Search: “dexamethasone”

What are the possible side effects of dexamethasone?

This is from medline plus:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202018.html#SXX20

Side Effects of This Medicine

Side Effects of This MedicineCorticosteroids may lower your resistance to infections. Also, any infection you get may be harder to treat. Always check with your doctor as soon as possible if you notice any signs of a possible infection, such as sore throat, fever, sneezing, or coughing.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. When this medicine is used for short periods of time, side effects usually are rare. However, check with your doctor as soon as possible if any of the following side effects occur:

  • Less common
  • Decreased or blurred vision; frequent urination; increased thirst
  • Rare
    • Blindness (sudden, when injected in the head or neck area); burning, numbness, pain, or tingling at or near place of injection ; confusion; excitement ; false sense of well-being; hallucinations (seeing, hearing, or feeling things that are not there); mental depression; mistaken feelings of self-importance or being mistreated; mood swings (sudden and wide); redness, swelling, or other sign of allergy or infection at place of injection; restlessness ; skin rash or hives
  • Additional side effects may occur if you take this medicine for a long time. Check with your doctor if any of the following side effects occur:

    • Abdominal or stomach pain or burning (continuing); acne; bloody or black, tarry stools ; changes in vision; eye pain; filling or rounding out of the face; headache; irregular heartbeat; menstrual problems; muscle cramps or pain; muscle weakness; nausea; pain in arms, back, hips, legs, ribs, or shoulders; pitting, scarring, or depression of skin at place of injection; reddish purple lines on arms, face, groin, legs, or trunk; redness of eyes; sensitivity of eyes to light; stunting of growth (in children); swelling of feet or lower legs; tearing of eyes; thin, shiny skin; trouble in sleeping; unusual bruising; unusual increase in hair growth; unusual tiredness or weakness; vomiting; weight gain (rapid); wounds that will not heal

    Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

    • More common
      • Increased appetite; indigestion; loss of appetite (for triamcinolone only); nervousness or restlessness
    • Less common or rare
      • Darkening or lightening of skin color; dizziness or lightheadedness; flushing of face or cheeks; hiccups; increased joint pain (after injection into a joint); increased sweating; nosebleeds (after injection into the nose) ; sensation of spinning

    After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. If you have taken large doses of this medicine for a long time, your body may need one year to adjust. During this time, check with your doctor immediately if any of the following side effects occur:

    • Abdominal, stomach, or back pain; dizziness ; fainting; fever; loss of appetite (continuing); muscle or joint pain; nausea; reappearance of disease symptoms; shortness of breath ; unexplained headaches (frequent or continuing) ; unusual tiredness or weakness; vomiting; weight loss (rapid)

    Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

    End of Cycle 5 – Talquetamab and Daratumumab plus Pomalyst

    During cycle 5, the study team was given some freedom to adjust my dose of dexamethasone.  We could do anything, from eliminating it completely to decreasing it.  For 3 cycles, I was having 40 mg of dex a week.  Dex is rough.  If you have taken 40 mg of dex for any amount of time, you know what I mean.

    I tried no dex at all, and I ended up having a fever because of CRS (cytokine release syndrome). The next week I took 10 mg of dex to tamp down my immune system just a little.  I still had fevers. So, this week I’m back at 40.  This sounds crazy, but I would rather have a fever than take dexamethasone.

    My nails are improving, so that’s nice.  I now have one really good nail on my left index finger.  That’s the one I can use to open cans. I’ve taken my finger nails for granted my entire life.  The other nails are growing out from the bottom, so it’s only the very tops that tend to be splintery and need to be kept trimmed so they don’t catch on things.

    My sense of taste has not improved.  Everything still tastes watered down.  There are still things I can’t taste at all. Yellow mustard is one of those things. Another thing I can’t taste is butter. If I have buttered toast, it tastes like toasted bread with Crisco on it. It’s not worth it.

    I still have a sensitivity to heat. That hasn’t changed at all.  I’m glad summer is behind me, and I don’t have to be tethered to a fan and/or air conditioning. Doing chores around the house will still cause me to get too hot and get that uncomfortable feeling of electrical zaps to my head.

    I have occasional itchy scalp.  This was the worst on the week when I had not taken any dexamethasone. It’s crazy-making!

    After work last weekend, I stopped to take a look at a covered bridge that’s on the way home. This is the Pisgah covered bridge. I was curious about why covered bridges were built, so I looked it up. According to Wikipedia, they were built that way to improve durability. A covered bridge could last up to 100 years.

    Carfilzomib and Cytoxan

    Well, the daratumumab and pomalyst train has left the station without me.  My doctor decided that it wasn’t helping me anymore, so I’ve moved on.

