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Boruzu
bortezomib
Adult Dosing .
Dosage forms: INJ
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments
multiple myeloma
- [previously untreated dz]
- Dose: 1.3 mg/m^2/dose SC/IV x1 on days 1, 4, 8, 11, 22, 25, 29, 32 of 42-day cycle for cycles 1-4, then 1.3 mg/m^2/dose SC/IV x1 on days 1, 8, 22, 29 of 42-day cycle for cycles 5-9; Info: give x9 cycles; give doses at least 72h apart; part of multi-drug chemo regimen; consider SC route if peripheral neuropathy risk
- [relapsed dz]
- Dose: 1.3 mg/m^2/dose SC/IV x1 on days 1, 4, 8, 11 of 21-day cycle x8 cycles; Info: may consider extended tx 1.3 mg/m^2/dose SC/IV x1 on days 1, 4, 8, 11 of 21-day cycle or 1.3 mg/m^2/dose SC/IV x1 on days 1, 8, 15, 22 of 35-day cycle starting cycle 9; give doses at least 72h apart; use w/ dexamethasone or as monotherapy; consider SC route if peripheral neuropathy risk
- [relapsed dz, retreatment]
- Dose: give last tolerated dose SC/IV x1 on days 1, 4, 8, 11 of 21-day cycle; Max: 8 cycles; Info: for pts who previously responded to bortezomib and have relapsed at least 6mo after prior bortezomib tx; give doses at least 72h apart; use w/ dexamethasone or as monotherapy; consider SC route if peripheral neuropathy risk
mantle cell lymphoma
- [previously untreated dz]
- Dose: 1.3 mg/m^2/dose IV x1 on days 1, 4, 8, 11 of 21-day cycle x6 cycles; Info: if response first noted at cycle 6, may give x2 additional cycles; give doses at least 72h apart; part of multi-drug chemo regimen
- [relapsed dz]
- Dose: 1.3 mg/m^2/dose SC/IV x1 on days 1, 4, 8, 11 of 21-day cycle x8 cycles; Max: 17 cycles; Info: may consider extended tx starting cycle 9; give doses at least 72h apart; consider SC route if peripheral neuropathy risk
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment, on dialysis days admin. after dialysis; no supplement; PD: not defined
hepatic dosing
- [previously untreated multiple myeloma]
- bilirubin >1.5x ULN: start 0.7 mg/m^2/dose x1 on days 1, 4, 8, 11, 22, 25, 29, 32 of 42-day cycle for cycle 1
- [all other indications]
- bilirubin >1.5x ULN: start 0.7 mg/m^2/dose x1 on days 1, 4, 8, 11 of 21-day cycle for cycle 1
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to boron
- hypersensitivity to mannitol (some forms)
- hypersensitivity to glycine (some forms)
- intrathecal use
- ANC <1000 (combo w/ melphalan and prednisone)
- Plt <70,000 (combo w/ melphalan and prednisone)
- avoid: breastfeeding during tx and x2mo after D/C
- caution: female pts of reproductive potential
- caution: male pts of reproductive potential
- caution: bilirubin >1.5x ULN
- caution: peripheral neuropathy
- caution: hypotension
- caution: syncope hx
- caution: dehydration
- caution: cardiac dz
- caution: pulmonary dz
- caution: diabetes mellitus
- caution: tumor burden, high
Drug Interactions .
Overview
bortezomib
proteasome inhibitor
- CYP3A4 substrate
- cardiotoxic effects
- hyperglycemic effects
- hypoglycemic effects
- hypotensive effects
- immunosuppressive oncologic agent
- myelosuppressive oncologic agent
- peripheral neuropathy
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- aldesleukin
- apalutamide
- butalbital
- carbamazepine
- chloramphenicol
- cladribine oral
- deferiprone
- dexrazoxane
- encorafenib
- enzalutamide
- epirubicin
- etrasimod
- fexinidazole
- fosphenytoin
- ganciclovir
- idarubicin
- ivosidenib
- lofexidine
- lumacaftor/ivacaftor
- mitotane
- palifermin
- penicillamine
- pentobarbital
- phenobarbital
- phenytoin
- pimecrolimus topical
- primaquine
- primidone
- rabies vaccine
- radium Ra 223 dichloride
- rifabutin
- rifampin
- ropeginterferon alfa-2b
- St. John's wort
- valganciclovir
Monitor/Modify Tx
- acarbose
- acebutolol
- adagrasib
- adalimumab
- ado-trastuzumab emtansine
- albendazole
- alemtuzumab
- alfentanil
- alfuzosin
- aliskiren
- allopurinol
- alogliptin
- amantadine
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- anagrelide
- anthrax vaccine
- anti-thymocyte globulin
- apomorphine
- apraclonidine ophthalmic
- aprocitentan
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- articaine
- asciminib
- asenapine
- atazanavir
- atenolol
- atidarsagene autotemcel
- auranofin
- avanafil
- avelumab
- axitinib
- azathioprine
- azilsartan medoxomil
- balsalazide
- baricitinib
- benazepril
- benznidazole
- berberine
- betaxolol
- betaxolol ophthalmic
- bethanechol
- betibeglogene autotemcel
- bevacizumab
- bexagliflozin
- bezlotoxumab
- binimetinib
- bisoprolol
- bosutinib
