Velcade is a brand-name prescription medication. It’s FDA-approved to treat two forms of blood cancer in adults: multiple myeloma and mantle cell lymphoma (MCL).

With either multiple myeloma or MCL, your body makes abnormal white blood cells. These abnormal cells can crowd out your healthy blood cells and make it hard for your body to fight off infections.

Velcade contains the active drug bortezomib. It belongs to a class of drugs called proteasome inhibitors. (A class of drugs is a group of medications that work in the same way.) Velcade works by inhibiting (blocking) the action of certain proteins called proteasomes. In this way, the drug helps to kill cancer cells in your body.

Velcade comes as a powder that’s mixed with liquid to form a solution. The solution can be given by either intravenous (IV) injection (an injection into your vein) or subcutaneous injection (an injection under your skin). You’ll receive doses of Velcade from a healthcare provider at a medical facility.

Effectiveness

In clinical studies, Velcade was effective in treating both multiple myeloma and MCL. For information about Velcade’s effectiveness, see the section “Velcade uses” below.

Velcade contains the active drug bortezomib, which is available as a generic medication.

A generic medication is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

For some medications, the brand-name drug and its generic version come in different forms and strengths. But this isn’t the case for Velcade and its generic drug bortezomib.

Velcade can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Velcade. These lists don’t include all possible side effects.

For more information on the possible side effects of Velcade, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Velcade, you can do so through MedWatch.

Your side effects may vary from those listed below depending your dosage of Velcade. They may also differ based on the condition you’re using Velcade to treat and whether you’re taking any other medications with Velcade.

Mild side effects

Mild side effects of Velcade can include:*

  • nausea and vomiting
  • constipation
  • tiredness
  • fever
  • trouble sleeping
  • decreased appetite, which may lead to weight loss
  • headache
  • dizziness
  • low blood pressure
  • peripheral edema (swelling in your arms or legs)

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Velcade. To learn about other mild side effects, talk with your doctor or pharmacist, or see Velcade’s prescribing information.

Serious side effects

Serious side effects from Velcade aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Severe skin reactions. Symptoms can include:
    • fever
    • rash
    • itching
    • blistering and peeling of your skin
  • Liver damage. Symptoms can include:
    • nausea and vomiting
    • loss of appetite
    • tiredness
    • dark colored urine
    • jaundice (yellowing of your skin or the whites of your eyes)
  • Lung damage. Symptoms can include:
    • shortness of breath
    • trouble breathing
    • cough
    • wheezing
  • Brain swelling. Symptoms can include:
    • seizures
    • vision problems
    • confusion
    • tiredness
  • Infections, such as pneumonia. Symptoms will vary depending on the infection you have, but they can include:
    • fever
    • cough
    • chest tightness
    • chills
    • tiredness
  • Clotting disorders. Symptoms can include:
    • unexplained bleeding or bruising
    • petechiae (small purple dots on your skin that form in clusters)
  • Tumor lysis syndrome (a condition that’s caused by cancer cell breakdown and may damage certain organs, such as your kidneys and heart). Symptoms can include:
    • nausea and vomiting
    • diarrhea
    • muscle cramps
    • joint pain
    • tiredness
  • Kidney disease. Symptoms may include:
    • urinating less often than usual
    • fatigue (lack of energy)
  • Injection site reaction, which is discussed below in “Side effect details.”

Other serious side effects, explained in more detail below in “Side effect details,” include:

  • allergic reaction
  • rash caused by infection
  • severe diarrhea
  • neuropathy (nerve damage)
  • heart disease, including cardiomyopathy (a weakened heart muscle) and cardiac amyloidosis (a condition that causes a buildup of protein in your heart muscle)
  • blood disorders, such as low levels of certain blood cells
  • psychiatric disorders, including thoughts of suicide

How long do side effects from Velcade last?

Velcade’s side effects will likely affect each person a little differently. And how long certain side effects of Velcade last will vary from person to person. If you have side effects from Velcade, talk with your doctor about how long you can expect them to last. Your doctor may be able to advise whether certain side effects will go away over time.

If you have side effects from Velcade that are bothersome or severe, your doctor may adjust your dosage of the drug. Or in some cases, they may have you stop using the medication.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on several of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Velcade. But it’s not known how often allergic reaction happens in people using Velcade.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Velcade. But call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Rash

You may develop a skin rash while you’re using Velcade.

If you do get a rash while you’re taking Velcade, call your doctor right away. In some cases, rash may be a sign of an allergic reaction. (For more information about this, see the section “Allergic reaction” just above.)

In other cases, rash may be a sign of an infection, such as shingles. (Shingles can be a result of infection from the varicella zoster virus, a type of herpes virus, which can occur with Velcade use if you’re exposed to this virus.)

Depending on your situation, your doctor may want to see you right away. And if needed, they may recommend changes to your treatment plan.

How common is rash with Velcade?

In clinical studies, between 11% and 23% of people taking the drug had a rash. (This percentage varied depending on the condition being treated.)

For example, one study looked at people with multiple myeloma that hadn’t been treated in the past. In this study:

  • 11% of people taking Velcade with melphalan and prednisone had a rash. (Melphalan and prednisone are other drugs that are sometimes used in multiple myeloma treatment.)
  • 2% of people taking melphalan and prednisone alone had a rash.

Another study looked at people with relapsed multiple myeloma. (With relapsed multiple myeloma, the cancer has come back after a period of remission. During remission, most or all signs of cancer have disappeared). In this study:

  • 13% of people taking Velcade had a rash.
  • 2% of people taking the steroid dexamethasone alone had a rash.

Injection site reaction

It’s possible to have an injection site reaction in the area where you receive Velcade injections. With these reactions, you have inflammation in the tissue where the drug was injected. This can cause redness, swelling, and pain in the area.

It’s not known for sure how many people taking Velcade have had an injection site reaction.

Most injection site reactions are mild. And typically, they only last for a few hours to a few days. But if you have severe swelling, pain, or redness at your injection site that lasts more than a few days, call your doctor. They can recommend ways to help relieve your discomfort.

Diarrhea

It’s very common to have diarrhea while you’re using Velcade. But keep in mind that severe diarrhea can cause weight loss, dehydration (low fluid level), and electrolyte imbalances.

So if you have diarrhea with 10 or more loose stools each day while you’re taking Velcade, call your doctor right away. They may prescribe medication to help stop your diarrhea.

How common is diarrhea with Velcade?

In clinical studies, between 19% and 52% of people taking the drug had diarrhea. (The percentage of people who had diarrhea in these studies varied depending on the condition being treated.) And diarrhea was one of the most common reasons people had to stop taking Velcade.

