Live Vaccines
Contraindicated
Database
Immunosuppression
Avoid live vaccines
Source: Kimi deep-research + Cla
Drug reference
Bortezomib
Proteasome inhibitor (boronic acid) · Antineoplastic
Also known as Velcade, PS-341
START
1.3 mg/m² SC days 1,4,8,11 q21d (per regimen); antiviral prophylaxis
TYPICAL MAX
1.3 mg/m²/dose
STOP IF
Grade ≥3 neuropathy/severe neuropathic pain, severe thrombocytopenia, cardiopulmonary deterioration
WATCH
Neuropathy grading each visit, platelets/CBC, zoster prophylaxis, hydration/TLS
CDSCO approvedSchedule HATC L01XG01
KDIGO 2024 + manufacturer label
- ONSET
- 8min · absorption onset
- PEAK
- 30min · Cmax
- t½
- 4.2d · terminal t½ (multi-dose)
- DURATION
- 3d · proteasome recovery
EXCRETION
Hepatic CYP3A4/2C19; metabolite excretion
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid — embryo-fetal toxicity; effective contraception both sexes
FDA category + note
Top interactionssee all 12 →
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AdalimumabSevereDatabaseDDInter
- ApalutamideSevereDatabaseDDInter
- BaricitinibSevereDatabaseDDInter
Available in India
47 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Reversible inhibition of the 26S proteasome chymotrypsin-like (β5) activity, causing accumulation of pro-apoptotic regulatory proteins (e.g. IκB → NF-κB suppression), ER stress and apoptosis, with particular sensitivity in plasma cells.
Indications
Multiple myelomaMantle cell lymphoma
Dosing
- Adult
- 1.3 mg/m² SC (preferred) or IV on days 1,4,8,11 of 21-day cycles (schedule varies by regimen); weekly schedules used to reduce neuropathy.
- Pediatric
- Protocol-specific (specialist).
- Renal adjustment
- No adjustment for renal impairment/dialysis (give after dialysis).
- Hepatic adjustment
- Bilirubin >1.5×ULN: reduce starting dose to 0.7 mg/m², titrate by tolerance.
- Geriatric
- No specific adjustment; monitor neuropathy.
- Max dose
- 1.3 mg/m²/dose (per schedule)
Pharmacokinetics
Onset
Proteasome inhibition within 1 h of dose
Peak effect
Cmax minutes (IV) ; SC similar exposure
Duration
Recovery of proteasome activity ~72 h
Half-life
~40–190 h (multi-compartment, after multiple dosing)
Bioavailability
SC bioavailability equivalent AUC to IV
Protein binding
~83%
Metabolism
Hepatic CYP3A4/2C19 (deboronation)
Excretion
Metabolite excretion; limited unchanged
Contraindications
- Hypersensitivity to bortezomib, boron or mannitol
- Intrathecal administration (fatal)
- Severe hepatic impairment (dose-reduce, not absolute)
Side effects
Common
Peripheral sensory neuropathyThrombocytopenia (cyclical), anaemia, neutropeniaFatigue, nausea, diarrhoea/constipationPyrexia
Serious
- Severe painful peripheral neuropathy
- Severe thrombocytopenia → bleeding
- Herpes zoster reactivation (give prophylaxis)
- Cardiac failure / pulmonary toxicity (PRES, ILD rare)
- Tumour lysis syndrome; hepatotoxicity
Pregnancy & lactation
Pregnancy
Avoid — embryo-fetal toxicity; effective contraception both sexes
Lactation
Do not breastfeed during and after therapy
Drug interactions
Adalimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Apalutamide
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Carbamazepine
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Deferiprone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drugs Causing Peripheral Neuropathy
Severe
Database
Additive neuropathy
Avoid combination; monitor neuro exam
Source: Kimi deep-research + Cla
Enzalutamide
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Etanercept
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Bortezomib
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19