Self-administration of bortezomib

This step-by-step guide explains how you can give yourself an injection of bortezomib at home. If you have any questions about the injections, please speak to your healthcare team. 

What is bortezomib?

Bortezomib is a type of drug used to treat myeloma and other plasma cell disorders. It is given as an injection under your skin (subcutaneous injection).  

Bortezomib is prescribed in cycles and there are usually four injections in each cycle. Your hospital doctor will advise you how many cycles and injections you may need. 

What is a subcutaneous injection?

In this type of injection, a short needle is used to inject a drug into the fatty layer between the skin and the muscle. Subcutaneous injections can be self-administered, which means you can do them yourself in the comfort of your home.  
 
Please note: Subcutaneous injections should not be given where the skin is burnt, hardened, inflamed, swollen or damaged by a previous injection.  

What are the benefits of self-administering bortezomib?

Self-administering bortezomib means that you don’t have to travel to the University College Hospital Macmillan Cancer Centre for the injections, or wait in the Chemotherapy Daycare Unit for your treatment.

Who will teach me how to give myself the injections? 

A nurse will go through the process with you and teach you how to self-inject. If you administer your first injection safely and feel confident in doing so, you will be able to self-administer the subsequent injections at home. If you don’t feel confident in giving yourself the injections, we can organise for you to come back to the Chemotherapy Daycare Unit when your next injection is due. 

Can someone else give me the injection?

Yes, provided they have been shown how to do it by a nurse in Chemotherapy Daycare. 

Will I still have clinic appointments?

You will have a clinic appointment before each cycle. This will be either in person in the Cancer Centre or via a telephone/video. You will need to have a blood test before your clinic appointment, which can be done up to seven days in advance. If your appointment is in the Cancer Centre, you will also need to have a negative result from your COVID swab before attending. During the appointment we will review your blood test results and assess any side effects you may be having. You will also have a chance to talk to the pharmacist about your side effects.  

How will I receive the injections?

We will ask you to come to Chemotherapy Daycare on day one of each cycle. A nurse will check your blood pressure and your blood test results. You can then have your first injection of the cycle, which can be administered by the nurse. Or she/he can observe you self-inject. 

The subsequent doses in the cycle (often called day eight, day 15 and day 22) will be sent to you via courier. 

What happens on the days I self-administer the bortezomib?

You will need to take your blood pressure before each dose, both when sitting and standing. This is because we know that bortezomib can affect your blood pressure. You can buy a blood pressure monitor from most pharmacies. They cost around £20-30.  

We have included a blank record of your bortezomib injections, which you can fill in after each dose. This will help you to track when the injections are due and to record your blood pressure along with any side effects. Ask your healthcare team to print it out for you. 

During your first cycle we will call you on the day of each injection to assess any side effects you may have. You don’t have to wait for us to call you before having your injection, unless there are side effects that you would like to discuss. We will add these telephone appointments into your appointment schedule on the patient portal MyCare UCLH. This can be helpful as a reminder to take your injection. 

After your first cycle is completed, your hospital doctor may decide that the telephone consultation is not needed on the day of each injection. This will mean that your symptoms will only be assessed during the monthly clinic appointment and on day one of each cycle. But if you are worried about any side effects at any point during the course of treatment, please contact the urgent advice line on 020 3447 3893.   

What should I do if I experience side effects?

Here are some of the more common side effects you may experience when taking bortezomib:

• changes to your blood pressure that make you feel lightheaded or faint  
• increased bruising and bleeding 
• tingling in your fingers and toes  
• constipation and/or diarrhoea  
• pain, redness or skin peeling around the injection site.  

Please contact the urgent advice line on 020 3447 3893 if you are worried about any side effects you have.  

Where should I store bortezomib?

The bortezomib syringes should be stored within a sealed plastic container in your fridge. Keep the container away from the sides, back or the bottom of the fridge. 

It’s important that you put the syringes in the fridge as soon as they’ve been delivered by the courier. 

Safety and handling of bortezomib

1. Bortezomib must not be handled by women who are trying for a baby, are pregnant or breastfeeding.  
2. It is safe to handle the bortezomib syringes in the plastic bags.  
3. Only people who have been shown how to handle the bortezomib syringes should handle them once they are out of the bag.  
4. Always keep the bortezomib syringes out of sight and reach of children and pets. 
5. A needlestick injury is where the needle has pierced or scratched the skin. If your carer gets a needlestick injury, they should wash the area thoroughly with water straight away. They should also contact the urgent advice line on 020 3447 3893 for further advice.  