One study looked at people with multiple myeloma that hadn’t been treated in the past. In this study:

  • 35% of people taking Velcade with melphalan and prednisone had diarrhea. (Melphalan and prednisone are other drugs that are sometimes used in multiple myeloma treatment.)
  • 6% of people taking melphalan and prednisone alone had diarrhea.

Another study looked at people with relapsed multiple myeloma. (With relapsed multiple myeloma, the cancer has come back after a period of remission. During remission, most or all signs of cancer have disappeared). In this study:

  • 52% of people taking Velcade had diarrhea.
  • 11% of people taking the steroid dexamethasone had a diarrhea.

In addition, a study looked at people with mantle cell lymphoma (MCL) that hadn’t been treated in the past. In this study:

  • 25% of people taking Velcade with rituximab, cyclophosphamide, doxorubicin, and prednisone had diarrhea.
  • 5% of people taking rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone without Velcade had diarrhea.

Hair loss

Hair loss isn’t a direct side effect of Velcade, but it may be a side effect of other drugs used with Velcade. For example, hair loss may occur in people using Velcade with cyclophosphamide, which is a cytotoxic drug. (Cytotoxic drugs work by killing cells.)

In fact, hair loss is a common side effect of many cytotoxic drugs. These drugs, which are used to treat cancer, affect rapidly multiplying cells in your body. (Cells that multiply are making more cells.) Cytotoxic drugs kill cancer cells because cancer cells rapidly multiply. But cytotoxic drugs also kill some healthy cells that multiply rapidly, such as hair cells.

One clinical study looked at people with mantle cell lymphoma (MCL) that hadn’t been treated in the past. In this study:

  • 13% of people taking Velcade with rituximab, cyclophosphamide, doxorubicin, and prednisone had hair loss.
  • 14% of people taking rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone without Velcade had hair loss.

If you have concerns about hair loss while you’re taking Velcade, talk with your doctor.

Neuropathy

Peripheral neuropathy is a very common side effect of Velcade. (Peripheral neuropathy is nerve damage that affects certain areas of your body.)

Symptoms of peripheral neuropathy, which can affect your feet, hands, legs, or arms, may include:

  • numbness, prickling, or tingling
  • throbbing or burning pain
  • sensitivity to touch
  • muscle weakness

If you have any symptoms of peripheral neuropathy, let your doctor know right away. Your doctor may adjust your dosage of Velcade. Or they may even recommend that you stop taking Velcade to help reduce this side effect.

How common is peripheral neuropathy with Velcade?

In clinical studies, this side effect occurred in 30% to 54% of people taking Velcade. (This percentage varied depending on the condition being treated and if other medications were used with Velcade.)

For example, one study looked at people with multiple myeloma that hadn’t been treated in the past. In this study:

  • 46% of people taking Velcade with melphalan and prednisone had peripheral neuropathy. (Melphalan and prednisone are other drugs that are sometimes used in multiple myeloma treatment.)
  • 1% of people taking melphalan and prednisone alone had peripheral neuropathy.

Another study looked at people with relapsed multiple myeloma. (With relapsed multiple myeloma, the cancer has come back after a period of remission. During remission, most or all signs of cancer have disappeared). In this study:

  • 35% of people taking Velcade had peripheral neuropathy.
  • 4% of people taking the steroid dexamethasone had a peripheral neuropathy.

In addition, a study looked at people with mantle cell lymphoma (MCL) that hadn’t been treated in the past. In this study:

  • 30% of people taking Velcade with rituximab, cyclophosphamide, doxorubicin, and prednisone had peripheral neuropathy.
  • 27% of people taking rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone without Velcade had peripheral neuropathy.

Heart disease

It’s possible to have certain heart problems while you’re taking Velcade. These problems can include:

A study looked at people with relapsed multiple myeloma. (With relapsed multiple myeloma, the cancer has come back after a period of remission. During remission, most or all signs of cancer have disappeared.) In this study:

  • 8% of people taking Velcade had a heart problem.
  • 5% of people taking the steroid dexamethasone alone had a heart problem.

If you have any symptoms related to heart disease, such as those listed below, call your doctor as soon as possible. Your doctor may want to see you as soon as possible to check on your heart. And in some cases, they may adjust your dosage of Velcade.

Examples of symptoms related to heart disease can include:

  • chest tightness
  • chest pain
  • shortness of breath
  • weakness
  • swelling in your arms or legs
  • dizziness

But keep in mind that if your symptoms feel severe or life threatening, you should call 911 right away.

Blood disorders

If you have a blood cancer such as multiple myeloma or mantle cell lymphoma (MCL), you may have abnormal blood cells in your body. Velcade, which is used to treat these two blood cancers, can decrease your level of abnormal blood cells. But the drug can also lower your levels of healthy blood cells.

The most common blood cell disorders that occur in people taking Velcade include:

  • Neutropenia. With neutropenia, you have a low neutrophil count. Neutrophils are white blood cells that help fight off infections. So having neutropenia may increase your risk of infection.
  • Thrombocytopenia. With thrombocytopenia, you have a low platelet count. Platelets help your blood to form clots, which prevents excessive bleeding and bruising. So having thrombocytopenia may increase your risk of bleeding and bruising.

During Velcade treatment, your doctor will order blood tests to monitor you for blood disorders. If you have a blood disorder, your doctor may adjust your dosage of Velcade. Or they may recommend treatment with a drug other than Velcade.

How common are blood disorders with Velcade?

Certain blood cell disorders were seen in people taking Velcade during clinical studies. (The percentages of people affected depended on the condition being treated.)

For example, one study looked at people with multiple myeloma that hadn’t been treated in the past. In this study:

  • 47% of people taking Velcade with melphalan and prednisone had neutropenia. (Melphalan and prednisone are other drugs that are sometimes used in multiple myeloma treatment.)
  • 42% of people taking melphalan and prednisone alone had neutropenia.
  • 48% of people taking Velcade with melphalan and prednisone had thrombocytopenia.
  • 42% of people taking melphalan and prednisone alone had thrombocytopenia.

Another study looked at people with relapsed multiple myeloma. (With relapsed multiple myeloma, the cancer has come back after a period of remission. During remission, most or all signs of cancer have disappeared.) In this study:

  • 18% of people taking Velcade had neutropenia.
  • less than 1% of people taking the steroid dexamethasone had a neutropenia.
  • 33% of people taking Velcade had thrombocytopenia.
  • 3% of people taking dexamethasone had a thrombocytopenia.

