Velcade side effects: What you should know

Velcade (bortezomib) is a prescription brand-name medication. It’s approved by the Food and Drug Administration (FDA) to treat mantle cell lymphoma (MCL) and multiple myeloma in adults.

Both MCL and multiple myeloma are blood cancers that affect white blood cells. These cells help your immune system fight infections.

Typically, Velcade is used as a long-term treatment for MCL and multiple myeloma.

Here are some fast facts about Velcade:

• Active ingredient: bortezomib
• Drug class: proteasome inhibitor
• Drug form: powder that’s mixed with liquid, which forms a solution that’s given as a subcutaneous injection or an IV injection

Like other drugs, Velcade injections can cause side effects. Read on to learn about possible common, mild, and serious side effects of this drug. For a general overview of Velcade, including details about its uses, see this article.

Velcade can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days or weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Velcade in clinical studies:

• fatigue (low energy)
• low levels of neutrophils (a type of white blood cell)
• peripheral neuropathy*
• low levels of platelets†
• severe digestive problems*

For details about the frequency of these side effects in clinical studies, see Velcade’s prescribing information.

* To learn more about this side effect, see the “Side effect specifics” section below.
† For more information about this side effect, see “Bruising” in the “Side effect specifics” section below.

Mild side effects can occur with Velcade use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to Velcade’s prescribing information.

Mild side effects that have been reported with Velcade include:

• dizziness
• fatigue (low energy)
• fever
• headache
• insomnia (trouble sleeping)
• loss of appetite
• low blood pressure
• peripheral edema (swelling in your legs or arms)
• rash
• eye-related side effects, such as blurry vision, double vision, eye irritation, and pink eye

These side effects may be temporary, lasting a few days or weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Velcade and want to tell the FDA about it, visit MedWatch.

Velcade may cause serious side effects, some of which were common in studies of the drug. The list below may not include all possible serious side effects of the drug. For more information, you can refer to Velcade’s prescribing information.

If you develop serious side effects while taking Velcade, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

• Blood disorders, such as low levels of neutrophils (a type of white blood cell) or anemia (low levels of red blood cells). You may not have symptoms from these blood disorders. But possible symptoms may include:
  • lightheadedness
  • pale skin
• Infection, such as shingles or pneumonia. Symptoms will vary based on the type of infection but may include:
  • chills
  • fever
  • pain on one side of your abdomen (belly), back, chest, or waist
  • skin rash that looks similar to chickenpox
  • tight chest
• Injection site reactions. Symptoms usually occur around the area where you receive Velcade injections and may include:
  • pain
  • red or discolored skin
  • swelling
• Kidney problems, such as kidney failure. Symptoms may include:
  • fatigue (low energy)
  • blood in your urine
  • loss of bladder control
  • urinary retention (trouble emptying your bladder completely)
• Liver problems, such as liver failure. Symptoms can include:
  • pain in your abdomen (belly)
  • dark urine
  • jaundice (yellow tint to your skin or the whites of your eyes)
  • loss of appetite
  • nausea and vomiting
• Lung problems, such as acute respiratory distress syndrome. Symptoms can include:
  • cough
  • fever
  • low blood pressure
  • shortness of breath
• Neuralgia, which refers to severe nerve pain. Other symptoms can include:
  • muscle cramping or twitching
  • muscle wasting (loss of muscle mass)
  • muscle weakness
• Posterior reversible encephalopathy syndrome, which is a rare type of severe brain swelling. Symptoms can include:
  • confusion
  • headache
  • high blood pressure
  • lethargy (lack of motivation, physical energy, and mental energy)
  • loss of vision
  • seizures
• Psychiatric problems, such as anxiety or psychosis. Symptoms can include:
  • feeling irritable, restless, or worried
  • hallucinations (seeing or hearing things that aren’t there)
  • mood changes
  • thoughts of suicide
• Severe skin reactions. Symptoms can include:
  • blisters
  • hives
  • peeling skin
• Tumor lysis syndrome, which is a condition in which cancer cells release harmful chemicals into your blood. Symptoms can include:
  • dark urine
  • diarrhea, nausea, or vomiting
  • muscle cramps
  • seizures
• Peripheral neuropathy.*
• Cardiac problems.*
• Bruising,* which may be caused by low levels of platelets.
• Severe digestive problems.*
• Allergic reaction.*

* For more information about this side effect, see the “Side effect specifics” section below.

Velcade may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Does Velcade cause side effects that are long term?

