I am on Venetoclax and have been for 4+months. No pesky side effects but my platelet count has fluctuated from the mid 40's to the 80's. My doctor originally reduced my dosage from 400 mg to 300mg. My last CBC which was taken 2 weeks after my 5th Gazyva (next to last Gazyva infusion, last one scheduled March 11) indicated a platelet count of 45 and with that the doctor further reduced the Venetoclax dosage to 200mg for 2 weeks.
I see where the Venetoclax instructions say "do not break or chew" but I was wondering if anyone knows the reason for that? I would like to propose to my doctor that I take 250mg (2 whole and 1-broken in half 100mg tablets) so as to keep a substantial amount of V in my system. Can anyone advise the reason not to break one of the pills prior to taking them.
We're not sure if the Gazyva is the cause of the problem with the platelets or if it's the Venetoclax or both. All of my other CBC values are at or near normal and I physically am doing well and feeling fine on the Venetoclax.
Your thoughts, experiences, and friendly advice is appreciated, so much.
Thank you all for your help,
Ron
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ronsolo306
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Although it is not first hand or confirmed by the technical team that developed the doses, the assumption is that the film coating and the caution "Swallow VENCLEXTA tablets whole. Do not chew, crush, or break the tablets." was to reduce problems in the patient's stomach and esphogus. The film coating likely delays the start of disolving, so the large oblong tablets can be swallowed easier and may not cause as much stomach upset.
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There is a 50 mg tablet as part of the starter pack, but whether you can get them separate from the starter pack is not known.
My dosage limit is 200mg due to interaction with another medicine I take. My ramp up started at 10mg, then 20, 50, 100,200. The pharmacy provided an extra box of 10mg tablets to accommodate this. I'm sure if the oncologist prescribes a supply of 50mg tablets you would be able to get them. But I'm guessing your oncologist won't go along with this. You might also find the cost of doing this prohibitive.
Thanks for your and everyone's response. Since low platelets are a common side effect of venclexta/gazyva, when in the process can one expect the platelets to return closer to a normal level?
The main reason not to break a non-scored tablet, is that the manufacturer is not guaranteeing a perfectly even mix of drug within that tablet. You may get only 30mg in a half. Plus the filmcoat prevents the drug from potentially irritating your esophagus as well as stomach lining. Venclexta comes as a 50mg tab, so getting 2 Rx's for the different strengths would be best. If you do choose to break them, get a professional pill splitter from your pharmacy & have them teach you the "trick" of using one to cut pills cleanly. PM me if you're interested in learning the trick. Unless a big response of lots of people want a "how to" post on "pill splitting".
I'll mention that my platelets seem to be affected more than my neuts, but I am still in ramp-up. I am looking to do my next jump only 100mg for a total daily dose of 300mg instead of doubling my current 200mg dose to 400mg. And even if my platelets stay around 80 (or lower) as long as I don't have petechiae, gum bleeds, nose bleeds, stool seems OK(i.e. no internal bleeding), & no oozing from my blood draws or other cuts, no one is alarmed. It's more the "low numbers can lead to symptoms, symptoms can mean bad things like internal or overt bleeding can happen/are happening".
I had ITP for the first time and I've had CLL for just over 10 years now. 7 on Ibrutinib and 2+ on Venetoclax. My platelets have always been 105-115. They dropped to 6 a couple days after I had the Moderna vaccine. I was hospitalized, had platelet transfusion, IVIG and dex; they recovered to 70 and have now been hovering around 60ish without help. I halved my Venetoclax dose to 200 mg and will see where that leads, but I believe there is some effect on the platelets. My WBC dropped to 2.5, but neutrophils are still normal.
It says the same thing on ibrutinib. I was concerned I would not be able (it was purely psychological) to swallow the capsule. In fact one got stuck and broke in my throat. (This was when the dose was 3 capsules. Now it's one tablet.)
I called the company pharmacist at the number they provide. He said they had not tested for splitting. I got the idea it was purely something they automatically add.
Now if a pill is time release or has a coating that will dissolve only in the intestine and not the stomach, that is different. So I cannot speak for venetoclax. But you might call the company and ask them why.
In fact I got over my phobia and was able to swallow them. Actually the tablets are easier, for me at least.
I do not think your doctor will approve of your idea. 250 mg is "outside" of the experimental region, and the response-dose relationship is not necessarily linear nor monotonic. Please keep us posted.
FYI My husband has been on Venclexta for 2 1/2 years and has always had a low platelet count. His last count was 136 which is pretty good for him. His oncologist also cut his dosage down to 200 mg a day last August because of some other health issues. As of now, 200 mg a day is doing its job and keeping him in remission.
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1st week on venetoclax - WOW, not what we expected...
Critically low white cell count
What is happening?
