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Side effects of bortezomib (Velcade)

Find out about the side effects of the targeted cancer drug bortezomib. 

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 37.5C.

Common side effects

Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.

Tips

  • Keep your hands and feet warm.
  • Wear well fitting, protective shoes.
  • Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Moisturise your skin at least a couple of times a day.
  • Take care when cutting your nails.

This affects 3 out of every 10 people (30%). 

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

This affects about 2 out of 10 people (20%).

You might have pain in your muscles, bones or tummy (abdomen). Let your doctor or nurse know if you have pain during or after having treatment.

There are lots of ways to treat pain, including relaxation and painkillers.

You might have to take an anti viral drug to prevent shingles (herpes zoster virus).

This can happen to about 1 out of 10 people (10%). 

High temperature

You might get a high temperature (fever) for a few hours after having this treatment. Tell your doctor or nurse if you have a fever.

This affects more than 3 out of 10 people (30%).

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

This affects around 6 out of 10 people (60%). 

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

This affects about 4 out of 10 people (40%). 

You might feel sick or be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

  • Avoid eating or preparing food when you feel sick.
  • Avoid hot fried foods, fatty foods or foods with a strong smell.
  • Eat several small meals and snacks each day.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Try fizzy drinks.
  • Sip high calorie drinks if you can’t eat.

This affects just over 6 out of 10 people (60%). 

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

This affects about 5 out of 10 people (50%). 

Cancer treatment can cause the level of red blood cells to fall (anaemia). This makes you breathless and look pale.

Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

Tell your doctor or nurse if you feel breathless.

This can affect about 3 out of 10 people (30%). 

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

This can happen to about 4 out of 10 people (40%). 

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 37.5C. Severe infections can be life threatening.

Cancer drugs can reduce the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

Your white blood cell level begins to fall after each treatment. Then it gradually goes up again.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

Occasional side effects

Each of these effects happens in 1 to 10 out of every 100 people (1 to 10%). You might have one or more of them.

It is important to tell your doctor or nurse if you have a cough, or are breathless.

Tell your doctor or nurse if you feel light headed or dizzy. You have your blood pressure checked regularly.

Don't drive or operate machinery if you have this. 

You might have blurred vision but it usually goes back to normal once the treatment has finished.

This is usually mild.

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

This can cause you difficulty or pain when passing urine, needing to pass urine often or blood in your urine. 

You may have a rash or red, dry, itchy skin. Let your doctor or nurse know.

Changes in taste can make you go off certain foods. Many people go off tea and coffee, for example. You might also find that some foods taste different. Some people find that they prefer to eat spicier foods.

Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

You might also lose weight. 

Indigestion is pain or discomfort in your chest or stomach. It often happens shortly after eating or drinking.

Symptoms can also include:

  • heartburn, a burning sensation in the lower chest
  • feeling sick
  • feeling bloated
  • belching

This is caused by stomach acid irritating the foodpipe, the stomach or the top part of the bowel. Ask your doctor or nurse for anti heartburn medicines if you need them.

Tips

  • Stop smoking.
  • Limit your caffeine intake found in coffee and tea, canned drinks and chocolate.
  • Avoid foods and drinks that can cause heartburn, such as citrus fruits and alcohol.
  • Raise the head of your bed when sleeping or lying down.
  • Don't eat for 2 or 3 hours before going to bed.
  • Reduce fatty foods in your diet, such as deep fried foods.

You may have swelling of your ankles, legs and eyes due to a build up of fluid (oedema). 

This is usually mild and affects 1 out of 20 people (5%). 

Talk to your doctor or nurse if you’re having problems sleeping. It can help to change a few things about when and where you sleep.

Tips

  • Go to bed and get up at the same time each day.
  • Make sure the temperature is right.
  • Spend time relaxing before you go to bed - have a bath, read or listen to music.
  • Do some light exercise each day to help tire yourself out.
  • Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon.
  • Have a light snack before you go to bed to stop hunger waking you up.

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

Your face may appear flushed. Or you may have small broken vessels in the skin. 

You may have chest pain or feel breathless during exercise. 

Contact your doctor or nurse as soon as possible if you have chest pain.

Mood changes can include feeling very sad and depressed. Tell your doctor or nurse if you’re feeling depressed. They can arrange for you to talk to someone and give treatment if necessary.

Other mood changes include feeling anxious, restless or agitated.

You may be dehydrated if you are very thirsty and have dark coloured urine. 

Other symptoms include:

  • dizziness or light headedness
  • headache
  • tiredness
  • dry mouth, lips and eyes
  • passing small amounts of urine infrequently (less than three or four times a day)

Increase the amount of fluids you drink. Contact your doctor or nurse if the symptoms continue despite drinking more fluids.

You might have a runny nose while having treatment.

Your mouth and throat might get sore. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Tell your doctor or nurse if your throat is sore.

Let your doctor or nurse know straight away if you have sudden, sharp tummy (abdominal) pain, vomiting, or blood in your poo (faeces) or vomit.

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the levels of chemicals produced by the liver.

Tell your doctor or nurse if you have this.

You might have eye problems, such as conjunctivitis.

Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.

Let your doctor or nurse know if you are sweating much more than normal.

Tips

  • Cut out coffee, tea and nicotine.
  • Cut down on alcohol.
  • Sip cold or iced drinks.
  • Wear layers of light clothing so you can take clothes off if you overheat.
  • Have layers of bedclothes to remove as you need to.
  • Wear natural fibres such as silk or cotton instead of man made fabrics.

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

You might have heart palpitations or chest pain.

If you have any chest pain, contact your doctor or nurse as soon as possible. 

This can affect less than 1 out of 100 people (less than 1%). 

High uric acid levels in the blood are due to the breakdown of tumour cells (tumour lysis syndrome). You will have regular blood tests to check your uric acid levels and may have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid.

You might get the hiccups with this drug. 

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

You may get ringing in your ears (tinnitus). This normally gets better on its own.

You may have some hearing loss, especially with high pitched sounds. 

Tell your doctor or nurse if you notice any changes.

This drug can cause changes to the blood supply to the brain which can lead to a stroke.

Contact your treatment centre urgently if you have symptoms of a stroke. The symptoms include your face drooping to one side or you can’t smile normally. You may not be able to lift your arms or they become weak or numb. Or your speech may be slurred or garbled.

Tell your nurse or doctor if you have this. 

Let your doctor know if you feel hot, sweaty, agitated, are losing weight, and have problems concentrating and sleeping.

The hair on your head could become thinner or you may gradually lose your hair. 

Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

This can happen if you have bortezomib as an injection under the skin. Tell your nurse if you have pain around the injection site. 

You might have a group of symptoms including: 

  • headaches
  • fits (seizures)
  • changes in eye sight
  • excessive sleepiness
  • changes in your behaviour
  • high blood pressure
If you notice this tell your doctor or nurse straight away.

Doctors call this group of symptoms reversible posterior leucoencephalopathy syndrome (RPLS).

About bortezomib (Velcade)

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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