Venetoclax

What is Venetoclax

Venetoclax is a B-cell lymphoma-2 (BCL-2) protein inhibitor that has demonstrated cytotoxic activity in tumor cells that overexpress BCL-2. It is indicated as a single agent or in combination with obinutuzumab or rituximab for the treatment of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).

Venetoclax has demonstrated efficacy in CLL or SLL with or without 17p deletion.

Venetoclax is also indicated in combination with azacitidine, decitabine, or low-dose cytarabine for the treatment of newly-diagnosed acute myelogenous leukemia in adults who are age 75 years or older or who have comorbidities that make them ineligible for intensive induction chemotherapy.

Due to a risk of tumor lysis syndrome, the venetoclax dose is increased using a ramp-up dosing schedule; prophylactic hydration and antihyperuricemic agents are recommended starting prior to the first dose.

Brand Name

Venclexta

Indications

  • acute myelogenous leukemia (AML)
  • chronic lymphocytic leukemia (CLL)
  • small lymphocytic lymphoma (SLL)

Side Effects

  1. abdominal pain
  2. anemia
  3. anorexia
  4. arthralgia
  5. back pain
  6. bleeding
  7. constipation
  8. cough
  9. diarrhea
  10. dizziness
  11. dyspnea
  12. edema
  13. elevated hepatic enzymes
  14. fatigue
  15. fever
  16. headache
  17. hemolytic anemia
  18. hyperbilirubinemia
  19. hypercalcemia
  20. hyperglycemia
  21. hyperkalemia
  22. hyperphosphatemia
  23. hypertension
  24. hyperuricemia
  25. hypoalbuminemia
  26. hypocalcemia
  27. hypoglycemia
  28. hypokalemia
  29. hypomagnesemia
  30. hyponatremia
  31. hypophosphatemia
  32. hypotension
  33. hypoxia
  34. infection
  35. leukopenia
  36. lymphopenia
  37. metabolic acidosis
  38. musculoskeletal pain
  39. myalgia
  40. nausea
  41. nephrotoxicity
  42. neutropenia
  43. oral ulceration
  44. peripheral edema
  45. rash
  46. renal failure (unspecified)
  47. thrombocytopenia
  48. tumor lysis syndrome (TLS)
  49. vomiting

Monitoring Parameters

  • CBC with differential
  • pregnancy testing
  • serum creatinine/BUN
  • serum electrolytes
  • serum uric acid

Contraindications

  • anemia
  • breast-feeding
  • contraception requirements
  • electrolyte imbalance
  • hepatic disease
  • infection
  • infertility
  • multiple myeloma
  • neutropenia
  • pregnancy
  • pregnancy testing
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • thrombocytopenia
  • treatment outside of a clinical trial
  • tumor lysis syndrome (TLS)
  • vaccination

Interactions

  • Afatinib
  • Amiodarone
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Apalutamide
  • Aprepitant, Fosaprepitant
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Betrixaban
  • Bexarotene
  • Boceprevir
  • Bosentan
  • Brigatinib
  • Cabozantinib
  • Capmatinib
  • Carbamazepine
  • Carvedilol
  • Cenobamate
  • Ceritinib
  • Chloramphenicol
  • Ciprofloxacin
  • Clarithromycin
  • Cobicistat
  • Colchicine
  • Colchicine; Probenecid
  • Conivaptan
  • Crizotinib
  • Cyclosporine
  • Dabrafenib
  • Daclatasvir
  • Danazol
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Dexamethasone
  • Dextromethorphan; Quinidine
  • Digoxin
  • Diltiazem
  • Dronedarone
  • Duvelisib
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix
  • Elagolix; Estradiol; Norethindrone acetate
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Encorafenib
  • Enzalutamide
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Eslicarbazepine
  • Etravirine
  • Everolimus
  • Fedratinib
  • Flibanserin
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluvoxamine
  • Fosamprenavir
  • Fosphenytoin
  • Fostamatinib
  • Glecaprevir; Pibrentasvir
  • grapefruit juice
  • Idelalisib
  • Imatinib
  • Indinavir
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Istradefylline
  • Itraconazole
  • Ivacaftor
  • Ketoconazole
  • Lapatinib
  • Ledipasvir; Sofosbuvir
  • Lefamulin
  • Letermovir
  • Live Vaccines
  • Lomitapide
  • Lopinavir; Ritonavir
  • Lorlatinib
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Mefloquine
  • Mifepristone
  • Mitotane
  • Modafinil
  • Nafcillin
  • Nefazodone
  • Nelfinavir
  • Neratinib
  • Netupitant, Fosnetupitant; Palonosetron
  • Nevirapine
  • Nilotinib
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Osimertinib
  • Palifermin
  • Penicillamine
  • Phenobarbital
  • Phenytoin
  • Ponatinib
  • Posaconazole
  • Primidone
  • Propafenone
  • Quinidine
  • Quinine
  • Ranolazine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rimegepant
  • Ritonavir
  • Rolapitant
  • Sapropterin
  • Saquinavir
  • Sarecycline
  • Simeprevir
  • Sirolimus
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sorafenib
  • St. John’s Wort, Hypericum perforatum
  • Talazoparib
  • Telaprevir
  • Telithromycin
  • Temsirolimus
  • Tezacaftor; Ivacaftor
  • Ticagrelor
  • Tipranavir
  • Tolvaptan
  • Topotecan
  • Trandolapril; Verapamil
  • Tuberculin Purified Protein Derivative, PPD
  • Tucatinib
  • Ubrogepant
  • Vemurafenib
  • Verapamil
  • Voriconazole
  • Warfarin
  • Zonisamide
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