Venetoclax (Venclexta™)

How to Take Venetoclax

Venetoclax comes in a tablet to be taken by mouth. Take this medication around the same time every day, with a meal and water. Swallow the tablets whole. Do not chew, crush, or break the tablets. If you are having trouble swallowing the tablets, talk to your pharmacist about options for a smaller tablet size.

The dose is increased slowly over a period of time. During this time, you will need to drink enough fluids during the day to prevent tumor lysis syndrome (TLS). TLS happens when tumor cells break down quickly and release their contents into your body.

• You should drink 6 to 8 glasses of non-alcoholic fluids (about 56 ounces total), starting 2 days before the first dose, the day of the first dose, and every time the dose is increased.
• At each increase of dose, you may have blood tests drawn.
• You may be given intravenous (IV, into a vein) fluids and medications to protect your kidneys.

If you miss a dose and it is within 8 hours of when you usually take your dose, take the missed dose and return to your normal schedule. If it has been longer than 8 hours since your normally scheduled dose, skip that dose and return to your normal schedule the next day. If you vomit after taking the dose, do not take an extra dose. Return to your normal schedule with the next dose.

It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.

The blood levels of this medication can be affected by medications and certain foods, so they should be avoided, especially when you start the medication and during dose increases. These include: grapefruit products, starfruit, Seville oranges, ketoconazole, voriconazole, ciprofloxacin, amiodarone, diltiazem, carvedilol, and verapamil, among others. Be sure to tell your healthcare provider about all medications and supplements you take.

Storage and Handling

Store your medication in the original, labeled blister pack or bottle, at room temperature and in a dry location (unless told otherwise by your provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your provider where to return any unused medication for disposal. Do not flush down the toilet or throw it in the trash.

Where do I get this medication?

Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your prescription drug coverage. Ask your provider or pharmacist for assistance in identifying where you can get this medication.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending on prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your provider can help you find these resources if they are available.

Possible Side Effects

There are a number of things you can do to manage the side effects of venetoclax. Talk to your provider about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Tumor Lysis Syndrome (TLS)

If there are a large amount of tumor cells in your body before treatment, you are at risk for tumor lysis syndrome. This happens when the tumor cells die too quickly and their waste overwhelms your body. You may be given a medication (allopurinol) and IV fluids to help prevent this. If you have nausea, vomiting, diarrhea, or become lethargic (drowsy, sluggish), tell your provider right away. TLS can affect your kidney function, which will be monitored with blood work. Tell your provider if you have little or no urine output.

Infection and Low White Blood Cell Count (Leukopenia or Neutropenia)

This medication can cause life threatening infections, with or without a decrease in white blood cell counts.

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your provider know right away if you have a fever (temperature greater than 100.4°F or 38.0°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your provider before scheduling dental appointments or procedures.
• Ask your provider before you, or someone you live with has any vaccinations.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your provider know if you have any shortness of breath, difficulty breathing, or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low, you are at a higher risk of bleeding. Let your provider know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can cause injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib) etc. as these can all increase the risk of bleeding. Talk with your provider before using these medications and all over the counter medications/supplements while on therapy.
• Do not floss or use toothpicks. Use a soft-bristle toothbrush to brush your teeth.

Electrolyte Abnormalities

This medication can affect the normal levels of electrolytes (calcium, potassium, phosphate, sodium, etc.) in your body. Your levels will be monitored using blood tests. If your levels become too low, your provider may prescribe specific electrolytes to be given by IV or taken by mouth. Do not take any supplements without first consulting with your provider. 

Nausea and/or Vomiting

Talk to your provider so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your provider if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your provider can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole-grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8 to 10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your provider for helpful tips on dealing with this side effect.

Muscle or Joint Pain/Aches and Headache

Your provider can recommend medication and other strategies to relieve pain.

Live Vaccines

You, or anyone you live with, should avoid having live or live-attenuated vaccines while receiving this medication. These include herpes zoster (Zostavax) for shingles prevention, oral polio, measles, nasal flu vaccine (FluMist®), rotavirus and yellow fever vaccines.

Peripheral Edema

Peripheral edema is swelling of the extremities caused by the retention of fluid. It can cause swelling of the hands, arms, legs, ankles, and feet. The swelling can become uncomfortable. Tell your provider if you are having any new or worsening swelling.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant while on this medication. Effective birth control for women is necessary during treatment and for at least 30 days after treatment. Even if your menstrual cycle stops, you could still be fertile and conceive. Men should talk with their provider about the need for birth control. You should not breastfeed while taking this medication or for 1 week after your last dose.