    A few weeks ago I started carfilzomib (Kyprolis) and cyclophosphamide (Cytoxan).  I also have 20 mg of dexamethasone every week. I have carfilzomib on Thursdays and Fridays and Cytoxan only on Thursdays.  I’ll have three weeks on, then one week off.  So far, my CBCs are pretty good.  I have only slightly low hgb, rbc and platelets.  Those were all low most of the time before this, anyway, so that’s nothing new.

    As soon as I have some test results to post, I’ll do that.

    If you’ve been on this treatment, I’d like to hear from you.

     

    Revlimid, Darzalex and Dex

    It’s been ages since I posted, but that’s because there’s been nothing new to report.

    I recently began treatment with one of the new-ish monoclonal antibodies called Darzalex (daratumumab, aka dara).  In addition to Darzalex, I’m taking an older drug that I’ve used before, called Revlimid. Once a week, I take a 20mg dose of dexamethasone.

    It had been a little more than 9 years since I had any treatment for myeloma. After a stem cell transplant in 2007, I had no need for treatment.  My disease stayed pretty stable for several years. Then, about 3 years ago, I began to relapse a little more noticeably. Finally, my doctor thought it was necessary to start treatment before I started to exhibit any symptoms. Only recently, my RBCs dipped below normal.

    PomalystI’ve had two infusions of dara so far. the first one took several hours to complete because of an infusion reaction. My blood pressure shot up to 203/97 and I developed a wheeze. The treatment was stopped for a while, and then the infusion was resumed at a lower rate. I was at the clinic for almost 12 hours that day.  I’ll write more about that in a future post.

    As for Revlimid, I had that in 2006. It did very little for me, but I’m on it because my insurance company won’t pay for Pomalyst. This is because the dara/pom combination is considered “off-label” use.  The price tag for Rev is about $11k per month, and Pom is about $13k per month. My clinic has billed about $45k for each infusion of dara.  It’s hard to imagine, really!

    Another first for me is that I’ve had a port implanted to handle the frequent infusions. It was an outpatient procedure. I was in at 7:15 Friday morning and out by 10:30 am. There’s some discomfort, but it’s not terrible. The surgeon prescribed some norco tablets. He even gave me a prescription for a lidocaine gel to apply before port accesses to numb the area before the needle is inserted.

    That’s it for me now.  I’ll provide some more details in future posts.

     

    https://www.darzalex.com/
    http://www.revlimid.com/

    Exciting Multiple Myeloma Data at ASH

    This is from a reader.

    Subject: Exciting Multiple Myeloma Data at ASH

    Message: Hi Beth,
    Here are some data highlights from The 50th Annual American Society
    of Hematology (ASH) Meeting this week:

    • Updated results from the ECOG study evaluating Revlimid plus low-dose dexamethasone in newly diagnosed patients was presented by Dr. Rajkumar in a joint symposium of the American Society of Clinical Oncology and ASH.  The results are the highest 3 year overall survival rates ever reported in this patient group.
    • Data presented by Dr. San Miguel showed that relapsed/refractory patients who received continuous treatment with Revlimid and dexamethasone after achieving their best response lived longer and had increased time to disease progression compared to those who discontinued treatment after ten months or less.
    • Dr. Lacy presented data which showed that pomalidomide with dexamethasone has promising activity for patients with relapsed/refractory MM.   Results from this ongoing trial showed high remission rates.

    Best,
    Allison

    IMF Says 90% overall response with new Relvlimd® combination (BiRD)

    This is a press release  from the  International Myeloma Foundation.

    I was on Revlimid with high dose dex for some time back in 2005, I think. I remember being miserable on the high doses of steroids and that my MM progressed after I cut back.  We figured the Revlimid didn’t work for me. But that doesn’t mean that it might not work if I added Biaxin.  It’s one more thing I can try when I have to start treatment again. The thought of having to take steroids again kind of causes a feeling of anxiety.

    ­–BiRD Study (Biaxin®-Revlimid-Dexamethasone) Provides Evidence of Deep Complete Response Rates In Newly Diagnosed Multiple Myeloma–

    North Hollywood, CA, January 4, 2008 – The International Myeloma Foundation (IMF)—supporting research and providing education, advocacy and support for myeloma patients, families, researchers and physicians—today said updated data from the Phase II BiRD study provide a new option for newly diagnosed patients with multiple myeloma whether or not they proceed to stem cell transplant. The findings show a superb overall response rate of 90.3%. 38.9% of the patients achieved a complete response (using EBMT criteria) and 73.6% achieved a 90% or greater decrease in m-protein levels. Using the new International Myeloma Working Group Criteria—recently developed to better define the magnitude of a complete response by a panel of experts led by Brian G.M. Durie, M.D., chairman and co-founder of the IMF—30.6% of the patients achieved this new stringent complete response* (sCR). The findings have been published in the online version of the journal BLOOD.