In addition, a study looked at people with mantle cell lymphoma (MCL) that hadn’t been treated in the past. In this study:

  • 87% of people taking Velcade with rituximab, cyclophosphamide, doxorubicin, and prednisone had neutropenia.
  • 71% of people taking rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone without Velcade had neutropenia.
  • 72% of people taking Velcade with rituximab, cyclophosphamide, doxorubicin, and prednisone had thrombocytopenia.
  • 17% of people taking rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone without Velcade had thrombocytopenia.

Psychiatric disorders

It’s possible to have psychiatric disorders while you’re taking Velcade. These disorders can include changes in your mood or behavior and having thoughts of suicide. In clinical studies, 7% to 10% of people taking Velcade had psychiatric disorders. (This percentage varied depending on the condition being treated.)

Symptoms of psychiatric disorders may include:

  • agitation
  • anxiety
  • confusion
  • trouble sleeping

If you have changes in your mood or behavior while you’re taking Velcade, call your doctor right away. But if you have thoughts of harming yourself or attempting suicide, call 911 or go to the nearest emergency room.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.

The Food and Drug Administration (FDA) approves prescription drugs such as Velcade to treat certain conditions. Velcade may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Velcade for multiple myeloma

Velcade is FDA-approved to treat multiple myeloma in adults.

Multiple myeloma is a type of cancer that affects white blood cells called plasma cells. These cells help your body to fight off infections. But with multiple myeloma, your body forms abnormal plasma cells. These abnormal cells crowd out your healthy blood cells, which prevents new healthy blood cells from being formed.

Velcade belongs to a class of drugs called proteasome inhibitors. (A class of drugs is a group of medications that work in the same way.) Velcade works by inhibiting (blocking) the action of certain proteins called proteasomes. In this way, the drug helps to kill cancer cells in your body.

Effectiveness for multiple myeloma

Velcade has been studied for use in people with untreated multiple myeloma and people with relapsed multiple myeloma. With relapsed multiple myeloma, the cancer has come back after a period of remission. (With remission, most or all signs of cancer have disappeared.)

Below, we describe Velcade’s effectiveness in treating both of these conditions.

Effectiveness for untreated multiple myeloma

One clinical study looked at people with multiple myeloma that hadn’t been treated in the past. Some people were given Velcade with both melphalan (a chemotherapy drug) and prednisone (a steroid). Other people were given melphalan and prednisone alone. In this study:

  • Half of the people who took the Velcade combination lived for at least 56.4 months. In comparison, half of the people who didn’t take Velcade lived for at least 43.1 months.
  • Of people who took the Velcade combination, half of them went at least 20.7 months without their cancer getting worse. In comparison, of people who didn’t take Velcade, half of them went at least 15 months without their cancer worsening.

Effectiveness for relapsed multiple myeloma

Another clinical study looked at people with multiple myeloma that had been treated in the past but had relapsed. Some people were given Velcade, while other people were given high doses of the steroid dexamethasone. In this study:

  • Of people who took Velcade, half of them went at least 6.2 months without their cancer getting worse. In comparison, of people who took dexamethasone, half of them went at least 3.5 months without their cancer getting worse.
  • 38% of people who took Velcade responded to treatment. (This was noted by improvements in people’s blood counts.) In comparison, 18% of people taking dexamethasone responded to treatment.

Velcade for mantle cell lymphoma

Velcade is FDA-approved to treat mantle cell lymphoma (MCL) in adults.

MCL is a type of cancer that affects white blood cells called lymphocytes. This condition is a type of non-Hodgkin lymphoma (NHL) that starts in an area of lymphocytes called the “mantle zone.”

Lymphocytes help your body to fight off infections. But with MCL, your body makes abnormal lymphocytes. These abnormal lymphocytes crowd out your healthy blood cells, which prevents new healthy blood cells from being formed.

Velcade belongs to a class of drugs called proteasome inhibitors. (A class of drugs is a group of medications that work in the same way.) Velcade works by inhibiting (blocking) the action of certain proteins called proteasomes. In this way, the drug helps to kill cancer cells in your body.

Effectiveness for mantle cell lymphoma

Velcade has been studied for use in people with untreated MCL and in people with relapsed MCL. With relapsed MCL, the cancer has come back after a period of remission. (With remission, most or all signs of cancer have disappeared.)

Below, we describe Velcade’s effectiveness in treating both of these conditions.

Effectiveness for untreated mantle cell lymphoma

One clinical study looked at people with MCL that hadn’t been treated in the past. Some people were given Velcade with the cancer drugs rituximab, cyclophosphamide, and doxorubicin. And these people were also given the steroid prednisone. Other people were given a combination known as R-CHOP, which contains rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.

In this study:

  • Of people who took the Velcade combination, half of them went at least 25 months without their cancer getting worse. In comparison, of people who didn’t take Velcade, half of them went at least 14 months without their cancer getting worse.
  • People who took Velcade had an average survival time of 91 months. In comparison, people who didn’t take Velcade had an average survival time of 56 months.

Effectiveness for relapsed mantle cell lymphoma

A clinical study also looked at people with relapsed MCL. These people had received at least one other therapy in the past. In this study, all of the people were given Velcade. There weren’t any people who took a different medication or a placebo (treatment with no active drug).

In this study:

  • An average of 31% people who took Velcade responded to treatment. (This was noted by improvements in the people’s blood counts.)
  • The people’s response to treatment lasted an average of 9.3 months.

Off-label uses for Velcade

In addition to the uses listed above, Velcade may be used off-label for other conditions. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved. Below are examples of off-label uses for Velcade.

Velcade for other forms of lymphoma

While Velcade is approved to treat certain types of lymphoma, it’s not approved to treat all forms of lymphoma. So in some cases, Velcade is used off-label to treat certain forms of lymphoma.

Below, we describe certain lymphomas that Velcade is sometimes used off-label to treat. If you have questions about using Velcade to treat certain forms of lymphoma, talk with your doctor. They can recommend appropriate treatment options for your condition.

T-cell lymphoma

T-cell lymphoma is a type of cancer that affects white blood cells called T cells. These cells are a part of your immune system, and they help your body fight off infections. Although Velcade isn’t approved to treat T-cell lymphoma, the drug has shown some benefit in small clinical trials of people with this condition.

For example, some people taking Velcade had higher response rates and longer survival times than people who didn’t take it. In addition, bortezomib (the active drug in Velcade) is now listed in current guidelines as a possible second treatment option for T-cell lymphoma. However, more studies are needed to test the effectiveness and safety of bortezomib in treating T-cell lymphoma.

Follicular lymphoma (FL)

FL is a type of cancer that affects white blood cells called lymphocytes. Lymphocytes are a part of your immune system, and they help your body fight off infections. FL is a type of non-Hodgkin lymphoma (NHL).