It’s possible that Velcade may cause side effects that are long term.

For example, using Velcade can lead to new or worsened cardiac problems, such as heart failure. (“Cardiac” means heart-related.) And these heart-related conditions can continue to worsen over time.

However, the duration (length of time) of Velcade’s side effects will differ from person to person. If you have questions about how long you can expect Velcade’s side effects to last, talk with your doctor or pharmacist.

Is hair loss one of Velcade’s side effects?

Possibly, but it isn’t known for sure whether hair loss is a direct side effect of Velcade.

Hair loss was reported as a side effect in clinical studies of Velcade. But hair loss was reported only when the drug was used in combination with other cancer drugs that are known to cause hair loss.

Examples include rituximab (Rituxan), cyclophosphamide (Cytoxan), and doxorubicin.

So, you may have hair loss if you’re using Velcade in combination with other cancer drugs. But hair loss may be caused by the other cancer drugs instead of Velcade itself.

If you’re concerned about hair loss with Velcade, talk with your doctor.

Is Velcade a chemotherapy drug?

No, Velcade isn’t a type of chemotherapy drug.

Chemotherapy is a type of cancer treatment. It works by destroying all cells in your body that are rapidly multiplying, such as cancer cells. But chemotherapy can also destroy healthy cells in your body that are rapidly multiplying.

Velcade is a type of targeted therapy called a proteasome inhibitor. It works by blocking the action of a type of protein called a proteasome. As a result, Velcade kills cancer cells that have this protein.

Velcade may affect fewer healthy cells in your body than chemotherapy does. This could mean that Velcade causes fewer side effects than chemotherapy drugs.

If you have questions about how Velcade and chemotherapy are alike and different, talk with your doctor or pharmacist.

Learn more about some of the side effects that Velcade may cause.

Peripheral neuropathy

Peripheral neuropathy may develop during Velcade treatment. This was a common side effect in clinical studies of the drug.

Peripheral neuropathy refers to pain, numbness, or weakness caused by nerve damage. It typically affects the arms, hands, legs, or feet.

Other symptoms of peripheral neuropathy may include:

• increased or decreased ability to feel pain
• not being able to feel changes in cold or heat
• infection or ulcers on your feet or legs
• loss of coordination
• tingling

What you can do

Tell your doctor right away if you experience any symptoms of peripheral neuropathy. They may lower your dosage of Velcade or prescribe a treatment other than Velcade.

Cardiac problems

Cardiac problems may occur with Velcade. (“Cardiac” means heart-related.) Heart-related side effects were common in clinical studies of the drug.

Heart-related problems from Velcade can include:

• arrhythmia (irregular heart rate or rhythm)
• angina (a type of chest pain)
• heart failure
• heart rate that’s slower or faster than usual

Symptoms of heart-related problems with Velcade can include chest tightness, trouble breathing, and swelling in your arms or legs.

What you can do

If you have any of the above symptoms while using Velcade, tell your doctor as soon as possible. They may want to check your heart.

But if your symptoms feel severe or life threatening, call 911 or your local emergency number right away.

Bruising

Bruising may develop during Velcade treatment. This side effect can be caused by a condition called thrombocytopenia (low levels of platelets). Platelets are cells that help your blood to clot.

Low platelet levels were a common side effect in clinical studies of Velcade. In some instances, this condition can be fatal.

What you can do

Tell your doctor if you have any unusual bruising while using Velcade. They may check your platelet levels to determine if low levels are causing you to bruise.

If your platelet levels are extremely low, your doctor may recommend a blood exchange (a type of blood filtering procedure). They may also recommend that you stop using Velcade until your condition improves.

Severe digestive problems

Severe digestive problems are possible with Velcade. These include nausea, vomiting, diarrhea, and constipation. Digestive problems were common side effects in clinical studies of the drug.

Severe digestive problems from Velcade can lead to:

• dehydration (fluid loss)
• electrolyte imbalances
• ileus (a condition that occurs when food doesn’t move through your intestines as it should)

What you can do

It’s important to stay hydrated if you have digestive problems while using Velcade. Drinking fluids such as Gatorade or Pedialyte can keep you hydrated. It can also help prevent or correct any electrolyte imbalances you may have.

Tell your doctor if you have digestive problems while using Velcade. They may prescribe medication to help treat your symptoms.

Allergic reaction

As with most drugs, Velcade can cause an allergic reaction in some people. But it’s not known how often this occurred in clinical studies of the drug.

