Is it okay to take Venetoclax without food?

[Excelsior13]

I normally don't eat breakfast and eat lunch around Noon. I take 400 mg of Venetoclax in the morning around 9:30 am. I have found that I don't have any reaction to the medicine if I take Zofran about 1 hour prior. Are there any negatives to skipping food intake with or before taking Venetoclax?

[MelloYellowMe]

Everything that I have been told and read, said it needs to be taken with a meal to absorb properly, to work best and be most effected. I would check with your Dr and ask if it’s okay.

Curious, why not take it at noon with your meal instead? As long as it is taken around the same time every day, that is most important. Plus, taking it at noon with a meal you might not need Zofran at all.

Unless you’re in a trial, then you might need to take it in the morning…..but might be worth the ask if you can take it at noon.

I took my first dose around midnight and have moved it up to 7-8pm.

I was in the hospital with my teenage son for a major surgery during the LA fires, and he had to stay longer than planned, so my husband had to drive to Orange County then back through the fires to get me my med to start. 🙃 He’s the best!

My pharmacist told me that if I need to move the time up, just to do it by one hour at a time until I get to the time I want.

I have noticed the less food I take it with, the more terrible nausea/vomiting/stomach pain I have. If I have a balanced meal with carbs, I usually don’t need to take any anti nausea meds. But I still get a gurgly tummy but it’s mostly tolerable. Some days I take 1 Ativan for nausea, which works great and has zero side effects for me, but I really try to save those for a really really bad day. I try to avoid Zofran because it constipates me even more than the V+O does on its own.

[Excelsior13 in reply to MelloYellowMe]

That is exactly what I am going to do.

[SofiaDeo in reply to Excelsior13]

Not just a meal, something with fat in it gives the best absorption. However, a number of us have monkeyed around with types of foods, fats/nonfats, to avoid the nausea/GI upset.

I have a theory that some GI upset may be due to unabsorbed drug directly irritating tissue. Why not try taking the medication as instructed? I took mine about 20 minutes after eating my cup of buttered vegetables (along with whatever else I was eating at dinner). I had a cup of buttered vegetables at every dinner once I figured out this stopped the nausea/GI upset.

"With food" means you need to have food actually in your stomach, you don't take it before there is anything in there. I always told my patients to take meds needed to be taken "with food" at the end of their meal.

Zofran isn't great to take on a daily basis IMO. It has that black-box warning about cardiac effects. I take it, but only As Needed. I would be hesitant to take it every day as a matter of course when it may not be needed, if you adjust a few things. It's one thing if you Must take it, it's another to try to avoid taking something if you can.

pmc.ncbi.nlm.nih.gov/articl...

[BigDee in reply to SofiaDeo]

Hello SofiaDeo

The taking Venetoclax right after meals makes sense to me. I finished Venetoclax about 1 1/2 years ago and took mine "with meals", don't remember exact order. I had diarrhea 2-3 times a week and vomiting every m-m-m-m month. I am still have vomiting being more frequent and with diarrhea. Getting that checked out now by doctors. Have had CT scan and Endoscope. Before CLL I only vomited maybe 3 times in my life.

[SofiaDeo in reply to BigDee]

I personally found I had to take my V about 20 minutes after finishing the meal, and zero food/snacks the rest of the evening. My nausea went away beautifully!

[flippingnora1 in reply to MelloYellowMe]

I take my 400mg with my meal in the evening about 6-7pm. I still feel queasy and have a funny head during the night, but its better then, than during the day.

[Jm954 Administrator]

I have the same eating pattern as you and never had any problems taking it at around 7am with coffee (full fat milk). We are all different, good luck with your treatment.

[Skyshark]

Just NO!