Velcade isn’t approved to treat FL. However, clinical studies have been done with bortezomib (the active drug in Velcade) in people with FL. (In the studies, people were also given the cancer drug rituximab.) The studies showed that, on average, people who took bortezomib went a longer time without their cancer worsening than did people who didn’t take bortezomib.

These results are promising. But more studies are needed to test the safety and effectiveness of Velcade in treating FL.

Waldenström macroglobulinemia

Waldenström macroglobulinemia, also called lymphoplasmacytic lymphoma (LPL), is a type of blood cell cancer. With this condition, your white blood cells make too much of an abnormal protein called a macroglobulin. This protein can build up and cause damage to your organs.

A clinical study looked at using bortezomib (the active drug in Velcade) in people with LPL. The people were also given the steroid dexamethasone and the cancer drug rituximab. (This combination of treatment is also called the BDR regimen.) In the study, 85% of people responded to treatment. And half of the people went at least 43 months without their cancer worsening. And at 7 years, 66% of the people were still alive.

More studies are needed to test the effectiveness and safety of bortezomib in people with LPL.

Velcade for AL amyloidosis

Velcade isn’t approved to treat amyloid light-chain (AL) amyloidosis. But sometimes, Velcade is used off-label for this condition. With AL amyloidosis, your antibodies (proteins that help fight off infections) don’t work properly. And they start to make proteins that can affect some of your organs, such as your heart, kidneys, and liver.

In a clinical study, bortezomib (the active drug in Velcade) was given to people with AL amyloidosis. (The people also received the steroid dexamethasone.) In this study, 45% of people had a complete response to treatment. (With a complete response, there isn’t any detectable cancer in your body.) Half of the people in the study went at least 45 months without their condition getting worse.

Even though these study results are promising, Velcade isn’t approved to treat AL amyloidosis. More studies need to be done to evaluate Velcade’s use in treating this condition.

If you have questions about using Velcade to treat certain forms of amyloidosis, talk with your doctor. They can recommend appropriate treatment options for your condition.

Velcade and children

The safety and efficacy of Velcade hasn’t been studied in children. Because of this, it’s not known if Velcade is safe or effective for use in people younger than 18 years of age.

Velcade is commonly used with other drugs to treat certain types of cancer. Examples of drugs that are often used with Velcade are discussed below.

If you have questions about using other drugs with Velcade, talk with your doctor.

Velcade with both lenalidomide and dexamethasone

Velcade is approved for use in people with untreated multiple myeloma and in people with relapsed multiple myeloma. With relapsed multiple myeloma, the cancer has come back after a period of remission. (During remission, most or all signs of cancer have disappeared.)

For either of these conditions, the preferred treatment regimen is Velcade, used in combination with both:

This treatment combination is sometimes called the VRD regimen. And it’s listed as the preferred first treatment choice in current guidelines for multiple myeloma.

Effectiveness of Velcade with lenalidomide and dexamethasone

In one study, people with untreated multiple myeloma were given the VRD regimen. In this study:

  • 100% of the people had at least a partial response to treatment. (With a partial response, their cancer didn’t worsen or it disappeared, either partly or completely.)
  • Half of the people taking the VRD regimen went at least 18 months without their cancer getting worse.

Velcade with dexamethasone

Velcade may be used with the steroid dexamethasone to treat certain blood cancers before a stem cell transplant is done. In this case, Velcade and dexamethasone help prepare your body for the transplant.

Effectiveness of Velcade with dexamethasone

In one study, bortezomib (the active drug in Velcade) was given to people with untreated multiple myeloma prior to the people receiving a stem cell transplant. Some people were given dexamethasone with bortezomib. (This treatment combination is also called the BD regimen.) Other people were given vincristine, doxorubicin, and dexamethasone. (This treatment combination is also called the VAD regimen.)

In this study:

  • Compared with people who didn’t take bortezomib, those taking the drug had better rates of their cancer improving or not getting worse.
  • People taking bortezomib went an average 6 months longer without their cancer getting worse than did people who didn’t take the drug.

Velcade with both daratumumab and dexamethasone

For some conditions, Velcade is used in combination with daratumumab (Darzalex). Daratumumab is a monoclonal antibody drug, which means it’s made from immune system cells. It’s used with Velcade and the steroid dexamethasone to treat certain types of multiple myeloma.

Specifically, this combination of drugs is used for both relapsed and refractory multiple myeloma. With relapsed multiple myeloma, the cancer has come back after a period of remission. (During remission, most or all signs of cancer have disappeared.) And with refractory multiple myeloma, the cancer didn’t respond to past treatment.

Effectiveness of Velcade with daratumumab

In one study of people with multiple myeloma, some people took daratumumab plus dexamethasone and bortezomib (the active drug in Velcade). Other people took bortezomib and dexamethasone alone.

In this study:

  • Of people taking daratumumab, 82.9% had their cancer either improve or not worsen with treatment.
  • In comparison, of people who didn’t take daratumumab, 63.2% had the same response to treatment.

The Velcade dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Velcade to treat
  • your body surface area (BSA)
  • how you receive your doses of Velcade
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Velcade comes as a powder that’s mixed with liquid to form a solution. It’s available in one strength: 3.5 milligram (mg) of drug per vial of medication.

However, the strength of your doses depends on how the drug will be administered to you. Velcade, which is given by healthcare providers, can be administered as either:

Your healthcare provider will prepare your doses of Velcade into the following strengths, depending on how you’ll receive your dose:

  • for IV injection, the strength of Velcade doses is 1 mg of drug per milliliter of solution (mg/mL)
  • for subcutaneous injection, the strength of Velcade doses is 2.5 mg/mL

Dosage for multiple myeloma

The typical dose of Velcade for multiple myeloma is calculated based on your body surface area (BSA). The recommended starting dose of Velcade is 1.3 mg of drug per meters squared (m2) of BSA. So your doses will be given in units of mg/m2.

For example, a man who weighs 180 pounds (about 82 kilograms) and is 6 feet tall (about 1.8 meters) has a body surface area of about 2.04 m2. He would receive 1.3 mg of drug per m² of BSA. So his dose would be around 2.65 mg of Velcade.

Your doctor may adjust your dosage of Velcade based on side effects that you may have. They may also adjust your dosage depending on results of certain blood tests or if you’re using other medications with Velcade.

Dosage schedule for untreated multiple myeloma

If you have untreated multiple myeloma, you’ll likely receive Velcade over nine 6-week treatment cycles. And Velcade is typically given with the chemotherapy drug melphalan and the steroid prednisone.

