Venetoclax

• Chronic Lymphocytic leukaemia (CLL)
• Acute Myeloid Leukaemia (AML)

When should one not use Venetoclax

• Use of strong CYP3A inhibitors such as ketoconazole, posaconazole, clarithromycin, and certain HIV medicines is contraindicated during the venetoclax ramp-up phase for CLL/SLL, unless specifically prescribed by your doctor, as they can significantly increase venetoclax levels and the risk of tumour lysis syndrome (TLS).

Common side effects of this drug are:

• Low white blood cell count (neutropenia): Increases the risk of serious infections.
• Febrile neutropenia: Fever combined with a low white blood cell count.
• Low platelet count (thrombocytopenia): Can cause easy bruising or bleeding.
• Low red blood cell count (anaemia): Can cause tiredness and breathlessness.
• Upper respiratory tract infections: Includes colds, sore throats, and runny noses.
• COVID-19
• Pneumonia: Lung infection.
• Sepsis:A serious infection that can spread throughout the body.
• Nausea and Vomiting
• Diarrhoea
• Constipation
• Abdominal pain
• Cough
• Shortness of breath (dyspnoea)
• Mouth and throat pain (oropharyngeal pain)
• Fatigue and weakness
• Bleeding (haemorrhage)
• Swelling (oedema): Typically in the hands, feet, or legs.
• Fever (pyrexia)
• Muscle and bone pain (musculoskeletal pain)
• Headache
• Dizziness
• Low blood pressure (hypotension)
• Skin rash
• Seek immediate medical attention if you experience any of the following serious complications:
• Tumour Lysis Syndrome (TLS): A serious and potentially fatal condition where cancer cells break down rapidly and release their contents into the bloodstream. It can cause kidney failure requiring dialysis, irregular heartbeat, seizures, or death.
• Severe Neutropenia: Leading to an increased risk of serious infections.
• Fatal and Serious Infections: Including pneumonia and sepsis.

Other General Warnings

• Consult your doctor If-
• You develop fever, chills, reduced urination, muscle cramps, irregular heartbeat, nausea, or unusual weakness, particularly when starting treatment or after restarting it, as these may indicate tumour lysis syndrome (TLS).
• You develop fever, persistent cough, chills, or other signs of infection, as Venetoclax can cause low white blood cell counts and increase infection risk.
• You have reduced kidney function, as this may increase TLS risk and require closer monitoring.
• You start any new medicine, especially CYP3A or P-glycoprotein inhibitors or CYP3A inducers, as these can significantly alter venetoclax levels.
• You take warfarin or other blood thinners, as monitoring may be required due to potential changes in their effects.
• You have severe liver impairment (Child-Pugh C), as dose adjustment and closer monitoring may be required.
• Avoid live vaccines during treatment and until your B-cell counts have recovered, unless your doctor advises otherwise.
• You are planning to father a child, as venetoclax may affect male fertility based on animal studies.
• Take Venetoclax with a meal and water each time; avoid taking it on an empty stomach.
• Follow the ramp-up dosing schedule exactly to reduce the risk of tumour lysis syndrome (TLS).
• Stay well hydrated, especially during the ramp-up phase, as your doctor advised.
• Avoid grapefruit, grapefruit juice, Seville oranges, and starfruit, as they may increase medicine levels.
• Seek immediate medical attention for fever, chills, reduced urination, muscle cramps, irregular heartbeat, or unusual weakness, which may indicate TLS or infection.
• Tell your doctor about all medicines, especially blood thinners, antifungals, antibiotics, and HIV medicines.
• Women who can become pregnant should use effective contraception during treatment and for 30 days after the last dose.
• Inform all doctors and dentists that you are taking Venetoclax.
• Keep out of reach of children and pets.

How Does It Work?

Interactions with other medicines

• Strong CYP3A inhibitors (e.g., ketoconazole, posaconazole, clarithromycin, and certain HIV medicines) can significantly increase venetoclax levels and require dose adjustment or avoidance, particularly during the ramp-up phase.
• Strong or moderate CYP3A inducers (e.g., rifampicin, carbamazepine, phenytoin, and St. John’s Wort) should be avoided, as they may reduce venetoclax effectiveness.
• Warfarin: Venetoclax may increase warfarin levels; closer INR monitoring is recommended.
• P-gp substrates such as digoxin may require separate administration and monitoring.
• Tell your doctor about all medicines, vitamins, supplements, and herbal products you take before starting treatment.

Interactions with food items

Overdose

Missed a Dose