From the Guidelines
Venetoclax is associated with several side effects, including neutropenia, febrile neutropenia, pneumonia, and sepsis.
Common Side Effects
- Neutropenia: a decrease in neutrophil count, which can increase the risk of infections 1
- Febrile neutropenia: a condition characterized by fever and low neutrophil count, which can be life-threatening if not treated promptly 1
- Pneumonia and sepsis: infections that can occur as a result of neutropenia 1
Management of Side Effects
- Dose interruptions or reductions may be necessary to allow for hematologic recovery in patients with severe neutropenia 1
- Antibacterial and antifungal prophylaxis may be considered in patients receiving venetoclax in combination with hypomethylating agents 1
- Granulocyte colony-stimulating factors (G-CSFs) may be used to support patients with neutropenia 1
Drug Interactions
- Venetoclax is metabolized by CYP3A4/5, and concomitant use with strong CYP3A4 inhibitors (e.g., posaconazole, erythromycin, ciprofloxacin) may require dose adjustments 1
- A 75% dose reduction of venetoclax is recommended when combined with posaconazole 1
From the Research
Side Effects of Venetoclax
The side effects of Venetoclax are numerous and can be categorized into hematologic and nonhematologic adverse events. Some of the common side effects include:
- Tumor lysis syndrome 2, 3, 4
- Neutropenia 2, 3, 4
- Gastrointestinal adverse events such as nausea, diarrhea, and constipation 2, 3, 4
- Infection 3, 4
- Autoimmune hemolytic anemia 3
- Cardiac toxicity 3
- Myelosuppression 3, 4
- Skin reactions, including vitiligo 5
Management of Side Effects
It is essential to provide information on the appropriate management of Venetoclax-associated side effects. Strategies for managing neutropenia and certain nonhematologic adverse events in patients receiving Venetoclax for the treatment of AML and CLL are crucial 4. Additionally, dose modifications and cautious co-administration with other medications may be necessary to minimize the risk of adverse events 3.
Rare Side Effects
Some rare side effects of Venetoclax include vitiligo, which has been reported in a few cases 5. The mechanism by which vitiligo develops remains unclear, and larger studies are needed to prove the hypothesis that drug-induced vitiligo may be associated with improved cancer prognosis.