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Venclexta

venetoclax

Used for Leukemia

Venclexta (venetoclax) is a first-choice medication that treats certain cancers of the blood or lymph nodes, like acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and small lymphocytic lymphoma (SLL). You typically take it by mouth once daily, either on its own or in combination with other chemotherapy or targeted medications, depending on your condition. Venclexta (venetoclax) can put you at risk for a serious side effect called tumor lysis syndrome (TLS).

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Connie Zheng, PharmD

Last reviewed on November 15, 2022

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Contraindications Alternatives Images Prices Medicare

What is Venclexta (venetoclax)?

What is Venclexta (venetoclax) used for?

Acute myeloid leukemia (AML) in older adults or people with certain medical conditions
Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) in adults

How Venclexta (venetoclax) works

Venclexta (venetoclax) is a type of targeted therapy called a BCL-2 inhibitor. BCL-2 is a protein that helps cancer cells survive. Certain cancers, like AML and CLL/SLL, have too many BCL-2 proteins. This allows them to continue growing uncontrollably. Venclexta (venetoclax) works by targeting and blocking BCL-2 on cancer cells, which allows it to kill and slow down the growth of cancer cells.

Are you looking for information on venlafaxine (Effexor), Zolinza (vorinostat), Zelboraf (vemurafenib) instead?

Drug Facts

Common BrandsVenclexta

Drug ClassTargeted therapy (BCL2 Inhibitors)

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

What are the side effects of Venclexta (venetoclax)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Low white blood cell count (50%)
Diarrhea (43%)
Nausea (42%)
Upper respiratory tract infection (36%)
Low red blood cell count (33%)
Tiredness (32%)
Low platelet count (29%)
Muscle and joint pain (29%)
Swelling in arms, legs, hands, or feet (22%)
Stomach pain (18%)
Headache (18%)
Rash (18%)
Vomiting (16%)
Constipation (16%)

Please note: These side effects were reported by people who took only Venclexta (venetoclax). The side effects you experience might differ if you're taking Venclexta (venetoclax) with other anticancer medications.

Other Side Effects

Fever
Infection in the blood
Trouble breathing
Infection in the lungs
Cough
Sore throat
Dizziness
Low blood pressure
Painful mouth sores

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

Tumor lysis syndrome: fever, chills, nausea or vomiting, confusion, shortness of breath, seizures, irregular heartbeat, dark or cloudy urine, muscle or joint pain, unusual tiredness
Serious infections: body aches, chills, fever, headache, new cough, sore throat, feeling tired

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
Tumor lysis syndrome (TLS)—nausea, vomiting, diarrhea, decrease in the amount of urine, dark urine, unusual weakness or fatigue, confusion, muscle pain or cramps, fast or irregular heartbeat, joint pain
Unusual bruising or bleeding

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

Bone, joint, or muscle pain
Constipation
Cough
Diarrhea
Fatigue
Nausea
Swelling of the ankles, hands, or feet

Pros and cons of Venclexta (venetoclax)

Pros

Taken by mouth

Only taken once daily

One of the first-choice treatment options for certain people with AML and CLL/SLL

More precise in the way it targets cancer cells, compared to traditional chemotherapy

Cons

Can cause nausea, diarrhea, and serious infections

Must be taken with food

Needs gradual dose ramp-up to reach the recommended daily dose

Only available as a brand medication, so it might be expensive

Pharmacist tips for Venclexta (venetoclax)

Take Venclexta (venetoclax) with a meal and with water at the same time every day. Swallow the tablet whole so that the medication works properly. Don’t cut, chew, or crush the tablet.

You should drink plenty of water (6 to 8 glasses a day) while you’re receiving Venclexta (venetoclax) treatment. This helps lower your risk of high uric acid levels (from TLS). Make sure you start this routine 2 days before your first dose of Venclexta (venetoclax). It’s important to drink water daily, but especially when your provider raises your dose

If you vomit after you take Venclexta (venetoclax), don’t take any additional doses to make up for it. Just continue your treatment at the usual time on the next day.

If you’re taking the 100 mg Venclexta (venetoclax) tablets and are having a hard time swallowing them, let your provider know. They might be able to prescribe you tablets in a smaller size.

Avoid grapefruit and grapefruit juice, Seville oranges (commonly found in marmalades), or starfruit while taking Venclexta (venetoclax). These foods or drinks can raise the levels of the medication in your body and raise your risk for more side effects.

