Venetoclax (Venclexta)

BCL-2 inhibitor used in combination with Azacitidine for Aml treatment. Started approximately December 2025.

Dose

Dose not documented in current raw sources. Typical dosing for AML (in combination with azacitidine) is 400 mg daily, with dose adjustments for CYP3A4 inhibitor interactions. A ramp-up schedule is standard during cycle 1 (100 mg day 1, 200 mg day 2, 400 mg day 3+) to mitigate tumor lysis syndrome risk.

Prescription documents needed to confirm actual dosing.

Schedule History

Venetoclax duration has been progressively reduced across cycles:

VEN was reduced from 10 days (Cycle 2) to 5 days (Cycle 4+). The duration for Cycles 1 and 3 is not yet confirmed. This progressive reduction likely reflects improving counts and/or tolerability optimization by the treating oncologist.

An earlier patient report stated VEN was given for 7 days in Cycle 4+. The patient subsequently corrected this: "last VEN cycle was actually 5 days." The wiki has been updated to reflect 5 days.

Mechanism

Venetoclax selectively inhibits BCL-2, a protein that prevents apoptosis in leukemic cells. By blocking BCL-2, venetoclax restores the apoptotic pathway, enabling leukemic cell death. The combination with azacitidine (a hypomethylating agent) has become a standard-of-care regimen for older adults or those unfit for intensive chemotherapy.

Observed Side Effects

• Myelosuppression: Contributing to pancytopenia observed during treatment cycles. Expected effect of the venetoclax + azacitidine combination.

Monitoring

• CBC with differential (for cytopenias)
• Tumor lysis syndrome labs during ramp-up (uric acid, potassium, phosphorus, calcium, creatinine)
• Hepatic function

Drug Interactions

Venetoclax is a CYP3A4 substrate. Strong CYP3A4 inhibitors (azole antifungals, clarithromycin) require dose reduction. Grapefruit and Seville oranges should be avoided.

Posaconazole Interaction (Active)

Patient is on Posaconazole (antifungal prophylaxis), which is a strong CYP3A4 inhibitor. This requires venetoclax dose reduction — typically from 400 mg to 50–100 mg daily — to avoid supratherapeutic venetoclax levels.

Per the patient's report (2026-04-15): the treating team in India intentionally uses this pharmacokinetic interaction as a cost-reduction strategy. Posaconazole (needed for antifungal prophylaxis) allows a much lower venetoclax dose to achieve equivalent drug exposure, reducing venetoclax cost by 75–87%.

[!important] Venetoclax dose is reduced due to posaconazole co-administration
The actual venetoclax dose is unknown but is expected to be significantly lower than the standard 400 mg due to this interaction. Prescription documents should be obtained to confirm.

Exact dose and ramp-up details are not available in current raw sources. Prescription records should be obtained and ingested.