Bortezomib interactions

Food & lifestyle

• green tea

  Moderate

  Antagonism

  Data from in vitro and animal (mice) studies suggest that green tea may antagonize the cytotoxic effects of bortezomib. Polyphenols in green tea such as (-)-epigallocatechin gallate (EGCG) have been shown to block the proteasome inhibitory action of bortezomib in multiple myeloma and glioblastoma cancer cell lines. The mechanism appears to involve a direct chemical reaction between the boronic acid moiety of bortezomib and the 1,2-benzenediol groups present in certain polyphenols leading to inactivation of bortezomib.

  What to do: Until more data are available, it may be advisable to avoid or limit consumption of green tea and green tea products during treatment with bortezomib. The interaction has not been demonstrated for other, non-boronic acid proteasome inhibitors.

  3 sources

  1. Bannerman B, Xu L, Jones M, et al. "Preclinical evaluation of the antitumor activity of bortezomib in combination with vitamin C or with epigallocatechin gallate, a component of green tea." Cancer Chemother Pharmacol 68 (2011): 1145-54
  2. Golden EB, Lam PY, Kardosh A, et al. "Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid�Cbased proteasome inhibitors." Blood 113 (2009): 5927-37
  3. Jia L, Liu FT "Why bortezomib cannot go with 'green'?" Cancer Biol Med 10 (2013): 206-13

Conditions

Conditions in which Bortezomib needs care, as documented in this source.

• Cardiotoxicity

  Moderate

  Acute development or exacerbation of congestive heart failure and new onset of decreased left ventricular ejection fraction have occurred during treatment with bortezomib, including in patients with no risk factors. Patients with risk factors for, or existing heart disease should be closely monitored. There have also been isolated cases of QT interval prolongation but causality has not been established.

  1 source

  1. "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc (2003):

• Diabetes Mellitus

  Moderate

  Hypoglycemia and hyperglycemia was reported during clinical trials in diabetic patients in treatment with oral hypoglycemics and receiving bortezomib. Patients on oral antidiabetic agents may require close monitoring of their blood glucose levels and adjustment of the dose of their antidiabetic medication when using bortezomib.

  1 source

  1. "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc (2003):

• Hypotension

  Moderate

  There was an incidence of 8% of hypotension in patients receiving bortezomib therapy. Caution should be used when treating patients with history of hypotension, syncope, dehydration, or taking antihypertensive medication.

  1 source

  1. "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc (2003):

• Liver Diseases

  Moderate

  Cases of acute liver failure and other hepatic reactions such as hepatitis, increases in liver enzymes, and hyperbilirubinemia have been reported in patients receiving bortezomib. Monitoring is recommended and caution should be used when using bortezomib in patients with hepatic impairment. The exposure of bortezomib is increased in patients with moderate and severe hepatic impairment, and starting dose should be reduced in those patients.

  1 source

  1. "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc (2003):

• Lung Diseases

  Moderate

  There have been reports of Acute Respiratory Distress Syndrome (ARDS) and acute diffuse infiltrative pulmonary disease of unknown etiology in patients receiving bortezomib. Additionally, there have been reports of pulmonary hypertension associated with bortezomib administration in the absence of left heart failure or significant pulmonary disease. Treatment interruption should be considered in the event of new or worsening cardiopulmonary symptoms until a comprehensive diagnostic evaluation is conducted. Caution should be exercised when using bortezomib in patients with cardiopulmonary pathologies.

  1 source

  1. "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc (2003):

• Peripheral Nervous System Diseases

  Moderate

  Bortezomib can cause peripheral neuropathy that is predominantly sensory; however cases of severe sensory and motor peripheral neuropathy have been also reported. Patients with preexisting symptoms (numbness, pain or burning feeling in hands or feet) may experience worsening symptoms during treatment. Patients should be monitored for symptoms of neuropathy, and a dose adjustment might be required in those patients that experience them.

  1 source

  1. "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc (2003):