During the first four treatment cycles, you’ll receive Velcade doses twice weekly. Then in the last five treatment cycles, you’ll receive Velcade doses once weekly. Your healthcare provider will make sure that at least 72 hours pass between your Velcade doses.

Dosage schedule for relapsed or refractory multiple myeloma

If you have relapsed* or refractory** multiple myeloma, your doctor will determine the best dosing schedule for you. They’ll base this on any treatments you’ve used in the past and how well your cancer responded to Velcade, if you’ve used it in the past.

For relapsed or refractory multiple myeloma, Velcade can be given alone or in combination with the steroid dexamethasone.

Below are examples of some dosing schedules that may be used for relapsed or refractory multiple myeloma:

  • Velcade given twice weekly for 2 weeks, followed by a 10-day rest period
  • Velcade given once weekly for 4 weeks, followed by a 13-day rest period
  • Velcade given twice weekly every 3 weeks for a maximum of eight cycles of treatment

* With relapsed multiple myeloma, the cancer has come back after a period of remission. (During remission, most or all signs of cancer have disappeared.)

** With refractory multiple myeloma, the cancer didn’t respond to past treatment.

Dosage for mantle cell lymphoma

The typical dose of Velcade for mantle cell lymphoma (MCL) is calculated using your body surface area (BSA). The recommended starting dose of Velcade is 1.3 mg of drug per meters squared (m2) of BSA. So your doses will be given in units of mg/m2.

For example, a man who weighs 180 pounds (about 82 kilograms) and is 6 feet tall (about 1.8 meters) has a body surface area of about 2.04 m2. He would receive 1.3 mg of drug per m² of BSA. So his dose would be around 2.65 mg of Velcade.

Your doctor may adjust your dosage of Velcade based on side effects that you may have. They may also adjust your dosage depending on results of certain blood tests or if you’re using other medications with Velcade.

Dosage schedule for untreated mantle cell lymphoma

If you have MCL that hasn’t been treated in the past, you’ll likely receive Velcade over six 3-week treatment cycles.

Typically, Velcade is given in combination with other drugs. This includes the cancer drugs rituximab, cyclophosphamide, and doxorubicin. And you’ll also likely take the steroid prednisone.

During the first 2 weeks of each cycle, you’ll receive Velcade twice weekly. Then, for the third week of each cycle, you’ll have a 10-day rest period. During the rest period, you won’t take any of the medications mentioned above. This 3-week treatment pattern is continued for a total of six cycles.

If your cancer responds to this treatment, your doctor may have you complete two additional cycles of treatment.

Dosage schedule for relapsed or refractory mantle cell lymphoma

If you have relapsed* or refractory** MCL, your doctor will determine the best dosing schedule for you. They’ll base this on any treatments you’ve used in the past and how well your cancer responded to Velcade, if you’ve used it in the past.

For relapsed or refractory MCL, Velcade can be given alone or in combination with the steroid dexamethasone.

Below are examples of some dosing schedules that may be used for relapsed or refractory MCL:

  • Velcade given twice weekly for 2 weeks, followed by a 10-day rest period
  • Velcade given once weekly for 4 weeks, followed by a 13-day rest period

* With relapsed MCL, the cancer has come back after a period of remission. (During remission, most or all signs of cancer have disappeared.)

** With refractory MCL, the cancer didn’t respond to past treatment.

What if I miss a dose?

If you miss an appointment to receive your Velcade dose, call your doctor’s office right away. Your doctor or their medical staff will recommend a time for you to come get your Velcade dose.

To help make sure that you don’t miss a dose, try setting an appointment reminder on your phone. You can also keep track of your appointments by writing them on a calendar.

Velcade is given at medical facilities by healthcare providers as either:

Before administering your Velcade dose to you, your healthcare provider will prepare the medication. Because Velcade comes as a powder, it must be mixed with liquid to form a solution. Then, the solution can be given to you as an injection.

The amount of liquid that’s mixed with Velcade depends on whether you’ll be receiving the drug as an IV injection or a subcutaneous injection. How much liquid is mixed with Velcade powder will determine the strength of your dose.

For more information about the possible strengths of Velcade doses, see the section “Velcade dosage” above.

Injection sites

If you receive Velcade by subcutaneous injection, your injection sites will usually be on your thigh or on your abdomen (belly). Your healthcare provider should rotate injection sites each time you receive an injection of Velcade. Doing this helps to avoid causing damage to your skin and the tissue surrounding the injection sites.

If you receive Velcade by IV injection, your healthcare provider will inject the drug into one of your veins. Typical IV injection sites include veins in your hands or arms.

How often Velcade is given

How often your Velcade dose is given is based on what condition you’re using the drug to treat. Your dose and dosing schedule may also depend on:

  • certain side effects that you may be having
  • results of certain blood tests
  • whether you’re using other medications with Velcade

For information on Velcade doses and dosing schedules based on your condition, see the section “Velcade dosage” above. In any case, it’s recommended that you wait at least 72 hours between Velcade doses.

It’s not known whether it’s safe to drink alcohol while you’re taking Velcade. But keep in mind that alcohol can cause some of the same side effects as Velcade does. These side effects include nausea, vomiting, and diarrhea. So avoiding alcohol may help prevent these side effects from worsening.

If you drink alcohol, talk with your doctor about how much is safe for you to drink during Velcade treatment.

Velcade can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Before taking Velcade, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Velcade and other medications

Below are lists of medications that can interact with Velcade. These lists do not contain all the drugs that may interact with Velcade.

Velcade and certain seizure medications

Taking Velcade with certain seizure medications can decrease the level of Velcade in your body. And this may prevent Velcade from working properly.

Examples of seizure medications that may interact with Velcade include:

If you’re taking one of the drugs listed above, talk with your doctor about whether it’s safe for you to take it with Velcade.

Velcade and rifampin

Rifampin (Rifadin) is an antibiotic that’s sometimes used to treat or prevent tuberculosis (TB). But if rifampin is taken with Velcade, it can lower the level of Velcade in your body. This may prevent Velcade from working properly.

If you’re taking rifampin, talk with your doctor about whether it’s safe for you to take it with Velcade.

Velcade and conivaptan

Conivaptan (Vaprisol) is a drug that’s used to treat low sodium levels. But if it’s taken with Velcade, conivaptan can increase the level of Velcade in your body. Conivaptan does this by preventing Velcade from being metabolized (broken down). This interaction can lead to toxic levels of Velcade in your body, which may increase your risk of serious side effects from Velcade.

If you’re taking conivaptan, talk with your doctor before taking Velcade.

