Venetoclax (VENCLEXTA)

Chronic lymphocytic leukemia

Acute myeloid leukemia

Chronic lymphocytic leukemia

• Oral
  • Week 1: 20 mg PO once daily for 7 consecutive days starting on day 1
  • ‍Week 2: 50 mg PO once daily for 7 consecutive days starting on day 8
  • Week 3: 100 mg PO once daily for 7 consecutive days starting on day 15
  • Week 4: 200 mg PO once daily for 7 consecutive days starting on day 22
  • Week 5 and beyond: 400 mg PO once daily starting on day 29

Acute myeloid leukemia

• Oral
  • Day 1: 100 mg PO once
  • Day 2: 200 mg PO once
  • Day 3: 400 mg PO once
  • Day 4 and beyond: venetoclax dose is dependent upon the combination agent:
    • 400 mg PO once daily (in combination with azacitidine) or 600 mg PO once daily (in combination with cytarabine)‍

‍Note: Given as monotherapy or in combination with other agents

Available as 10 mg, 50 mg, and 100 mg film-coated tablets. Tablets should NOT be crushed or broken. Store at room temperature.

BCL-2 Inhibitor

Take with food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 8 hours of the missed dose. If it is over 8 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Anemia, Neutropenia, Thrombocytopenia, Diarrhea, Nausea, Fatigue, Pyrexia, Upper respiratory tract infection.

Less Common: Autoimmune hemolytic anemia, Pneumonia, Tumor lysis syndrome.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline (required, within 72 h of first treatment): CBC and differential, potassium, calcium, magnesium, phosphate, uric acid, creatinine, urea, bilirubin, ALT, LDH, albumin, HBsAg, HBcoreAb. 

CLL: Prior to each dose increment during ramp-up phase (weeks 1 to 5): potassium, calcium, phosphate, uric acid, creatinine, LDH, albumin.

Tumour lysis syndrome (TLS) monitoring: potassium, calcium, phosphate, uric acid, creatinine, LDH, albumin based on tumour burden/TLS risk.

Each time seen by physician post ramp-up phase (week 6 onwards): CBC and diff, creatinine, bilirubin, ALT.

AML: Cycle 1.

Tumour lysis syndrome (TLS) monitoring: potassium, calcium, phosphate, uric acid, creatinine, LDH, albumin. Frequency determined by prescriber.

Days 1 to 4: CBC & differential, platelets

Days 8, 11, 15, 18, 22, 25: CBC & differential, platelets, creatinine, sodium, potassium, chloride, serum bicarbonate, bilirubin, ALT, alkaline phosphatase, GGT, LDH, INR, PTT.

Cycle 2 onward:

Day 1: CBC & differential, platelets, creatinine, sodium, potassium, chloride, serum bicarbonate, bilirubin, ALT, alkaline phosphatase, GGT, LDH, INR, PTT.

Weekly on Days 8, 15, and 22 of each cycle: CBC & differential, platelets, creatinine, bilirubin, ALT, alkaline phosphatase, GGT, LDH.

This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.

Current drug interaction databases should be consulted for more information.

Avoid in pregnancy and lactation.

BC Cancer. BC Cancer Drug Manual. Venetoclax. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Venetoclax_monograph.pdf. Updated August 1, 2022. Accessed February 2, 2024.

Lexicomp. Venetoclax Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7806?cesid=03fBEycKdeV&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dtretinoin%26t%3Dname%26acs%3Dtrue%26acq%3Dtretuno. December 5, 2023. Accessed February 2, 2024.

Cancer Care Ontario. Venetoclax Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44476. Updated July 2023. Accessed January 22, 2024.

AbbVie Corporation. VENCLEXTA® Product Monograph. St-Laurent, Quebec. Updated JUly 17, 2018.