    The BiRD regimen is made up of REVLIMID® (lenalidomide) plus a low dose of the steroid dexamethasone, and adds Biaxin® (clarithromycin). The BiRD treatment did not impede stem cell transplantation, and demonstrated two-year event-free survival rate of 85.2% for patients who underwent stem cell transplant and 75.2% for those who continued on therapy without transplant. Median event-free survival time was not reached.

    In addition to the response criteria, the findings from the BiRD study, like a previous study of REVLIMID with low-dose dexamethasone, show response deepening over time: the average time to partial response was just over six weeks, but average time to complete response was 22 weeks, and stringent complete response was reached at 38 weeks.
    "This is an exciting time for the treatment of myeloma," said Susie Novis, president and co-founder of the IMF. "We now have multiple studies showing improved response and survival with various regimens including REVLIMID/dexamethasone in previously treated and newly diagnosed patients, DOXIL®/VELCADE® for previously-treated patients who want a steroid-free regimen, and thalidomide/melphalan/prednisone in older patients not eligible for transplant."

    Myeloma, also called multiple myeloma, is a cancer of the bone marrow that affects production of red cells, white cells and stem cells. It affects an estimated 750,000 people worldwide, and in industrialized countries it is being diagnosed in growing numbers and in increasingly younger people.

    The data were published in an article by lead author Ruben Niesvizky of the Multiple Myeloma Service, Division of Hematology and Medical Oncology, Weill-Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center.

    * sCR requires complete absence of M-protein by immunofixation, normal free light chain ratio and a negative marrow biopsy by immunohistochemistry.

    ABOUT THE INTERNATIONAL MYELOMA FOUNDATION
    The International Myeloma Foundation is the oldest and largest myeloma organization, reaching more than 165,000 members in 113 countries worldwide. A 501 (c) 3 non-profit organization dedicated to improving the quality of life of myeloma patients and their families, the IMF focuses in four key areas: research, education, support and advocacy. To date, the IMF has conducted more than 120 educational seminars worldwide, maintains a world-renowned hotline, and operates Bank on a Cure®, a unique gene bank to advance myeloma research. The IMF was rated as the number one resource for patients in an independent survey by the Target Research Group. The IMF can be reached at (800) 452-CURE, or out of the United States at (818) 487-7455. More information is available at www.myeloma.org.

    Media Contact: Stephen Gendel or Jennifer Anderson (212) 918-4650

    Sleep is good

    When I got home from having Doxil and Velcade yesterday, I could hardly stay awake. I have benedryl in my IV to try to keep me from getting those hives from the Velcade. They’re not completely eliminated, but much less severe with the benedryl and dexamethasone. However, it makes me very sleepy! It’s amazing that when I have IV benedryl, it has this effect on me. When I take a pill, I hardly feel it at all. I can feel the benedryl move up the veins in my arm when it’s pushed. It burns. Then I feel like I’m drunk. When I get home, all I want to do is sleep. So, that’s what I do. It’s not as though I have a choice.

    Today I got up early. I bought some sod for the back yard, and someone came to lay it down, but his helper left at lunch time. After lunch, I looked out the window and saw him and his mamacita working out there, so I decided to go help them. Boy, is that back breaking work! I had done another part of the yard a few months ago, which is why I decided to hire someone to do it this time. Thank goodness it started to rain. We all got to quit then.

    Anyway, after working hard today and having chemo yesterday, I’m beat. It will be an early night for me.

    Effectiveness of bortezomib (Velcade)

    Until I just did some reading, I hadn’t realized that Velcade doesn’t work for about 2/3 of us. I have been told by my doctor, however, that it does seem to work especially well for IgA MM patients (I’m one of those).

    “Bortezomib seems to work in about one-third of patients who use it, but we have not been able to predict which ones,” says the study’s lead author, Leif Bergsagel, M.D., a hematologist at Mayo Clinic Arizona. “We now have identified a group that will likely respond because these nine mutations seem to be present in at least 25 percent of newly diagnosed patients.” From http://www.mayoclinic.org/news2006-rst/3817.html

    The combination of Velcade + Doxil does have better results in people who respond to it. Based on a study conducted at UNC and other places, Dr. Orlwoski reports, “the combination group’s median time to progression – the time interval between the response to treatment and the time the disease starts to show evidence of growing or recurring – was 9.3 months, while those on Velcade alone progressed after 6.5 months.”
    From: http://www.unchealthcare.org/site/newsroom/news/2006/Dec/myeloma. One question I have to remember to ask about this is, is this TTP after the 8 21-day cycles of treatment?

    I still haven’t decided whether or not I’m going to add IV dexamethasone to the Velcade/Doxil regimen. I have until Tuesday to decide.

    I hate to admit this, but I’m envious of the people who have remissions from their first line of treatment. Any treatment, to be honest. I’m secretly hoping for such good results from Velcade that I’ll decide to wait for relapse to have an SCT. What? It could happen!