Velcade and vaccines

Getting a live vaccine while you’re taking Velcade may increase your risk of infection. This is because live vaccines contain live forms of certain viruses. But Velcade may lower the activity of your immune system, so your body might not be able to properly react to live vaccines. This means that in some cases, you may actually get the infection the vaccine was meant to protect you from.

Examples of live vaccines include:

If you’re considering having any vaccinations while you’re using Velcade, talk with your doctor. They can advise whether it’s safe for you to get certain vaccines.

Velcade and herbs and supplements

Velcade may interact with certain herbs and supplements. Below, we describe two possible interactions. But other interactions may also be possible. Be sure to check with your doctor or pharmacist before using any herb or supplement products while you’re taking Velcade.

Velcade and St. John’s wort

St. John’s wort is an herbal supplement that’s sometimes used by people with anxiety and depression. But taking St. John’s wort with Velcade may decrease levels of Velcade in your body. And this can prevent Velcade from working properly.

Talk with your doctor before taking St. John’s wort with Velcade.

Velcade and vitamin C

Vitamin C supplements are usually taken to help boost the activity of your immune system. But in one animal study, Velcade’s effect was blocked by vitamin C. This means Velcade wasn’t able to work properly. However, keep in mind that animal studies don’t always predict what will happen in people.

Talk with your doctor about whether it’s safe for you to take vitamin C while you’re taking Velcade.

Velcade and foods

The manufacturer of Velcade hasn’t stated that there are any food interactions with Velcade. But below, we describe one possible food interaction with this drug.

If you have any questions about eating certain foods with Velcade, talk with your doctor.

Velcade and green tea

Some studies have shown that flavonoids and other compounds found in green tea can block Velcade’s effect. (This interaction may also happen with other drugs that are similar to Velcade.) However, there hasn’t been enough research to show that this interaction significantly changes how well Velcade works in your body.

If you drink green tea, be sure to talk with your doctor. They can recommend whether it’s safe for you to continue drinking green tea while you’re taking Velcade.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Velcade, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed below are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for multiple myeloma

Examples of other drugs that may be used to treat multiple myeloma include:

  • proteasome inhibitors other than Velcade, such as:
  • alkylating agents, such as:
    • melphalan (Alkeran)
  • immunomodulatory drugs, such as:
    • thalidomide (Thalomid)
  • steroids, such as:
  • mitotic inhibitors, such as:
    • vincristine
    • etoposide

Alternatives for mantle cell lymphoma

Examples of other drugs that may be used to treat mantle cell lymphoma (MCL) include:

  • proteasome inhibitors other than Velcade, such as:
  • alkylating agents, such as:
  • BTK inhibitors, such as:
    • acalabrutinib (Calquence)
  • immunomodulatory drugs, such as:
    • thalidomide (Thalomid)

You may wonder how Velcade compares with other medications that are prescribed for similar uses. Here we look at how Velcade and Kyprolis are alike and different.

Ingredients

Velcade contains the active drug bortezomib, while Kyprolis contains the active drug carfilzomib. Velcade and Kyprolis both belong to a drug class called proteasome inhibitors. (A drug class is a group of medications that work in the same way.)

Uses

Velcade is approved to treat the following conditions in adults:

Kyprolis is also approved to treat multiple myeloma in adults. Specifically, it’s approved to treat either relapsed* or refractory** multiple myeloma. For this use, Kyprolis can be given in one of these two ways:

  • used in combination with either dexamethasone alone or dexamethasone plus lenalidomide (Revlimid); this regimen is given to people who’ve had one to three past therapies for the condition
  • used alone in people who’ve had at least one past therapy for the condition

* With relapsed multiple myeloma, the cancer has come back after a period of remission. (During remission, most or all signs of cancer have disappeared.)

** With refractory multiple myeloma, the cancer didn’t respond to past treatment.

Drug forms and administration

Velcade is given by either intravenous (IV) injection (an injection into your vein) or subcutaneous injection (an injection under your skin). You’ll receive doses of Velcade from a healthcare provider at a medical facility.

Kyprolis is given by healthcare providers as an IV infusion. (With an IV infusion, the drug is injected into your vein over a period of time.) Kyprolis infusions last about 10 to 30 minutes.

Your dosing schedule of either Velcade or Kyprolis will vary depending on the condition you’re treating. It will also depend on how your body is tolerating treatment and if you’re taking other medications as well.

Side effects and risks

Velcade and Kyprolis are both proteasome inhibitors. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Velcade, with Kyprolis, or with both drugs (when taken individually).

  • Can occur with Velcade:
    • decreased appetite and weight loss
    • low blood pressure
  • Can occur with Kyprolis:
    • backache
    • cough
    • upper respiratory infection
    • high blood pressure
  • Can occur with both Velcade and Kyprolis:
    • nausea and vomiting
    • constipation
    • tiredness
    • fever
    • headache
    • trouble sleeping
    • dizziness
    • peripheral edema (swelling in your arms or legs)

Serious side effects

These lists contain examples of serious side effects that can occur with Velcade, with Kyprolis, or with both drugs (when taken individually).

  • Can occur with Velcade:
    • severe skin reactions
    • brain swelling
    • clotting disorders
  • Can occur with Kyprolis:
    • blurred vision
    • cataracts (cloudiness in the lens of your eye)
    • anemia (low red blood cell level)
  • Can occur with both Velcade and Kyprolis:
    • diarrhea
    • neuropathy (nerve damage)
    • liver disease
    • heart disease
    • kidney disease
    • blood cell disorders, such as thrombocytopenia (low platelet level) and neutropenia (low level of a type of white blood cell)
    • tumor lysis syndrome (a condition that’s caused by cancer cell breakdown)
    • lung damage

Effectiveness

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Velcade and Kyprolis to be effective in treating certain forms of multiple myeloma.

Costs

Velcade and Kyprolis are both brand-name drugs. But generic forms of these medications are available. (A generic drug is an exact copy of the active drug in a brand-name medication.) Generic medications usually cost less than brand-name medications cost.

You can view cost estimates for both Velcade and Kyprolis at WellRx.com. But the actual price you’ll pay for either drug depends on your prescribed dosage. The cost will also depend on your insurance plan, your location, and the facility where you receive the drug.

Like Kyprolis, discussed above, other medications are also prescribed for similar uses. Here we look at how Velcade and Ninlaro are alike and different.

Ingredients

Velcade contains the active drug bortezomib, while Ninlaro contains the active drug ixazomib. Velcade and Kyprolis both belong to a drug class called proteasome inhibitors. (A drug class is a group of medications that work in the same way.)

Uses

Velcade is approved to treat the following conditions in adults:

Ninlaro is also approved to treat multiple myeloma. Specifically, Ninlaro is prescribed for people who’ve received at least one past therapy for the condition. And it’s approved for this use in combination with both lenalidomide (Revlimid) and dexamethasone.