Taking 400mg of Venetoclax without food is like taking 133mg "fully fed". All trials have been conducted with patients "fully fed".

drugs.com/pro/venclexta.html

Effect of Food

Administration with a low-fat meal (approximately 512 kilocalories, 25% fat calories, 60% carbohydrate calories, and 15% protein calories) increased venetoclax exposure by approximately 3.4-fold and administration with a high-fat meal (approximately 753 kilocalories, 55% fat calories, 28% carbohydrate calories, and 17% protein calories) increased venetoclax exposure by 5.1- to 5.3-fold compared with fasting conditions.

pubmed.ncbi.nlm.nih.gov/270...

I've seen a report from China where dose was reduced to 100mg/day to reduce cost of treatment but that was using an adjunctive and still "fully fed". Treatment protocol for AML uses 100mg daily due to the effect of the anti-fungal that is a standard part of the protocol but again is still "fully fed". There isn't any data for "starving" and an adjunctive.

"Starving" is defined as before one hour before meal and over two hours after.

There is a current trial of V+O that stops at cycle9 if undetectable minimum residual disease (1 in 10,000, uMRD4) has been reached at cycle 6. Dose reductions after cycle 7 may not be critical if uMRD4 has been reached as CLL14 trial found 72% were uMRD4 at cycle 7 and that only increased to 74% at 3 cycles after treatment. What was notable was uMRD6 (1 in 1,000,000) increased from 32% at cycle 7 to 50% at cycle 12 but reduced to 40% at 2 cycles after end of treatment. This shows that some patients had an excellent deep response but started to relapse as soon as they were taken off Venetoclax.

Venetoclax Pharmacokinetics

[Floxxy]

I was always advised to take food at the sam3 time. I took mine with lunch which worked well for me and my consultant was happy with this. I finished my 2 years on Venetoclax and Rituximab a month ago. I hear my results in a couple of weeks. Good luck to you. X

[bettyba]

Hi I was the same, not a breakfast person, so I took them with a shake or greek yogurt. But due to feeling nauseous with the tablets I spoke to my consultant and she advised to gradually moved the time each day until I took the tablets with my evening meal. This sorted the taking with food and stopped the constant feeling nauseous. Also, my evening meal had the most fat content which my consultant explained was the best way for the tablets to absorb. All the best.

[SeymourB in reply to bettyba]

I'm not sure that it needs to move gradually from morning to evening. I simply made the jump. There was maybe a 12 hour difference in time - not much time to be without the drug. Eventually, I took it at bed time.

=seymour=

[bettyba in reply to SeymourB]

If that worked for you great.

[Skyshark in reply to SeymourB]

Going later isn't really an issue as the next dose will be 24 hours later. The problem is taking a missed dose over 8 hours late and then the next dose at normal time within 16 hours. Or even worse taking a double dose to make up for the missed dose.

Similarly moving the time forwards needs care, the 16 hour lapse for a missed dose isn't supposed to be repeated. So moving from 8pm to 8am would have to be done slowly, 8pm > 4pm > 12pm > 8am.

This particularly important during ramp-up when TLS is a risk. I had first 3 doses of 20mg in 37 hours, 16 hours and 21 hours, they doubled up the number of blood tests.

There should be warnings about sausage sarnies or bin lid breakfasts. A high fat, high calorie meal can increase the uptake by 50%.

[Sewster]

I took my 400 mg with fatty food - avocado, peanut butter, or ice cream. Why take Zofran, if you don’t have too?

[akirsch973]

My CLL specialist recommends taking the 4 tablets with food and specifically with a fatty meal which approaches a 50% fat content to enhance drug absorption. I take Venclexta with lunch. Foods including peanut butter (70% fat content), sardines, high fat yogurt, olives are good. I have had no issues taking the medication.

[Exerciselover]

Hello, I have been taking venetoclax with lunch at noon since day one because don't eat breakfast. But I asked a provider. I have never had nausea, but I have had diarrhea and have been tired. I eat a lot of soy protein and lots of vegetables, as I am a vegetarian. Now in month 8 of obin/venetoclax my provider suggested I switch to taking the 400 mg. at dinner time to help with daytime fatigue. The nausea sounds terrible.