Proteasome inhibitor (specialist)
Bortezomib
Brand names: Velcade
Adult dose
Dose: 1.3mg/m² SC twice weekly per cycle (per protocol)
Route: SC / IV
Frequency: Per cycle
Clinical pearls
- NICE TA228 / TA427 / TA755: multiple myeloma 1st-line / relapsed; mantle cell lymphoma
- BSH myeloma; ESMO
- SC route preferred over IV (less neuropathy); aciclovir prophylaxis
Contraindications
- Severe hepatic impairment
- Pregnancy
- Hypersensitivity
Side effects
- Peripheral neuropathy (very common)
- Cytopenias
- GI upset
- Hepatotoxicity
- Heart failure
- HSV/VZV reactivation (give aciclovir prophylaxis)
- Tumour lysis
Interactions
- Strong CYP3A4 inhibitors
- Antidiabetics (hypo or hyper)
Monitoring
- FBC
- LFTs
- Neurological exam
- BP
- Glucose
Reference: BNF; NICE TA228; NICE TA427; BSH myeloma; ESMO; SmPC; https://bnf.nice.org.uk/drugs/bortezomib-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- Revised ISS (R-ISS) for Multiple Myeloma · Haematological Malignancy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
Pathways
- Acute Myeloid Leukaemia Presentation · BSH; NICE — NG146
- Tumour Lysis Syndrome · Cairo-Bishop; BSH; NICE — Best Practice
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158