  • Because of the potential for dizziness, you should not drive or operate heavy machinery until you know how this medicine affects you.
  • Bortezomib contains boron and mannitol. More specifically, it is a form of modified boronic acid, and mannitol, an inactive ingredient, is used to reconstitute bortezomib powder. Tell your healthcare provider if you are allergic to either of these ingredients.
  • Bortezomib can potentially cause or worsen heart problems. Your healthcare provider may choose to closely monitor your heart if you have heart disease or if you are at risk for it. Let your healthcare provider know if you experience any signs of heart problems during treatment, such as:
    • Shortness of breath
    • Chest pain
    • An abnormal heartbeat
    • Swelling of the hands, legs, ankles, or feet.
  • There have been reports of lung problems, including lung infections, occurring in people receiving bortezomib. Let your healthcare provider know if you experience any signs of lung problems, such as:
    • Shortness of breath
    • Cough
    • Difficulty breathing.
  • This medication has been associated with a rare brain condition known as reversible posterior leukoencephalopathy syndrome (RPLS). People who develop this condition should not continue bortezomib treatment. Let your healthcare provider know if you develop any signs of RPLS, such as:
  • Many people will experience stomach and intestinal side effects from bortezomib, including nausea, vomiting, diarrhea, and constipation. Talk to your healthcare provider about ways to manage or help prevent these problems. He or she may recommend you take other medicines, such as antinausea or antidiarrheal medicines.
  • Like other chemotherapy medicines, bortezomib can cause tumor lysis syndrome. This potentially life-threatening complication occurs when the breakdown of dying cancer cells leads to metabolic and electrolyte problems. People who have many tumors, or who have more advanced cancer, are at a higher risk for tumor lysis syndrome. Your healthcare provider will monitor you for this condition using blood and urine tests, and treat you for it if it occurs.
  • There have been reports of liver failure occurring in people who were receiving bortezomib in combination with several other medicines, as well as in people who had other serious medical problems. Let your healthcare provider know if you develop yellowing of the skin or whites of the eyes (jaundice), as this could be a sign of liver problems. People with moderate or severe liver disease should be started on a lower bortezomib dosage and closely monitored during treatment for any liver problems.
  • This medicine may increase blood glucose (blood sugar) levels. If you have diabetes, your healthcare provider may ask you to check your blood sugar levels more often. You may need a different dose of your diabetes medicines during treatment.
  • Bortezomib is a pregnancy Category D medication, which means it may harm an unborn child if taken during pregnancy (see Velcade and Pregnancy).
  • It is unknown whether this medicine passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to receiving the drug (see Velcade and Breastfeeding).
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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