Bortezomib (patient information)

# Why this medication is prescribed
Bortezomib is used to treat people with multiple myeloma (a type of cancer of the bone marrow) who have already been treated with at least one other medication. Bortezomib is also used to treat people with mantle cell lymphoma (a fast-growing cancer that begins in the cells of the immune system) who have already been treated with at least one other medication. Bortezomib is in a class of medications called antineoplastic agents. It works by killing cancer cells.

# How this medication should be used
Bortezomib comes as a solution (liquid) to inject into a vein. Bortezomib is given by a doctor or nurse in a medical office or clinic. It is usually given on a rotating schedule that alternates 2 weeks when bortezomib is given twice a week with 10 days when the medication is not given. During the weeks that bortezomib is given, doses will always be at least 72 hours apart. The rotating schedule may be followed for up to eight cycles. After that, your doctor may decide to continue your treatment, but you will receive bortezomib less often.
Be sure to tell your doctor how you are feeling during your treatment. Your doctor may stop your treatment for a while or decrease your dose of bortezomib if you experience side effects of the medication.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before using bortezomib:
- tell your doctor and healthcare provider if you are allergic to bortezomib, mannitol, any other medications, or boron.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, or nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); cimetidine (Tagamet); clarithromycin (Biaxin, Prevpac); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E.E.S., E-Mycin, Erythrocin); fluvoxamine; certain antifungals such as itraconazole (Sporanox) or ketoconazole (Nizoral); medications to treat diabetes or high blood pressure; certain medications to treat human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as indinavir (Crixivan), nelfinavir (Viracept), or ritonavir (Norvir); certain medications to treat seizures such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Luminal, Solfoton), or phenytoin (Dilantin, Phenytek); mibefradil (no longer available in the U.S.); nefazodone; rifabutin (Mycobutin); rifampin (Rifadin, Rifamate, Rimactane, others); troleandomycin (TAO) (no longer available in the U.S.); or verapamil (Calan, Covera, Isoptin, in Tarka, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John's wort.
- tell your doctor if you or anyone in your family has or has ever had heart disease and if you have or have ever had a herpes infection (cold sores, shingles, or genital sores); diabetes; fainting; high cholesterol (fats in the blood); low or high blood pressure; peripheral neuropathy (numbness, pain, tingling, or burning feeling in the feet or hands) or weakness or loss of feeling or reflexes in a part of your body;or kidney or liver disease. Also tell your doctor if you smoke or drink large amounts of alcohol.
- tell your doctor if you are pregnant or plan to become pregnant. Bortezomib may harm the fetus. Use birth control to prevent pregnancy during your treatment with bortezomib.Ask your doctor if you have questions about types of birth control that will work for you. If you become pregnant while using bortezomib, call your doctor immediately.
- do not breast-feed during your treatment with bortezomib. After your treatment has finished, talk to your doctor or nurse about when it is safe to restart breast-feeding.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using bortezomib.
- you should know that bortezomib may make you drowsy, dizzy, or lightheaded, or cause fainting or blurred vision. Do not drive a car or operate machinery or dangerous tools until you know how this medication affects you.
- you should know that bortezomib may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common in people who have fainted in the past, people who are dehydrated, and people who are taking medications that lower blood pressure. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

# Special dietary instructions
Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.
Drink plenty of fluids every day during your treatment with bortezomib, especially if you vomit or have diarrhea.

# What to do if you forget a dose
If you miss an appointment to receive a dose of bortezomib, call your doctor right away.

# Side Effects

## Minor Side Effects
Bortezomib may cause side effects. Tell your doctor if any of these symptoms, or those in the SPECIAL PRECAUTIONS section, are severe or do not go away:
- general weakness
- nausea
- vomiting
- diarrhea
- stomach pain
- anxiety
- back pain
- muscle cramps
- difficulty falling asleep or staying asleep

## Severe Side Effects
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- pain, burning, numbness, or tingling in the hands or feet
- weakness in the arms or legs
- changes in the sense of touch
- shortness of breath
- cough
- swelling of the feet, ankles, or lower legs
- hives
- rash
- itching
- difficulty breathing or swallowing
- swelling of the face, throat, tongue, lips, eyes, or hands
- hoarseness
- fever, sore throat, chills, or other signs of infection
- unusual bruising or bleeding
- black and tarry stools
- red blood in stools
- bloody vomit
- vomiting material that looks like coffee grounds
- slurred speech or inability to speak or understand speech
- loss of balance or coordination
- loss of memory
- paralysis (loss of ability to move a part of the body
- vision changes or loss of vision
- loss of consciousness
- excessive tiredness
- pale skin
- fast heartbeat
- fainting
- headache
- thoughts of harming or killing yourself
- difficulty thinking clearly, using good judgment, or understanding reality
- hallucinating (seeing things or hearing voices that do not exist)
- confusion
- restlessness
- thirst
- decreased urination
- loss of appetite
- constipation
- seizures
- skin blisters that are itchy or painful
Bortezomib may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

# Storage conditions needed for this medication
Bevacizumab will be stored in the medical office or clinic.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- fainting
- dizziness
- blurred vision
- unusual bruising or bleeding

# Other information
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to bortezomib.

# Brand names
- Velcade