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- butorphanol
- cabergoline
- canagliflozin
- candesartan cilexetil
- cannabis
- capecitabine
- captopril
- carfilzomib
- cariprazine
- carteolol ophthalmic
- carvedilol
- ceritinib
- certolizumab pegol
- chikungunya vaccine
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cidofovir
- cilostazol
- clarithromycin
- clevidipine
- clofarabine
- clomipramine
- clonidine
- clozapine
- cobicistat
- cobimetinib
- codeine
- coenzyme Q-10
- colchicine
- colesevelam
- COVID-19 vaccine
- cyclophosphamide
- dabrafenib
- dapagliflozin
- dapsone
- daunorubicin
- deferasirox
- denileukin diftitox
- desflurane
- desipramine
- deuruxolitinib
- dexmedetomidine
- dexmedetomidine injection
- dihydrocodeine
- diltiazem
- dinutuximab
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- dipyridamole
- doxazosin
- doxepin
- doxorubicin
- dronabinol
- dronedarone
- dulaglutide
- duloxetine
- ebola vaccine, live
- efbemalenograstim alfa
- eflapegrastim (G-CSF)
- elivaldogene autotemcel
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- eplerenone
- epoprostenol
- ertugliflozin
- esmolol
- etanercept
- ethacrynic acid
- ethanol
- everolimus
- exagamglogene autotemcel
- exenatide
- fam-trastuzumab deruxtecan
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- filgrastim (G-CSF)
- flaxseed
- flibanserin
- flucytosine
- fluorouracil
- fluphenazine
- foscarnet
- fosinopril
- foslevodopa
- fostamatinib
- furosemide
- garlic
- gilteritinib
- givinostat
- glimepiride
- glipizide
- glyburide
- golimumab
- guanfacine
- Haemophilus b vaccine
- haloperidol
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydromorphone
- hydroxychloroquine
- hydroxyurea
- ibrutinib
- idelalisib
- ifosfamide
- iloperidone
- iloprost
- iloprost inhaled
- imatinib
- imipramine
- indapamide
- infliximab
- influenza H5N1 vaccine
- influenza vaccine
- insulin
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- irbesartan
- iron sucrose
- isocarboxazid
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- itraconazole
- Japanese encephalitis vaccine
- ketoconazole
- labetalol
- landiolol
- lapatinib
- leflunomide
- lenvatinib
- levobunolol ophthalmic
- levodopa
- levoketoconazole
- levorphanol
- lidocaine
- linagliptin
- linezolid
- liraglutide
- lisinopril
- lonafarnib
- lopinavir/ritonavir
- losartan
- lovotibeglogene autotemcel
- loxapine
- lubiprostone
- lumateperone
- lurasidone
- lymphocyte immune globulin, anti-thymocyte globulin
- magnesium sulfate
- maraviroc
- margetuximab
- mavacamten
- meningococcal vaccine
- meperidine
- mepivacaine
- mercaptopurine
- mesalamine
- mesalamine rectal
- metformin
- methadone
- methohexital
- methotrexate
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- midazolam
- mifepristone
- miglitol
- milrinone
- minoxidil
- mirdametinib
- mirtazapine
- mitoxantrone
- mobocertinib
- moexipril
- molindone
- morphine
- mycophenolate mofetil
- mycophenolic acid
- nadolol
- nalbuphine
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- nefazodone
- nelfinavir
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- olanzapine
- oliceridine
- olmesartan medoxomil
- olsalazine
- opicapone
- opium
- osimertinib
- oxazepam
- oxycodone
- oxymorphone
- paliperidone
- palopegteriparatide
- pazopanib
- pegfilgrastim (G-CSF)
- peginterferon alfa 2a
- peginterferon beta 1a
- pentamidine
- pentazocine
- perindopril
- perphenazine
- pertuzumab
- phenelzine
- phenoxybenzamine
- phentolamine
- pindolol
- pioglitazone
- pneumococcal vaccine
- poliovirus vaccine
- ponatinib
- posaconazole
- pramipexole
- pramlintide
- prazosin
- procarbazine
- prochlorperazine
- proguanil
- promethazine
- propafenone
- propofol
- propranolol
- protriptyline
- pyrimethamine
- quetiapine
- quinapril
- ramipril
- rasagiline
- remifentanil
- remimazolam
- repaglinide
- respiratory syncytial virus vaccine
- ribavirin
- ribociclib
- riociguat
- ripretinib
- risperidone
- ritonavir
- rituximab
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- ruxolitinib topical
- sacubitril
- safinamide
- sargramostim (GM-CSF)
- sarilumab
- satralizumab
- saxagliptin
- selegiline
- selegiline transdermal
- selumetinib
- semaglutide
- sevoflurane
- sildenafil
- silodosin
- sipuleucel-T
- sirolimus
- sitagliptin
- smallpox/mpox vaccine, live
- sodium ferric gluconate complex
- sorafenib
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- stiripentol
- succimer
- sufentanil
- sulfasalazine
- sunitinib
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- teplizumab