Drug forms and administration

Velcade is given by either intravenous (IV) injection (an injection into your vein) or subcutaneous injection (an injection under your skin). You’ll receive doses of Velcade from a healthcare provider at a medical facility.

Ninlaro comes as capsules that are taken by mouth. It’s taken on certain days of each of your prescribed treatment cycles.

Your dosage of either Velcade or Ninlaro will vary based on the condition you’re treating. Your dosage will also depend on how your body is tolerating treatment and if you’re using other medications as well.

Side effects and risks

Velcade and Ninlaro are both proteasome inhibitors. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Velcade, with Ninlaro, or with both drugs (when taken individually).

  • Can occur with Velcade:
    • trouble sleeping
    • decreased appetite, which may lead to weight loss
    • dizziness
    • fever
    • tiredness
    • headache
  • Can occur with Ninlaro:
    • backache
    • upper respiratory infection
  • Can occur with both Velcade and Ninlaro:
    • constipation
    • nausea and vomiting
    • peripheral edema (swelling of your arms or legs)

Serious side effects

These lists contain examples of serious side effects that can occur with Velcade, with Ninlaro, or with both drugs (when taken individually).

  • Can occur with Velcade:
    • lung damage
    • brain swelling
    • clotting disorders
    • heart disease
  • Can occur with Ninlaro:
    • eye disease, such as dry eye or blurred vision
  • Can occur with both Velcade and Ninlaro:
    • diarrhea
    • severe skin rash
    • neuropathy (nerve damage)
    • liver damage
    • tumor lysis syndrome (a condition that’s caused by cancer cell breakdown)

Effectiveness

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Velcade and Ninlaro to be effective in treating certain forms of multiple myeloma.

Costs

Velcade and Ninlaro are both brand-name drugs. But a generic form of Velcade is available. (A generic drug is an exact copy of the active drug in a brand-name medication.) Generic medications usually cost less than brand-name medications cost.

You can view cost estimates for both Velcade and Ninlaro at WellRx.com. But the actual price you’ll pay for either drug depends on your prescribed dosage. The cost will also depend on your insurance plan, your location, and the facility where you receive the drug.

Here are answers to some frequently asked questions about Velcade.

How long will Velcade stay in my body?

The length of time that Velcade stays in your body depends on a couple things, such as:

  • your liver function
  • your kidney function
  • how quickly your body breaks down the drug

This length of time can vary from person to person. However, the average half-life of Velcade is between 40 hours and 193 hours. (The half-life of a drug describes how long it takes for half of your dose to leave your body.)

Just one dose of Velcade can stay in your system over a long period of time. Because of this, it’s recommended that you wait at least 72 hours between Velcade doses.

Can I use Velcade if I have multiple myeloma and I’ve had a stem cell transplant?

Yes, you may be able to if your doctor recommends it. In fact, Velcade is quickly becoming the main therapy for multiple myeloma in people who’ve had a stem cell transplant.

Several studies have shown that Velcade can lengthen the time people go without their cancer coming back or getting worse after they’ve had a stem cell transplant. (In these studies, Velcade was used with two other drugs: thalidomide [Thalomid] and lenalidomide [Revlimid].)

If you’ve had a stem cell transplant and you have questions about using Velcade, talk with your doctor.

How long should I take Velcade if I’ve never had treatment for my cancer before?

How long you’ll need to take Velcade depends on a few things. These include:

  • the condition you’re treating
  • how well your body is tolerating treatment
  • the results of certain blood tests
  • whether you’re taking other medications with Velcade

If you’re using Velcade for multiple myeloma that hasn’t been treated in the past, you’ll likely take Velcade for nine 6-week treatment cycles. And this treatment regimen typically lasts for an average of 54 weeks.

If you’re using Velcade for mantle cell lymphoma (MCL) that hasn’t been treated in the past, you’ll likely take Velcade for six 3-week treatment cycles. If your cancer responds to this therapy, your doctor may have you complete two additional treatment cycles.

Keep in mind that treatment length can vary from person to person. Talk with your doctor to learn how long you’ll need to take Velcade given your unique situation.

Is Velcade chemotherapy?

No, Velcade isn’t a chemotherapy drug. (Chemotherapy is used to describe traditional drugs used to treat cancer.)

Chemotherapy drugs work by killing cells in your body that are quickly multiplying. (Cells that multiply are making more cells.) Cancer cells multiply quickly, so chemotherapy affects them. But chemotherapy also affects healthy cells that multiply quickly.

Velcade, on the other hand, is a targeted therapy. In fact, it’s called a proteasome inhibitor. It works by inhibiting (blocking) the action of proteins called proteasomes. By targeting these specific proteins, Velcade causes cancer cells that have that protein to die.

Targeted therapies like Velcade may affect fewer cells in your body than chemotherapy does. Because of this, targeted therapies typically have different, and sometimes fewer, side effects than chemotherapy drugs do.

If you have questions about chemotherapy versus targeted therapy, talk with your doctor.

Will Velcade cure my cancer?

No, it won’t. And unfortunately, there’s no known cure for cancer at this time. However, in clinical studies, Velcade helped to stop people’s cancer from getting worse. And the drug also helped to prolong people’s survival time.

Keep in mind that Velcade’s effect varies from person to person. And how your cancer responds to treatment can depend on:

  • the condition you’re treating
  • how well your body tolerates the drug
  • if you’re taking other drugs with Velcade

To learn about Velcade’s effectiveness in treating cancer, see the section “Velcade uses” above. And be sure to talk with your doctor about what you can expect with Velcade treatment.

Velcade is approved to treat certain types of cancer that affect your blood cells. It contains the active drug bortezomib, which belongs to a drug class called proteasome inhibitors. (A drug class is a group of medications that work in a similar way.)

Velcade works by inhibiting (blocking) the action of proteins called proteasomes. (These proteins are found in certain cancer cells.) By inhibiting the proteins, Velcade disrupts how certain cells work. This disruption can lead to cell death, which can help stop cancer growth in your body.

How long does it take to work?

Velcade may start working within 5 minutes after it’s been given to you. However, you may not notice that Velcade is working. This is because the drug works to stop your cancer from worsening. But it may not reduce symptoms you’re having from your cancer.

Your doctor may order certain tests, such as blood tests, to help monitor your treatment progress. And they’ll let you know how your cancer is responding to Velcade.

There haven’t been any studies done in humans to test the safety and efficacy of Velcade use during pregnancy.

