Velcade interactions: Alcohol, medications, and other factors

Velcade interactions with other drugs

Before you start treatment with Velcade, tell your doctor and pharmacist about any prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

To learn whether Velcade interacts with supplements, herbs, or vitamins, see the “Velcade and other interactions” section.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Velcade. However, it doesn’t include all drugs that may interact with this medication. Some of these interactions are described in detail in “Drug interactions in depth.”

When to avoid Velcade 

Certain factors or conditions could prevent your doctor from prescribing Velcade due to the risk of harm. These are known as contraindications. Below are the contraindications of Velcade.

Note: Before you start treatment with Velcade, it’s important to tell your doctor if these contraindications apply to you. They can determine whether doctors prescribe it.

Intrathecal administration

Doctors won’t inject Velcade as an intrathecal injection, which involves injecting the medication into the spine. There are reports of death when it has been given as an intrathecal injection.

Velcade is only approved for administration by intravenous or subcutaneous injection. Talk with your doctor if you have questions about how you’ll receive this medication.

Having had an allergic reaction to Velcade or any of its ingredients

If you’ve had an allergic reaction to Velcade or any of its ingredients, your doctor will likely not prescribe it. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Velcade and alcohol

There are no known interactions between Velcade and alcohol. However, if you drink alcohol, your doctor may advise on avoiding or limiting it during treatment.

This is because drinking alcohol while taking the drug may worsen some of Velcade’s side effects. For example, you may experience:

• nausea
• vomiting
• headache
• low blood sugar

In addition, consuming large amounts of alcohol can cause liver damage. Velcade may also damage the liver as a side effect. This means that drinking alcohol during treatment may increase the risk of liver problems.

If you consume alcohol during Velcade treatment, these side effects may be more likely to occur. If you have questions about drinking alcohol during treatment, talk with your doctor.

Drug interactions in depth  

Here’s a closer look at certain drug interactions of Velcade.

Certain anticonvulsant medications

Velcade interacts with phenytoin and carbamazepine, which are anticonvulsant medications prescribed for managing seizures.

Your body relies on an enzyme (a special type of protein) called cytochrome P450 3A4 (CYP3A4) to break down Velcade. This makes it easier to remove it from your system. Carbamazepine and phenytoin increase CYP3A4 activity in the body, which means Velcade may be broken down faster than usual. This can make the medication less effective for treating multiple myeloma or mantle cell lymphoma.

Steps you or your doctor may take

Due to the risk of affecting Velcade’s effectiveness, doctors typically won’t prescribe the medication with phenytoin or carbamazepine. Instead, they can prescribe different anticonvulsant drugs that don’t have this interaction.

Cobicistat and treatments that contain it

Velcade interacts with cobicistat (Tybost) and treatments that contain it. These medications are prescribed for treating hepatitis C and HIV.

To break down Velcade and make it easier to remove from your system, your body relies on an enzyme called cytochrome P450 3A4 (CYP3A4). However, Cobicistat works by decreasing CYP3A4 activity in your body. This can help certain medications work better, which is why it is included in certain treatments. However, decreasing CYP3A4 activity while you’re using Velcade can increase your risk for side effects of this medication.

Here are some treatments containing cobicistat that may interact with Velcade:

• Genvoya (cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide fumarate)
• Stribild (cobicistat/elvitegravir/emtricitabine/tenofovir disoproxil fumarate)
• Symtuza (cobicistat/darunavir/emtricitabine/tenofovir alafenamide fumarate)
• Evotaz (cobicistat/atazanavir)
• Prezcobix (darunavir/cobicistat)

Steps you or your doctor may take

Due to the increased risk for Velcade side effects, some doctors avoid prescribing cobicistat and treatments that contain it with Velcade.

However, it’s not always possible to avoid this interaction. In cases where Velcade and a treatment containing cobicistat must be used, your doctor may prescribe a lower Velcade dosage. They’ll also monitor you closely for any symptoms of Velcade side effects throughout treatment.

Oral diabetes medications

Velcade can interact with oral diabetes medications, which are prescribed for treating type 2 diabetes. In studies, people who used Velcade and oral diabetes medications experienced both high blood sugar and low blood sugar as side effects. However, these side effects weren’t reported in people who took Velcade but didn’t use oral diabetes medications.

Here are some oral antidiabetic medications that may interact with Velcade:

• metformin (Fortamet, Glumetza)
• sulfonylureas, such as glipizide (Glucotrol XL)
• dipeptidyl peptidase (DPP-4) inhibitors, such as sitagliptin (Januvia)
• sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as empagliflozin (Jardiance)
• incretin mimetics, such as oral semaglutide (Rybelsus)

Steps you or your doctor may take

Although Velcade appears to interact with oral antidiabetic medications, this likely won’t prevent doctors from prescribing them together. Instead, your doctor can adjust the dose of your diabetes medications based on your blood sugar levels. They may want you to frequently monitor your blood sugar at home, especially when you first start treatment with Velcade or any time your dosage is changed.

