Written By: Todd Murphree, PharmD
Description Venetoclax (Brand name: VENCLEXTA) is an oral BCL-2 inhibitor that is indicated for the treatment of patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL), with or without 17p deletion, who have received at least one prior therapy. Venetoclax has a specific dose titration schedule and recommendations for patients in different risk categories for Tumor Lysis Syndrome (TLS). This poses potential challenges in the workflow of dispensing the drug.
Background: Below, you will find an overall dispensing process with additional ramp-up phase dosing schedule and TLS risk assessment and prophylaxis information. Patient Centered Activities (PCA) are placed within process to highlight areas of additional intervention.
PQI Process: Upon receipt of a new prescription for Venetoclax:
1) Ensure that the prescriber has assigned a TLS risk category to the patient and the dose is appropriate for assigned risk category*
2) Confirm based on recent labs that TLS risk category is still appropriate*
3) Ensure a prescription for allopurinol is sent (unless patient receiving Elitek).
a. Allopurinol should be started 2-3 days prior to Venetoclax if possible.
4) Once Venetoclax is ready to be dispensed
a. Alert them that their prescription is ready for pick up/shipment.
b. (PCA) Educate patient on lab/hydration schedule.
If the patient is picking up the prescription and starting outpatient:
1) Pharmacy should ask patient when they are coming to pick up and start.
a. Example method:
i. Patient starting on cycle 1, with day 1 between Tuesday and Thursday
ii. Patient must take each dose at 9:00 a.m.
iii. These two requirements allow time for pre-dose and post-dose labs as recommended.
2) Pharmacy should notify healthcare team that patient is ready start treatment so appropriate follow up labs can be scheduled.
3) Patient should be counseled by pharmacy on dosing and lab schedule at time of dispense
a. Example method:
i. Labs drawn prior to first dose (day before).
ii. Take first dose at 9:00a.m. the following day.
iii. Patient returns to receive labs 6 hours after dose (3:00 p.m.).
iv. Patient should return the next day at 9:00 a.m. for labs
4) (PCA) Consider providing a calendar with dosing and lab appointments populated by the pharmacist.
If the prescription is shipped to patient:
1) Pharmacy should contact patient by phone and ask what date they are starting.
a. Example Method:
i. Patient to start cycle 1, day 1 between Tuesday and Thursday
ii. Patient should take each dose at 9:00 a.m.
2) Pharmacy will coordinate with shipping carrier for delivery date.
3) Pharmacy will coordinate with healthcare team to schedule labs
4) (PCA) Patient can receive schedule/calendar with dosing and lab appointments populated by the pharmacist with their prescription.
5) Patient will be counseled on dosing and lab schedule.
If the patient is starting inpatient:
1) Pharmacy should ensure that the physician has added the proper inpatient regimen into the patient’s chart so that the patient’s labs will be scheduled correctly while inpatient.
2) Pharmacy should provide calendar of patient’s schedule with prescription.
a. Allopurinol start date
b. Admittance date
c. Start date
d. Lab schedule
e. Ramp-up dates
3) (PCA) Patient will receive all other counseling as detailed in previous paths.
1. VENCLEXTA® (Venetoclax) [Prescribing Information]. Chicago, IL: AbbVie, Inc., February 2018.
Supplemental Information can be found on the downloadable pdf version.