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The information below outlines essential safety warnings and potential risks associated with the use of Velcade (bortezomib). It's important to review these carefully and consult your healthcare provider with any questions or concerns:

• Nerve Complications (Peripheral Neuropathy): Velcade can cause new or worsening peripheral neuropathy, affecting nerves in the arms, hands, legs, and feet. Symptoms may include numbness, pain, tingling, tremors, balance issues, or weakness. Patients with a history of nerve problems are at increased risk. If these occur, contact your provider as your dosage may need adjustment. Typically, these issues improve after dose modification.

• Cardiac Issues: The medication may lead to new or aggravated heart failure, impacting heart function. Patients with existing heart conditions will require frequent monitoring during treatment. Be alert for symptoms such as shortness of breath, leg swelling, sudden weight gain, fatigue, or dizziness, and report them to your provider immediately.

• Respiratory Concerns: Although rare, severe lung issues like inflammation or pneumonia have been reported. Notify your provider if you experience breathing difficulties, coughing, or fatigue.

• Brain Condition (PRES): Rare cases of posterior reversible encephalopathy syndrome (PRES) have been observed. Seek immediate medical attention for sudden severe headaches, confusion, vision changes, behavioral alterations, or seizures. Discontinuation of Velcade is necessary if diagnosed with PRES.

• Low Blood Cell Counts: Velcade may decrease white blood cell and platelet levels, increasing infection and bleeding risks. Routine lab work will monitor your blood counts. Inform your provider if you experience fevers, chills, or unexplained bleeding or bruising.

• Tumor Lysis Syndrome (TLS): This serious condition arises from rapid cancer cell breakdown, leading to high uric acid and electrolyte levels, potentially causing kidney damage and heart rhythm abnormalities. Higher risk exists with a significant cancer cell load or large tumors. Report reduced urination, dark urine, muscle cramps, or a racing heart to your provider promptly.

• Liver Damage: Liver damage can occur, especially when combined with other liver-affecting medications. Patients with pre-existing liver conditions should inform their provider. Watch for symptoms like fatigue, appetite loss, nausea, dark urine, right-side abdominal pain, or jaundice, and report them immediately.

• Blood Clots in Small Vessels: Rare occurrences of thrombotic microangiopathy have been noted, affecting small blood vessels in the brain and kidneys. Report any cognitive changes, dizziness, altered urination, or dark urine to your provider as treatment may need to be halted.

• Pregnancy Risks: Velcade can harm an unborn baby based on animal studies. Women capable of pregnancy should use contraception during treatment and for 7 months after the last dose. Men with partners who can conceive should also use birth control during treatment and for 4 months after the last dose. Notify your provider if pregnancy occurs.

Contraindications:

Avoid using Velcade if you have allergies to bortezomib, boron, or mannitol, or if administration is intrathecal (into the spinal canal). Always consult your healthcare provider if these apply to you before starting treatment.

When using this medication, some common side effects may include dizziness, lightheadedness, nausea, vomiting, diarrhea, constipation, loss of appetite, tiredness, and weakness. Injection site reactions such as pain or redness may also occur. While these effects are usually mild, if they persist or worsen, consulting a healthcare provider is advisable. To minimize dizziness and lightheadedness, it's recommended to rise slowly from sitting or lying positions.

There are also more serious side effects that require immediate medical attention. These include symptoms of infections like persistent fever, chills, cough, and difficulty breathing, as well as serious bleeding, such as blood in the urine or black, tarry stools. Other serious concerns include low blood pressure symptoms like fainting and vision changes, liver problems indicated by dark urine or yellowing of the skin, and heart issues such as chest pain and swelling of the legs.

Rare but severe allergic reactions can occur, characterized by rash, itching, severe dizziness, or trouble breathing. If any of these symptoms develop, seek medical help promptly. Additionally, this medication can affect blood cell counts, potentially leading to anemia, increased infection risk, or easy bruising and bleeding.

Peripheral neuropathy symptoms such as tingling or numbness in the hands and feet, severe headaches, mood changes, and signs of heart failure like unusual tiredness or sudden weight gain also warrant immediate consultation with a healthcare provider. If you experience a rash, even if it seems mild, it's important to get it checked, as it could signal a more severe reaction. Always inform your healthcare provider of any effects you experience that are not listed here.

Bortezomib, known by its brand name Velcade, can interact with certain medications and supplements, potentially altering its effectiveness. Notable interactions include drugs like rifamycins (such as rifabutin), St. John's wort, and medications for seizures, including carbamazepine and phenytoin. These substances may influence how bortezomib is metabolized in your body.

Additionally, bortezomib should generally not be used with live vaccines, such as those for measles, mumps, rubella, rotavirus, varicella, and zoster, as these combinations are usually discouraged. In some cases, if live vaccines like adenovirus, BCG, cholera, dengue, influenza, poliovirus, smallpox, typhoid, or yellow fever are needed, your doctor might adjust your treatment plan to ensure safety and efficacy. Always inform your healthcare provider about all the medications and supplements you are taking to avoid potential interactions.