It isn’t clear whether this interaction also applies to injectable diabetes medications, such as insulin or injectable semaglutide (Ozempic). If you’re prescribed Velcade, you and your doctor can discuss plans to manage your blood sugar.

Velcade and other interactions 

Velcade may have other interactions, such as with supplements, foods, vaccines, or lab tests.

Here are some potential interactions with Velcade. Keep in mind that the following information does not include all possible interactions.

Velcade interactions with supplements

Before you start treatment with Velcade, tell your doctor and pharmacist about any supplements, herbs, and vitamins you take. This information may help prevent possible interactions.

In addition to the interactions below, Velcade may interact with green tea supplements. These supplements may affect this medication’s effectiveness when it is used to treat multiple myeloma. This interaction is not expected with green tea drinks or when Velcade is used to treat mantle cell lymphoma. Therefore, your doctor will likely advise against consuming green tea supplements if you’re using Velcade to treat multiple myeloma.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Velcade interactions with herbs

Doctors typically recommend avoiding taking St. John’s wort with Velcade. St. John’s wort is an herbal supplement that may be used to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Velcade.

By speeding up this enzyme, St. John’s wort can cause Velcade to break down more quickly, which may lead to a low level of this medication in your system. If this level becomes too low, the drug may not work to treat your condition.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Velcade interactions with vitamins

There are no specific reports of vitamins interacting with Velcade. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you need to talk with your doctor or pharmacist before taking any vitamin product with Velcade.

Velcade interactions with food

Grapefruit and grapefruit juice can interact with Velcade. Specifically, grapefruit products can stop your body from breaking down this medication. This raises the level of Velcade in your body, which increases your risk of side effects. Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.

Velcade interactions with vaccines

There aren’t any known interactions between Velcade and vaccines. Talk with your doctor or pharmacist to check whether you’re due for any vaccines.

Velcade interactions with lab tests

Velcade isn’t known to interact with lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

VELCADE INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Velcade. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Velcade. The effects of cannabis may affect how well you stick to your Velcade treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Velcade and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with Velcade. Before you take this drug, be sure to talk with your doctor about your health history. Velcade may not be suitable if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Velcade include:

• Breathing or lung conditions: Velcade side effects can include acute respiratory distress syndrome (ARDS) and other lung-related side effects. If you have a breathing or lung condition such as asthma, you may be at higher risk for lung-related side effects due to Velcade. Treatment with this medication could also worsen your condition. Talk with your doctor to learn more about the risks and benefits of Velcade treatment based on your lung condition.
• Heart failure or other heart conditions: New and worsening heart failure are possible Velcade side effects. If you have heart disease or another heart condition, you may have a higher risk of heart-related side effects from taking Velcade. If your doctor prescribes this medication to you, they’ll likely closely monitor your heart health throughout treatment.
• History of syncope: Velcade can cause low blood pressure as a side effect. If you have a history of syncope (fainting), you may be at higher risk of this side effect. If your doctor prescribes Velcade to you, it’s important to stay hydrated throughout treatment to lower your risk of low blood pressure and fainting.
• Liver conditions: If you have a liver condition such as cirrhosis, your doctor may prescribe a lower Velcade dosage. Your body relies on your liver to metabolize (break down) this medication. Having a liver condition can affect this process and raise your risk for Velcade side effects. Velcade can also cause liver damage as a side effect, and having a liver condition means you may be at a higher risk. Your doctor can help determine whether treatment with Velcade is safe based on your liver health.
• Allergic reaction: If you’ve had an allergic reaction to Velcade or any of its ingredients, your doctor will likely not prescribe this medication. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be more suitable.
• Breastfeeding: It’s unknown whether it’s safe to use Velcade while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects it may have on a breastfed child. However, due to the possible risk of serious side effects, health experts recommend against breastfeeding during Velcade treatment or for at least 2 months after your last dose. If you’re breastfeeding or planning to, talk with your doctor before using Velcade. They can talk with you about treatment options and ways to feed a child other than breastfeeding.
• Pregnancy: There haven’t been enough clinical trials to determine whether Velcade is safe to use while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth abnormalities) or pregnancy loss. However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Velcade. They can advise you on the right treatment plan for you.

Preventing interactions  

You can take certain steps to help prevent interactions with Velcade. Your doctor and pharmacist are key resources, so reaching out to them before starting treatment can help. For example, it’s important that you plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Velcade label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. The paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Velcade doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Velcade by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.