Nurses Compass
Drug Guide
Bortezomib
Classification
Therapeutic: Antineoplastic agent
Pharmacological: Proteasome inhibitor
FDA Approved Indications
- Multiple myeloma
- Mantle cell lymphoma (in relapsed or refractory cases)
Mechanism of Action
Bortezomib inhibits the 26S proteasome, leading to accumulation of ubiquitinated proteins, inducing apoptosis in malignant cells.
Dosage and Administration
Adult: Typically 1.3 mg/m² administered intravenously or subcutaneously twice weekly for 2 weeks followed by a 10-day rest period (28-day cycle). Dose adjustments are based on tolerability and adverse reactions.
Pediatric: Not approved for pediatric use.
Geriatric: Use with caution; age-related decline in renal function may require dose adjustment.
Renal Impairment: Adjust dose based on renal function.
Hepatic Impairment: Use with caution; no specific dosing guidelines established.
Pharmacokinetics
Absorption: Rapidly absorbed when administered subcutaneously or intravenously.
Distribution: Widely distributed in tissues; plasma protein binding approximately 83%.
Metabolism: Metabolized via hepatic CYP enzymes; primarily CYP3A4/5, CYP2C19, CYP1A2.
Excretion: Excreted primarily in feces (68%) and urine (30%).
Half Life: Approximately 4.5 to 7 hours.
Contraindications
- Hypersensitivity to bortezomib or to any component of the formulation.
Precautions
- Use in patients with significant cardiac disease, severe neuropathy, active infections, or bleeding disorders is cautioned. Monitor for peripheral neuropathy, thrombocytopenia, and increased risk of peripheral neuropathy.
Adverse Reactions - Common
- Fatigue (Common)
- Nausea (Common)
- Thrombocytopenia (Common)
- Neuropathy (peripheral) (Common)
Adverse Reactions - Serious
- Sepsis, including septic shock (Serious)
- Progressive multifocal leukoencephalopathy (PML) (Serious)
- Severe peripheral neuropathy leading to disability (Serious)
- Myelosuppression with risk of bleeding and anemia (Serious)
Drug-Drug Interactions
- Chloroquine, clarithromycin, and other CYP3A4 inhibitors or inducers may alter metabolism of bortezomib.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood counts, renal and hepatic function, and signs of neuropathy.
Diagnoses:
- Risk of infection due to immunosuppression.
- Risk of bleeding due to thrombocytopenia.
- Risk for peripheral neuropathy.
Implementation: Administer as prescribed, monitor lab values closely, manage side effects, educate patient about symptoms of neuropathy and infection.
Evaluation: Assess for adverse reactions and treatment efficacy; adjust dose as needed.
Patient/Family Teaching
- Report any signs of infection, unusual bleeding, or neuropathy.
- Avoid contact with individuals with contagious diseases.
- Follow safe handling procedures for injections.
Special Considerations
Black Box Warnings:
- Peripheral neuropathy that can be severe and irreversible.
- Risk of herpes zoster reactivation — consider antiviral prophylaxis.
Genetic Factors: Pharmacogenomic markers are not currently used for dose adjustments.
Lab Test Interference: Can cause transient increases in serum creatinine and decreases in blood counts, mask other conditions.
Overdose Management
Signs/Symptoms: Severe peripheral neuropathy, thrombocytopenia, or serious infections.
Treatment: Supportive care; no specific antidote. Discontinue bortezomib and provide supportive management.
Storage and Handling
Storage: Store at 2°C to 8°C (36°F to 46°F). Protect from light.
Stability: Stable under recommended storage conditions for the duration of the label.