Side effects and mitigation methods of Laotian version Venetoclax
Venetoclax, as a BCL-2 inhibitor, commonly has side effects such as bone marrow suppression, gastrointestinal reactions, and tumor lysis syndrome, which need to be managed through dose adjustment, prophylactic medication, and close monitoring. The following categories describe the manifestations of side effects and corresponding mitigation measures, emphasizing the principle of individualized medication.
1. Hematological system side effects
(1) Neutropenia: The incidence rate is as high as 63%, and weekly blood routine monitoring is required. Suspend administration when there is a 3-4 level decrease, and restart in a stepwise manner after recovery (such as reducing from 400mg to 200mg).
(2) Thrombocytopenia: Approximately 47% of patients experience it. It is recommended to avoid traumatic activities, use a soft bristled toothbrush, and administer platelet transfusions if necessary.
(3) Anemia: The incidence rate is about 29%, and in severe cases, blood transfusion support is required while evaluating iron metabolism indicators.
2. Digestive system response
(1) Nausea and vomiting: About 52% of patients experience it. It is recommended to take it with meals in divided doses, and if necessary, use 5-HT3 receptor antagonists (such as ondansetron).
(2) Diarrhea: The incidence rate is 35%, and electrolyte balance needs to be maintained. Mild symptoms can be treated with oral montmorillonite powder.
(3) Constipation: About 15% of patients experience it. Increase dietary fiber intake and use osmotic laxatives if necessary.
3. Tumor Lysis Syndrome (TLS)
(1) High risk patients need to be hospitalized for monitoring, and intravenous hydration (3000ml/day) and alkalization of urine should be started 24 hours before medication.
(2) Prophylactic use of allopurinol (300mg/day) or raprolizumab to maintain uric acid levels below 7.5mg/dL.
(3) The stepwise dose escalation scheme (20 → 50 → 100 → 200 → 400mg) reduces TLS risk.
4. Other important side effects
(1) Risk of infection
The incidence of bacterial/fungal infections is about 18%, and prophylactic use of compound sulfamethoxazole is required. Immediate intravenous antibiotic treatment is required when febrile neutropenia occurs.
(2) Fatigue
About 22% of patients reported that it is recommended to adjust the activity rhythm, avoid driving or operating machinery, and evaluate thyroid function in severe cases.
5. Management of special populations
(1) Liver damage patients: Child Pugh B/C grade should reduce dosage by 50-75% and avoid combination with potent CYP3A inhibitors.
(2) Renal insufficiency: CrCl ≥ 30ml/min does not require adjustment, and data on end-stage renal disease patients is limited.
(3) Childbearing age period: During treatment and 30 days after discontinuation of medication, it is necessary to take effective contraceptive measures.
Disclaimer：《Side effects and mitigation methods of Laotian version Venetoclax》Edited and sorted by Seagull Pharmacy's editors. Please contact us in time if there is any infringement. In addition, the suggestions for drug usage, dosage and disease mentioned in the article are only for medical staff's reference, and can not be used as any basis for medication！