- terazosin
- teriflunomide
- thalidomide
- thioridazine
- thiothixene
- tick-borne encephalitis vaccine
- timolol
- timolol ophthalmic
- tipranavir
- tirzepatide
- tivozanib
- tizanidine
- tocilizumab
- tofacitinib
- tolcapone
- torsemide
- trabectedin
- tramadol
- trametinib
- trandolapril
- tranylcypromine
- trastuzumab
- trazodone
- treprostinil
- triamterene
- trifluoperazine
- trimethoprim
- trimipramine
- tucatinib
- typhoid vaccine
- upadacitinib
- valproic acid
- valsartan
- vandetanib
- vardenafil
- verapamil
- voriconazole
- vosoritide
- yohimbe
- zanidatamab
- zenocutuzumab
- zidovudine
- ziprasidone
Caution Advised
- abatacept
- abrocitinib
- amiodarone
- anakinra
- anifrolumab
- avacopan
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- betamethasone
- bimekizumab
- bosentan
- brentuximab vedotin
- brodalumab
- budesonide
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- cabazitaxel
- canakinumab
- cenobamate
- ciltacabtagene autoleucel
- ciprofloxacin
- cisplatin
- clobetasol ophthalmic
- corticotropin
- cortisone
- crovalimab
- cyclosporine
- danicopan
- daptomycin
- deflazacort
- delafloxacin
- deucravacitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- diroximel fumarate
- disulfiram
- docetaxel
- dupilumab
- eculizumab
- efavirenz
- efgartigimod alfa
- elranatamab
- emapalumab
- enfortumab vedotin
- eribulin
- ethanol (in some formulations)
- etravirine
- fingolimod
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- glofitamab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- inebilizumab
- iptacopan
- ixabepilone
- ixazomib
- ixekizumab
- lebrikizumab
- levofloxacin
- lorlatinib
- loteprednol ophthalmic
- methylprednisolone
- metronidazole
- miglustat
- mirikizumab
- mirvetuximab soravtansine
- mitapivat
- modafinil
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- moxifloxacin
- nadofaragene firadenovec intravesical
- nafcillin
- natalizumab
- nelarabine
- ocrelizumab
- ofatumumab
- ofloxacin
- oxaliplatin
- ozanimod
- paclitaxel
- pacritinib
- pegcetacoplan
- pexidartinib
- polatuzumab vedotin
- pomalidomide
- ponesimod
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- ravulizumab
- repotrectinib
- rifapentine
- rilonacept
- risankizumab
- ritlecitinib
- rozanolixizumab
- secukinumab
- siltuximab
- siponimod
- sotorasib
- spesolimab
- sutimlimab
- tacrolimus
- talquetamab
- teclistamab
- tezepelumab
- tildrakizumab
- tinidazole
- tisagenlecleucel
- tisotumab vedotin
- tralokinumab
- triamcinolone
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vamorolone
- vedolizumab
- vigabatrin
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zilucoplan
Adverse Reactions .
Serious Reactions
- peripheral neuropathy
- posterior reversible encephalopathy syndrome
- optic neuropathy
- blindness
- hypotension, severe
- CHF
- cardiac arrest
- arrhythmia
- ARDS
- pneumonitis
- pneumonia, interstitial
- pulmonary HTN
- thrombocytopenia
- neutropenia
- anemia
- hemorrhage
- herpes zoster (shingles) reactivation
- pneumonia
- PML
- thrombotic microangiopathy
- hemolytic uremic syndrome
- diarrhea, severe
- dehydration
- ileus
- pancreatitis
- hepatotoxicity
- tumor lysis syndrome
- anaphylaxis
- angioedema
- toxic epidermal necrolysis
- Stevens-Johnson syndrome
- acute febrile neutrophilic dermatosis
- Guillain-Barre syndrome
- demyelinating polyneuropathy
Common Reactions
- nausea
- diarrhea
- peripheral neuropathy
- fatigue
- thrombocytopenia
- vomiting
- constipation
- fever
- anemia
- anorexia
- neutropenia
- headache
- paresthesia
- rash
- weakness
- hypotension
- dizziness
- abdominal pain
- dyspnea
- herpes viral infection
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; LFTs at baseline, then frequently if hepatic impairment; CBC w/ diff prior to each dose
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; risk of embryo-fetal toxicity and death, based on animal data at 0.5x recommended human dose and drug's mechanism of action
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and x7mo after D/C in female pts and during tx and x4mo after D/C in male pts
Lactation
Clinical Summary
avoid breastfeeding during tx and x2mo after D/C; no human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 1A2, 2C9, 2C19, 2D6, 3A4 substrate
Excretion: unknown; Half-life: 76-108h
Subclass: Proteasome Inhibitors
Mechanism of Action
inhibits 26S proteasome, disrupting cellular homeostasis and causing cell death
Formulary .
No Formulary Selected
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