However, in animal studies, Velcade did cause pregnancy loss, even when the drug was used at low doses. Keep in mind that animal studies don’t always predict what will happen in people. But because of possible risks, it’s recommended that pregnancy be avoided while you’re using Velcade.

For information about birth control recommendations, see the section “Velcade and birth control” just below.

If you’re pregnant or thinking about becoming pregnant, talk with your doctor. They’ll recommend a treatment plan that’s appropriate for you.

Velcade may be harmful if it’s used during pregnancy. Because of this, it’s recommended that pregnancy be avoided during Velcade treatment.

If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control options while you’re using Velcade. Below, we describe birth control recommendations for both males and females using this drug.

For females using Velcade

If you’re a female who’s able to become pregnant, it’s recommended that you use birth control while you’re taking Velcade. And you should continue to use birth control for at least 7 months after your last dose of the drug.

For males using Velcade

If you’re a male who’s sexually active with a female who can become pregnant, it’s recommended that you use birth control while you’re taking Velcade. And you should continue to use birth control for at least 4 months after your last dose of the drug.

It’s not known whether Velcade can pass into breast milk. It’s also not known if Velcade’s metabolites can pass into breast milk. (Metabolites are chemicals that are made as a drug is broken down in your body.)

However, Velcade may potentially cause serious side effects in children who are breastfed. Because of this, it’s recommended that breastfeeding be avoided while you’re taking the drug. And you should continue to avoid breastfeeding for at least 2 months after you’ve completed Velcade treatment.

If you have questions about the safety of breastfeeding while you’re using Velcade, talk with your doctor. They can recommend safe and healthy ways to feed your child.

As with all medications, the cost of Velcade can vary. To find current prices for Velcade in your area, check out WellRx.com.

The cost you find on WellRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan and your location.

It’s important to note that you’ll get Velcade doses at your doctor’s office. So there may be additional costs related to getting Velcade based on where you receive doses of the drug.

Your insurance plan may require you to get prior authorization before approving coverage for Velcade. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Velcade.

If you’re not sure if you’ll need to get prior authorization for Velcade, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Velcade, or if you need help understanding your insurance coverage, help is available.

Takeda Pharmaceutical Company Limited, the manufacturer of Velcade, offers a program called Takeda Oncology 1Point. The manufacturer also offers a program called Velcade Reimbursement Assistant Program (VRAP). Both of these programs provide financial assistance and may be able to help lower the cost of Velcade.

For more information and to find out if you’re eligible for support, call 844-817-6468 or visit the manufacturer’s website.

Generic version

Velcade is available as a generic drug called bortezomib. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

To find out how the cost of bortezomib compares to the cost of Velcade, visit WellRx.com. Again, the cost you find on WellRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

If your doctor has prescribed Velcade and you’re interested in using bortezomib instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

Before taking Velcade, talk with your doctor about your health history. Velcade may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Heart disease. Velcade can cause new or worsening heart disease, including heart failure and cardiomyopathy (a weakened heart muscle). For more information about heart disease related to Velcade, see the “Velcade side effects” section above. If you’ve had heart problems in the past, be sure to talk with your doctor before starting Velcade.
  • Low blood pressure. If you have a history of fainting, you’re dehydrated, or you take certain medications, you may have any increased risk of low blood pressure with Velcade. Talk with your doctor about your medical history and all medications you’re taking before starting Velcade.
  • Liver disease. Velcade can cause new or worsening liver problems, such as increased liver enzymes. For more information about Velcade’s effect on your liver, see the “Velcade side effects” section above. If you’ve had any liver problems in the past, talk with your doctor before starting Velcade.
  • Lung disease. Velcade can cause new or worsening lung problems, such as trouble breathing and pneumonia. For more information about lung problems caused by Velcade, see the “Velcade side effects” section above. And be sure to discuss any past lung problems with your doctor before starting Velcade.
  • Allergic reaction. If you’ve had an allergic reaction to Velcade or any of its ingredients, you shouldn’t take Velcade. Instead, ask your doctor about other medications that are better options for you. If you’re unsure about your medication allergies, talk with your doctor.
  • Diabetes. If you have diabetes and you’re taking diabetes drugs by mouth, talk with your doctor before starting Velcade. This medication may cause your blood sugar level to be either too high or too low. If you take Velcade, your doctor may have you monitor your blood sugar levels more often than usual. And in some cases, your doctor may change the dose of your diabetes medication.
  • Pregnancy. Velcade can be harmful if used during pregnancy. Because of this, it’s recommended that pregnancy be avoided by both males and females using Velcade. For more information, see the “Velcade and pregnancy” and “Velcade and birth control” sections above.
  • Breastfeeding. Velcade may be harmful to children who are breastfed. Because of this, it’s recommended that breastfeeding be avoided during Velcade treatment. For more information, see the “Velcade and breastfeeding” section above.

Note: For more information about the potential negative effects of Velcade, see the “Velcade side effects” section above.

The following information is provided for clinicians and other healthcare professionals.

Indications

Velcade is approved to treat both multiple myeloma and mantle cell lymphoma (MCL) in adults.

Administration

Velcade is available as single-use vials, in a strength of 3.5 mg/vial. It must be reconstituted with 0.9% sodium chloride (NaCl) prior to administration.

Velcade can be given via either intravenous (IV) or subcutaneous route. The amount of diluent used to reconstitute the medication varies based on the route of administration.

For IV administration, reconstitute with 3.5 mL of 0.9% NaCl for a final concentration of 1 mg/mL. For subcutaneous administration, reconstitute with 1.4 mL of 0.9% NaCl for a final concentration of 2.5 mg/mL.

Mechanism of action

Velcade is a proteasome inhibitor. It is a boronic acid dipeptide derivative that selectively inhibits the 26S proteasome. By inhibiting the 26S proteasome, Velcade disrupts cell signaling and homeostasis within the cell, which leads to apoptosis.

Pharmacokinetics and metabolism

The onset of action of Velcade is typically within 5 minutes of administration, via either subcutaneous or IV route. Duration of response is usually 48 hours to 72 hours.

Bortezomib is metabolized to inactive metabolites by several metabolic enzymes, including CYP2C19 and CYP3A4. The elimination half-life of the parent compound ranges from 40 hours to 193 hours.

Contraindications

Velcade is contraindicated in people with previous hypersensitivity to bortezomib, boron, or mannitol.

In addition, Velcade is contraindicated for intrathecal injection. It can only be administered via either subcutaneous or IV route.

Storage

Velcade vials may be stored at room temperature (77°F/25°C). The vials should be stored in original packaging to maintain protection from light.

Once reconstituted, Velcade solution can be kept at room temperature for up to 8 hours in either its original vial or a syringe.

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