Symptoms can be mild or serious and can include:

• rash
• itching
• flushing (temporary warmth, redness, or deepening of skin color)
• swelling under your skin, typically in your lips, eyelids, feet, or hands
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Velcade. But if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Be sure to talk with your doctor about your health history before you take Velcade. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. Some conditions and factors to consider include:

Cardiac problems. Velcade treatment can lead to new or worsened cardiac problems, such as heart failure and arrhythmia. (“Cardiac” means heart-related.) For more information about possible heart-related side effects with Velcade, see the “Side effect specifics” section above. If you already have heart-related problems, be sure to tell your doctor before using Velcade.

Liver problems. Velcade use can lead to new or worsened liver problems, such as liver failure. To learn more about possible liver problems with Velcade, see the “Serious side effects of Velcade” section above. If you already have liver problems, talk with your doctor before starting Velcade treatment.

Lung problems. The use of Velcade can lead to new or worsened lung problems, such as acute respiratory distress syndrome. In rare cases, this side effect can be fatal. For more information about possible lung problems with Velcade, see the “Serious side effects of Velcade” section above. Before using Velcade, be sure to tell your doctor about any lung problems you have.

Peripheral neuropathy. Velcade treatment can lead to new or worsened peripheral neuropathy. To learn more about this side effect, see the “Side effect specifics” section above. If you already have peripheral neuropathy, talk with your doctor before you start using Velcade.

Allergic reaction. You should not take Velcade If you’ve ever had an allergic reaction to Velcade or any of its ingredients. Talk with your doctor about which other treatments are better choices for you.

Conditions that can cause low blood pressure. Velcade use can lead to low blood pressure. Before you start Velcade treatment, be sure to tell your doctor about your medical history and all drugs you take. Your risk of low blood pressure may increase if you have a condition that can cause it, such as dehydration or a history of fainting. Your risk also may also increase if you take Velcade with medications that lower your blood pressure.

Diabetes. Velcade treatment can cause your blood sugar to be higher or lower than usual. Before using the medication, tell your doctor if you have diabetes and are taking oral diabetes drugs. They may have you check your blood sugar levels more often than usual while you’re using Velcade. In some situations, your doctor may adjust the dosage of your diabetes medication.

Alcohol use with Velcade

There aren’t any known interactions between alcohol and Velcade. But drinking alcohol could worsen certain side effects of Velcade, such as nausea, vomiting, and diarrhea.

If you drink alcohol, talk with your doctor before using Velcade. They can recommend how much is safe for you to consume during your Velcade treatment.

Pregnancy and breastfeeding while taking Velcade

Here’s some information about pregnancy, breastfeeding, and Velcade treatment.

Pregnancy. It is not safe to use Velcade while pregnant. This is because animal studies have shown that Velcade may cause pregnancy loss when used during pregnancy. Animal studies don’t always predict what will happen in humans. But it’s safest to avoid using Velcade while you’re pregnant.

In fact, the manufacturer of Velcade recommends that females* who are able to become pregnant use birth control while taking the drug. They should continue using birth control for at least 7 months after their last dose of Velcade.

Males* who are sexually active with a female who can become pregnant should also use birth control during Velcade treatment. And they should continue using birth control for at least 4 months after their last dose of the drug.

* Sex and gender exist on spectrums. Use of the terms “female” and “male” in this article refers to sex assigned at birth.

Breastfeeding. It is not safe to use Velcade while breastfeeding. It isn’t known for sure if Velcade can pass into breast milk during breastfeeding. But there’s potential for Velcade to cause serious side effects in children who are breastfed by a person using the drug.

Because of this risk, you should avoid breastfeeding while using Velcade and for at least 2 months after your last dose.

Talking with your doctor. If you’re pregnant or planning to be, talk with your doctor. You should also talk with them if you’re breastfeeding or thinking about doing so. Your doctor can advise you on treatments other than Velcade.

Velcade may cause mild or serious side effects. Most side effects should go away with time. But if you have side effects that are bothersome or won’t go away, talk with your doctor or pharmacist.

You can also talk with your doctor or pharmacist to learn more about Velcade. They can help answer any questions you have about side effects from taking the drug.

Besides talking with your doctor, you can do some research on your own. These articles might help:

• More information about Velcade. For details about other aspects of Velcade, refer to this article.
• A look at cancer. For more information about cancer, see our cancer content hub and our list of cancer and oncology articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.