Venetoclax is a treatment for chronic lymphocytic leukaemia (CLL).
What is venetoclax?
Venetoclax is a type of targeted cancer drug. You have it as a treatment for chronic lymphocytic leukaemia (CLL) either on its own or in combination with another drug.
How does venetoclax work?
Venetoclax is a type of targeted cancer drug called a cancer growth blocker. It blocks certain proteins on cancer cells that help them grow and survive. By blocking this protein it is able to kill and slow down the growth of cancer cells.
How do you have venetoclax?
You take venetoclax as tablets once a day with a meal. You swallow the tablets whole with a glass of water. You take them at the same time each day, usually with breakfast.
You must take tablets according to the instructions your doctor or pharmacist gives you.
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.
How often do you have venetoclax?
You take venetoclax for as long as it’s controlling the cancer and the side effects aren’t too bad.
The amount (dose) of venetoclax you have starts off low and is gradually increased over the first 5 weeks of treatment. Some people have to stay in hospital overnight (inpatient) for the few days of treatment.
If you are having this drug in combination with rituximab, you have it for up to 2 years or for as long as it’s working and the side effects aren’t too bad.
If you are having this drug in combination with obinutuzumab, you have it for up to 1 year or for as long as it’s working and the side effects aren’t too bad.
You should drink at least 1.5 to 2 litres of water a day during the first 5 weeks of treatment to help flush out the breakdown of cancer cells from your body.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
What are the side effects of venetoclax?
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might develop a cough or breathing problems. This could be due to infection, such as pneumonia. Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Changes in levels of minerals in your blood
You may have changes in levels of minerals and salts in your blood, such as high potassium and phosphate and low calcium. This could be caused by the breakdown of cancer cells. You have regular blood tests during treatment to check this.
Diarrhoea or constipation
Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help.
Feeling or being sick
Feeling or being sick can be severe. It can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Contact your doctor or nurse straight away if you’ve been sick more than once in a day.
Tiredness and weakness (fatigue)
Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- a bladder infection causing difficulty in passing urine, urgency or going more often, pain or burning
- changes to the level of chemicals in your blood due to the breakdown of tumour cells – you will have regular blood tests to check this
- high levels of uric acid in the blood – you have regular blood tests to check this, you may also have medicine to help get rid of this – drink plenty to help lower these levels
- high levels of a waste product called creatinine in your blood – this can tell your doctor if your kidneys are working properly
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
You should not eat, drink or take supplements of the following while you are taking venetoclax:
- grapefruit and grapefruit juice
- Seville oranges and Seville orange juice
- starfruit (carambola) and starfruit juice
These may increase the side effects of venetoclax.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Pregnancy and contraception
It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.
Women must not become pregnant for at least 1 month (30 days) after the end of treatment. Women should also use a barrier contraceptive such as a condom if you’re taking hormonal contraceptives such as the pill, patches or injection.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.