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This medication, Velcade (bortezomib), comes with important safety warnings that should be reviewed carefully. Please consult your healthcare provider if you have any concerns or questions.

• Peripheral Neuropathy: Velcade may cause nerve damage in the arms, hands, legs, and feet. Symptoms include numbness, pain, burning, "pins and needles," tremors, balance issues, or weakness. Notify your healthcare provider if these symptoms occur, as dosage adjustments may be necessary. Those with a history of nerve problems are at higher risk.

• Heart Problems: This medication can lead to new or worsening heart failure. If you have pre-existing heart issues, regular monitoring will be conducted during treatment. Watch for symptoms like shortness of breath, swelling in legs or feet, unexpected weight gain, fatigue, or dizziness, and report them immediately.

• Lung Problems: Though rare, severe lung conditions, including lung inflammation and pneumonia, can occur. Report any breathing difficulties, persistent cough, or fatigue to your provider.

• Posterior Reversible Encephalopathy Syndrome (PRES): Rare cases of this serious brain condition have been reported. Seek immediate medical attention if you experience severe headaches, confusion, vision changes, behavioral changes, or seizures.

• Low Blood Cell Counts: Velcade can reduce white blood cell and platelet counts, increasing infection and bleeding risks. Regular blood tests will be conducted. Report fevers, chills, or unusual bruising or bleeding promptly.

• Tumor Lysis Syndrome (TLS): This serious condition can occur due to rapid cancer cell breakdown, affecting kidney function and heart rhythm. Monitor for decreased urine output, dark urine, muscle cramps, or rapid heartbeat, especially if you have a high tumor burden.

• Liver Damage: Some patients may experience liver damage, particularly when combined with other liver-affecting drugs. Watch for symptoms such as fatigue, appetite loss, nausea, dark urine, stomach pain, or yellowing of the skin or eyes.

• Thrombotic Microangiopathy: Rare blood clots in small vessels can occur, affecting the brain and kidneys. Report confusion, dizziness, or changes in urination promptly.

• Pregnancy Risks: Velcade may harm an unborn baby. Women of childbearing potential should use contraception during treatment and for 7 months after the last dose. Men should use contraception during treatment and for 4 months afterward. Inform your provider if pregnancy occurs during this period.

Contraindications: Do not use Velcade if you have allergies to bortezomib, boron, or mannitol, or if administration into the spinal canal is planned.

Always consult with your healthcare provider for personalized advice and follow their recommendations closely to manage your treatment safely.

Common side effects:

• Diarrhea
• Nausea
• Fatigue
• Numbness or tingling in hands or feet
• Nerve pain
• Constipation
• Vomiting
• Reduced appetite
• Fever
• Pain or redness at the injection site
• Dizziness
• Weakness
• Headache
• Trouble sleeping

Less common but important to monitor:

• Swelling of the legs or feet
• Changes in blood pressure
• Rashes
• Shingles
• Lung infections

Serious side effects:

• Infections with repeated fevers, chills, or difficulty breathing
• Significant bleeding (blood in urine or vomiting blood)
• Extremely low blood pressure (dizziness or fainting)
• Severe headaches or seizures
• Signs of liver damage (dark urine or yellowing of the skin)
• Heart issues (chest pain or rapid heartbeat)
• Severe allergic reaction (rash, swelling, or difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Adenovirus Vaccine, Live
• Bacillus of Calmette and Guerin Vaccine, Live
• Cholera Vaccine, Live
• Dengue Tetravalent Vaccine, Live
• Influenza Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine, Live
• Yellow Fever Vaccine

Interactions with low risk that usually do not require a change in therapy:

• Rifamycins (such as rifabutin)
• St. John's Wort
• Carbamazepine
• Phenytoin