Venetoclax: BCL-2 Inhibitor for Leukemia Treatment

Venetoclax is a modern anti-cancer medication that helps the body fight certain types of blood cancer. It works by blocking a protein called BCL-2 — a kind of "shield" that protects cancer cells from dying naturally. Once this shield is removed, cancer cells lose their protection and die.

The drug is taken as tablets and is often used in combination with other medications for the best results. On Unifarm, you can find generic versions of medications (such as Venclexta, Venclyxto) containing this active ingredient.

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Indications

Chronic Lymphocytic Leukemia (CLL): Treatment of adults with CLL — both newly diagnosed and relapsed or treatment-resistant disease. Usually prescribed in combination with other drugs (obinutuzumab or rituximab).
Acute Myeloid Leukemia (AML): Treatment of adults with newly diagnosed AML who are not suitable for intensive chemotherapy due to age or health conditions. Used in combination with azacitidine, decitabine, or low-dose cytarabine.

Dosage and administration

Available as tablets taken by mouth.

Important — gradual dose increase (ramp-up):

Treatment with venetoclax starts with a small dose that is gradually increased over 4–5 weeks. This is necessary to reduce the risk of a serious complication called tumor lysis syndrome (rapid breakdown of cancer cells that can harm the kidneys).

CLL — ramp-up schedule (5 weeks):
- Week 1: 20 mg daily
- Week 2: 50 mg daily
- Week 3: 100 mg daily
- Week 4: 200 mg daily
- Week 5 and beyond: 400 mg daily
AML — ramp-up schedule (4 days):
- Day 1: 100 mg
- Day 2: 200 mg
- Day 3: 400 mg
- Day 4 and beyond: 400 mg daily

How to take: Swallow the tablet whole with food and water. Do not crush or chew. Take at approximately the same time each day. During the ramp-up phase, drink plenty of water (1.5–2 liters daily) to protect the kidneys.

Allergy (hypersensitivity) to venetoclax or any ingredient in the tablet.
Taking strong CYP3A4 inhibitors (certain antifungal drugs — ketoconazole, itraconazole; certain antibiotics — clarithromycin) during the dose ramp-up phase — this can dangerously increase drug levels in the blood.
Pregnancy and breastfeeding — the drug may harm the baby.
Taking St. John's wort (reduces venetoclax effectiveness).

Always tell your doctor about all medications, vitamins, and supplements you are taking, including grapefruit juice — it can also affect how this drug works.

Venetoclax is a powerful medication, so your doctor will order regular blood tests, especially at the start of treatment. The most common side effects include:

Tumor lysis syndrome (TLS): A serious complication where the rapid breakdown of cancer cells overwhelms the kidneys. This is why the dose is increased gradually and blood tests are monitored closely. Symptoms: nausea, vomiting, weakness, irregular heartbeat — tell your doctor immediately.
Blood: Low white blood cell count (neutropenia) — increases infection risk; anemia (weakness, paleness); low platelet count (risk of bleeding and bruising).
Infections: Increased susceptibility to colds, pneumonia, and other infections. Tell your doctor if you develop fever, chills, or cough.
Digestive system: Diarrhea, nausea, vomiting, constipation.
General well-being: Tiredness, headache, dizziness.
Musculoskeletal: Muscle and joint pain, back pain.
Respiratory: Cough, shortness of breath, upper respiratory tract infections.
Swelling: Swelling of legs, arms, or face.