Velcade (bortezomib) is used for hematologic malignancies such as multiple myeloma, but some populations require contraindication or cautious use. The following explains two categories: severe hepatic or renal impairment and allergy.

I. Patients with Severe Hepatic Impairment

1. Basis of Risk

Bortezomib is primarily metabolized by the liver, and drug clearance is slowed when liver function is severely impaired.

Increased exposure can worsen toxicities such as peripheral neuropathy and thrombocytopenia.

2. Dosing Principles

Severe hepatic impairment should be avoided or used only after strict assessment of benefit and risk.

Moderate hepatic impairment usually requires a reduced starting dose.

Monitor liver enzymes, bilirubin, and neurologic symptoms closely during treatment.

3. Warning Signs

Jaundice, worsening fatigue, or altered consciousness should prompt timely medical attention.

Severe hepatotoxic reactions require discontinuation and management.

II. Patients with Severe Renal Impairment

1. Basis of Risk

Renal impairment affects clearance of drug metabolites and tolerability.

Dosing timing requires special arrangement in dialysis patients.

2. Dosing Principles

Severe renal impairment requires individualized assessment, cautious use, or regimen adjustment.

Dialysis patients should be dosed after dialysis to reduce the impact of drug removal.

Monitor serum creatinine, electrolytes, and urine output changes.

3. Warning Signs

Oliguria, edema, fatigue, or electrolyte disturbances require timely evaluation.

Concurrent dehydration or infection can worsen renal injury.

III. Patients Allergic to Bortezomib or Mannitol

1. Scope of Contraindication

Contraindicated in patients allergic to bortezomib, boric acid, or mannitol.

The formulation contains mannitol, and allergic patients may experience cross-reactions.

2. Allergic Manifestations

Rash, urticaria, pruritus, facial or throat swelling.

Severe reactions such as dyspnea, hypotension, and bronchospasm.

3. Management Principles

Ask in detail about allergy history, including excipient allergies, before administration.

If an allergic reaction occurs, stop the drug immediately and give antiallergic treatment.

Patients with severe allergy are permanently contraindicated and should not be rechallenged.

IV. Other Populations Requiring Caution

1. Patients with Peripheral Neuropathy

Those with pre-existing severe neuropathy require evaluation before use or dose adjustment.

2. Patients with Thrombocytopenia

Those with low baseline platelets require blood count monitoring and possibly delayed dosing.

3. Pregnancy and Lactation

Use during pregnancy can cause fetal harm; people of reproductive potential need contraception.

Breastfeeding is not recommended during lactation.

V. Information for Patients

1. Proactive Disclosure

Inform the doctor of any history of liver or kidney disease, dialysis status, and drug allergies.

Disclose other medications and supplements currently being used.

2. Cooperation with Monitoring

Have liver and kidney function, complete blood count, and neurologic symptoms checked on schedule.

Seek timely medical attention for rash, dyspnea, jaundice, or decreased urine output.

3. No Self-Medication

Do not adjust the dose or change the administration route on your own.

Patients with a clear allergy history should avoid re-exposure to this product.