You might also receive medications to lower uric acid levels, like allopurinol (Zyloprim), before starting and during treatment with Venclexta (venetoclax).

Tell your provider and pharmacist about all the medications you take, including supplements and over-the-counter medications, so they can help you check for interactions. For example, medications like posaconazole (Noxafil) and ritonavir (Norvir) can raise Venclexta (venetoclax) levels in your body and put you at higher risk for side effects. Medications like phenytoin (Dilantin) or carbamazepine (Tegretol) might cause Venclexta (venetoclax) to not work as well in treating your cancer.

Venclexta (venetoclax) can cause a very serious problem called tumor lysis syndrome (TLS). Let your provider know if you experience symptoms of TLS, such as nausea, extreme tiredness, muscle cramps, and dark-colored urine.

Your provider will order lab tests for you before and during your treatment with Venclexta (venetoclax) to check for things like TLS and your blood cell count. Ask your provider if you’re not sure when your lab appointments are. Once you know your appointment schedule, please mark your calendar so you remember when the dates are.

Don’t get any live vaccines while you’re receiving Venclexta (venetoclax). Doing so might put you at risk for serious infections or it might cause the vaccines to not work as well. Please ask your providers when it’s safe to receive live vaccines.

Ask your provider or pharmacist about the best way to handle and throw away Venclexta (venetoclax) safely. Anticancer medications can be very harmful to people who handle or come into contact with them.

Frequently asked questions about Venclexta (venetoclax)

Is Venclexta (venetoclax) a type of chemotherapy?

No, Venclexta (venetoclax) is not a chemotherapy medication. It’s a type of targeted anticancer therapy. Chemotherapy is a class of medication that kills cells that multiply quickly in your body, like cancer cells. But it can also end up killing some healthy cells as well. Venclexta (venetoclax) is more precise in the way it targets cancer cells. It blocks a specific protein found in cancer cells called BCL-2. This causes the cancer cells to stop growing and die.

Is Venclexta (venetoclax) safe if I have liver problems?

Let your provider know if you have liver problems because you might need to receive Venclexta (venetoclax) treatment at a lower dose. Your provider might order blood work to check your liver health more often. In addition, because this medication is broken down by the liver, your body might have a harder time getting rid of it if you have liver problems. As a result, you might be at higher risk for side effects. Let your provider know right away if you experience symptoms of liver problems, such as extreme tiredness, stomach pain, or yellowing of the skin or whites of the eyes.

Why does my provider gradually raise my dose of Venclexta (venetoclax) when I first start this medication?

When you first begin Venclexta (venetoclax), your provider will start you at a lower dose and raise your dose slowly over time. This is done to prevent a serious condition called tumor lysis syndrome (TLS). TLS happens when cancer cells break down rapidly and release its contents, such as uric acid and electrolytes. When there’s too much uric acid and electrolytes in your body, you can experience serious kidney damage, which can be fatal. TLS is more likely to happen if you have a large tumor burden. By taking a lower dose of Venclexta (venetoclax) in the beginning and slowly raising the dose (called a"ramp-up"), your provider can lower your tumor burden and lower your risk for TLS. Your healthcare provider might recommend that you start Venclexta (venetoclax) in the hospital so they can monitor you during the ramp-up phase. Let your provider know right away if you notice symptoms of TLS, such as nausea, extreme tiredness, numbness, seeing things that aren’t there (hallucinations), and muscle cramps.

Is Venclexta (venetoclax) safe in pregnancy?

Venclexta (venetoclax) isn’t recommended for use in pregnancy. While this medication hasn’t been studied in human pregnancies, animal studies show that it might cause harm to your unborn baby. If you’re a female who’s able to become pregnant, you should use birth control while taking Venclexta (venetoclax) and for at least 1 month after the last dose. Let your provider know right away if you become pregnant while taking this medication.

Is Venclexta (venetoclax) safe while breastfeeding?

It isn’t recommended to breastfeed while taking Venclexta (venetoclax). We don’t know if the medication can pass into your breast milk, but there’s a risk of serious harm to nursing infants if it does. Because of this risk, you shouldn’t breastfeed while taking Venclexta (venetoclax) and for 1 week after your last dose. Talk with your provider about other ways to feed your baby during treatment.