Equipment needed to give yourself an injection

1. Pre-prepared syringe containing bortezomib . 
2. Orange needles (size 25G).  
3. Plastic gloves and apron (apron not needed if you are self-administering). 
4. ChloraPrep™ to clean the skin. 
5. Cotton ball or gauze. 
6. Plaster. 
7. Purple cytotoxic sharps container. 
8. Cytotoxic spillage kit (only needs to be used if there is a spillage). 

We will give you all equipment on day one of each cycle. Please bring the container for your bortezomib syringes and the purple sharps box with you to Chemotherapy Daycare on day one of each cycle. 

Preparing your area (such as a work surface, clean tray or lid)

1. Wash and dry your hands and clean your preparation area thoroughly.  
2. Place the equipment on the preparation area. You may want to use a piece of kitchen roll on top of your clean surface.  
3. Only people who are helping you should be present in the room. Avoid distractions such as children and pets.  
4. Make sure you have all the equipment close at hand before you make yourself comfortable to give the injection.  
5. Make sure you inject into a different area each time to reduce the risk of soreness.

Step-by-step instructions for administering bortezomib

1. Wash your hands thoroughly with soap and water. 
2. Open the gauze swabs and uncover the chosen injection site. 
3. Check that the plastic packaging of the syringe is intact and does not contain any liquid. 
4. Open the outer packaging of both the needle and the bortezomib syringe. Do not take them out of the packaging. Be careful not to touch the end of the syringe where the needle is attached. 
5. Put on gloves and remove the syringe from the packaging. 
6. Make sure the syringe has your name written on it and that the drug is still in date. 
7. Make sure the syringe is not cracked, there is no leakage and the solution is clear with no particles in it.  
8. Take the cap off. Connect the syringe to the needle by twisting them into place.  
9. Squeeze the ChloraPrep™ and rub alcohol on the skin with back-and-forth motion. This will move bacteria away from the injection site. Allow the site to dry. 
10. Pick up the syringe and needle. Flip down the safety cover of the needle to prepare for injecting.  
11. Remove the clear cover from the needle, pulling away from your body.  
12. Hold the syringe between your thumb and forefinger of your dominant hand, as if holding a dart. 
13. With your free hand, pinch the skin where you are going to inject. It should not be painful where you pinch. The amount of skin you need to pinch will depend on the area you are injecting. Your nurse will show you how to do this. 
14. Insert the needle into the skin at a 90-degree angle. 
15. If needed, let go of your skin and use your free hand to push the plunger down. 
16. Hold the syringe in place for at least 10 seconds to make sure all the drug has gone in. 
17. Once you have waited at least 10 seconds and the syringe is empty, take the needle out of your skin. Apply gauze to the injection site. Do not massage or apply pressure to the injection site. 
18. Flip back the safety cover on the needle until you hear a click. Put the used syringe and needle in the cytotoxic sharps container. 
19. Dispose of any remaining empty packets into the cytotoxic sharps container. Keep unused gauze swabs for future use. 
20. Wash your hands thoroughly with soap and water and wipe down any surfaces.  

Changing your injection site

Injecting into the same area too many times can cause fatty lumps to appear on the surface of your skin. This is known as lipohypertrophy and can make injections more difficult and painful. To avoid this from developing, make sure you pick a different area of skin for each injection. You can administer your bortezomib injection into your abdomen (tummy) and your outer thigh. Your nurse, pharmacist or doctor will help you choose the best sites for your injections. 

What to do if you accidentally spill bortezomib

1. Move things that the drug has not touched out of the area and try to contain the spillage. 
2. Open the spillage kit and put on the disposable gown, facemask with visor and both pairs of gloves. If the spillage is on the floor, put on overshoes. 
3. Mop up the spillage using a paper towel. Start at the outside edge of the spillage and work towards the middle. 
4. When the spillage has been removed, wash and dry the area at least twice using clean water and paper towels. 

Contact us

If you have any concerns about giving yourself an injection or you are worried about  any side effects, please call our 24-hour urgent advice line on 020 3447 3893.