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What are the risks and warnings for Venclexta (venetoclax)?

Venclexta (venetoclax) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

High uric acid and electrolyte imbalances (from tumor lysis syndrome)

Risk factors: Kidney problems | Higher tumor burden, including tumor that’s in your bone marrow | Enlarged spleen | Circulating blasts | Higher lactate dehydrogenase (LDH) level

Treatment with Venclexta (venetoclax) can cause a serious reaction called tumor lysis syndrome (TLS). TLS is a condition where many cancer cells die quickly and suddenly break down in your body. In the process, these cells release their inner contents, like uric acid, potassium, and phosphorus, into your blood. High levels of uric acid and electrolytes in your body can cause serious problems, such as kidney damage and abnormal heart rhythms. TLS can happen as early as 6 to 8 hours after your first dose of Venclexta (venetoclax). You’re more likely to experience TLS each time your provider raises your dose.

Your provider will order labs for you regularly to check for signs of TLS. To lower your risk of TLS, your provider will start you on a lower dose of Venclexta (venetoclax) and raise your dose slowly over time. They’ll also recommend that you drink enough fluids daily to keep hydrated. If need be, they might also give you intravenous (IV) fluids and prescribe you medications to lower your uric acid levels. Tell your provider right away if you’re urinating less than usual or have dark urine, muscle cramps, or a racing heartbeat.

Low blood cell counts

Venclexta (venetoclax) can cause your white blood cells, red blood cells, and platelets to drop. When these cell counts are lower than normal, you have a higher risk of anemia, bleeding, bruising, and infections. Your provider will check your blood counts often while you’re receiving Venclexta (venetoclax). Let your provider know if you develop a fever or start to feel sick or have any unusual bruising or bleeding. If this happens you might need to have your dose lowered or stop this medication altogether.

Infections

Venclexta (venetoclax) can raise your risk of serious infections, such as pneumonia and blood infection (sepsis). The infections might lead to death, especially if they’re not treated right away. Let your provider know as soon as possible if you develop a fever, chills, fatigue, cough, or have other signs of an infection.

Caution with immunizations

You shouldn’t receive any live vaccines before, during, or after treatment with Venclexta (venetoclax) until your healthcare provider says it’s safe. Live vaccines contain a live, but weakened, version of the bacteria or virus they're meant to protect you from. A live vaccine could cause an infection if you have a weakened immune system, like when taking Venclexta (venetoclax). In addition, vaccines might not work as well as intended when you have a weakened immune system. Examples of live vaccines can include yellow fever, measles, mumps, and rubella, or the flu vaccine given as a nasal spray.

Harm to an unborn baby

Based on animal studies, Venclexta (venetoclax) can harm an unborn baby. If you’re a female who’s able to become pregnant, you should use birth control during Venclexta (venetoclax) treatment and for at least 1 month after the last dose. Let your provider know right away if you become pregnant during this time.

Venclexta (venetoclax) dosage forms

Typical dosing for Venclexta (venetoclax)

Your provider might prescribe other anticancer medications for you to take along with Venclexta (venetoclax). Make sure to ask your provider about the specific directions and dosing of all the medications of your treatment plan.

Your dose of Venclexta (venetoclax) might differ depending on whether you're experiencing side effects or if you've any kidney or liver problems.

AML

The typical starting dose for Venclexta (venetoclax) is 100 mg by mouth daily. Your provider will raise your dose daily over 3 to 4 days until you reach the maintenance dose of 400 mg or 600 mg daily, depending on which other anticancer medications you’re taking with Venclexta (venetoclax).

CLL or SLL

The typical starting dose for Venclexta (venetoclax) is 20 mg by mouth daily. Your provider will raise your dose every week during your first 5 weeks of treatment until you reach a maintenance dose of 400 mg daily.

Venclexta (venetoclax) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Venclexta (venetoclax) will not be safe for you to take.

Taking venetoclax at the same time as other strong CYP3A inhibitors when starting and during the ramp-up phase in people with CLL/SLL due to the risk of tumor lysis syndrome

What are alternatives to Venclexta (venetoclax)?

There are a number of medications that your doctor can prescribe in place of Venclexta (venetoclax). Compare a few possible alternatives below.

Venclexta (venetoclax)

Used for:

Acute myeloid leukemia (AML) in older adults or people with certain medical conditions
Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) in adults

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Imbruvica (ibrutinib)