We will be starting Velcade maintenance and our oncologist said that we would have to continue the same antibiotic and antiviral that we used during our induction therapy to prevent pneumonia and shingles. We do Bactrim (sulfamethoxazole and trimethoprim) and acyclovir 2x per day on Saturday and Sunday.
Just wondering if others do the same.
Also, he is giving us a month "holiday" before starting our maintenance. While the thought of feeling normal for my husband is appealing, just wondering if that is the standard.
I know standard of care and multiple myeloma are an oxymoron.
Thanks again for the help. It's so appreciated.
Kerri
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Re: Antibiotics and antifungal during maintenance
Kerrirunnergirl, I had approximately three weeks off before starting actual Velcade maintenance. It was wonderful being off Revlimid/ dexamethasone. Since initially starting with Velcade, I have been on 400 mg acyclovir twice a day, every day. It interests me that your husband takes it only on Saturdays and Sundays.
Re: Antibiotics and anti viral during maintenance
Hello Kerri:
I agree with what Mrozdav said and will add the following.
1. Antiviral is almost always given with Velcade (so far as I can tell). Shingles can be nasty, and the acyclovir gives minimal problems (in my wife's case, no problems).
2. For the "holiday", for persons getting an ASCT with Revlimid, they typically need 6-8 week holiday, and almost never have a problem (this is what our transplant doctors and nurses advised us).
The 3rd question I find a little interesting. I am not aware of continuous antibiotics. I can understand getting the flu shot and the pneumonia shot. I am not a doctor, but I recall the conversation with our doctor, that the antibiotics would be given as needed. I would ask if this approach is of limited duration (say 6 months) or continuous going forward. If its the latter, I would ask the doctor to explain in detail why, if your husband is healthy, it is the right thing to do.
Lastly, there is one antibiotic that has been proven to have anti-myeloma effect. That is Biaxin (clarithromycin). (Google Niesvizky Biaxin myeloma, BIRD myeloma, CarBird myeloma, ClaPD myeloma.) It dos not have single-agent activity, but it does seem to improve the effectiveness of other drugs, when given. If your doc feels strongly about the antibiotic, I might ask him or her why not go with the Biaxin.
Good luck.
I agree with what Mrozdav said and will add the following.
1. Antiviral is almost always given with Velcade (so far as I can tell). Shingles can be nasty, and the acyclovir gives minimal problems (in my wife's case, no problems).
2. For the "holiday", for persons getting an ASCT with Revlimid, they typically need 6-8 week holiday, and almost never have a problem (this is what our transplant doctors and nurses advised us).
The 3rd question I find a little interesting. I am not aware of continuous antibiotics. I can understand getting the flu shot and the pneumonia shot. I am not a doctor, but I recall the conversation with our doctor, that the antibiotics would be given as needed. I would ask if this approach is of limited duration (say 6 months) or continuous going forward. If its the latter, I would ask the doctor to explain in detail why, if your husband is healthy, it is the right thing to do.
Lastly, there is one antibiotic that has been proven to have anti-myeloma effect. That is Biaxin (clarithromycin). (Google Niesvizky Biaxin myeloma, BIRD myeloma, CarBird myeloma, ClaPD myeloma.) It dos not have single-agent activity, but it does seem to improve the effectiveness of other drugs, when given. If your doc feels strongly about the antibiotic, I might ask him or her why not go with the Biaxin.
Good luck.
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JPC - Name: JPC
Re: Antibiotics & antivirals during maintenance therapy
Hi jpc and mrozdav
Thanks for your input.
During entire induction he took acyclovir and bactrim on Saturday and Sunday only.
Not sure the rationale but when I asked the doc he thought it provided enough coverage
Since it was being used as prevention.
I will ask about biaxin.
Glad a holiday from drugs is an option..
Not sure we will do antibiotic, but we will continue acyclovir.. I will research efficacy
in prevention of shingles..
Really want to cut down on meds.
Our doc wants us to continue zometa iv monthly but I found a clinical trial result that
stated that every 3 months zometa " is not inferior" to every month infusion so I think we
are going to choose to cut back on the zometa since it kicks my husbands butt. He is
down for 2 days after his zometa infusion with flu like symptoms without fever.
Thanks again. Kerri
Thanks for your input.
During entire induction he took acyclovir and bactrim on Saturday and Sunday only.
Not sure the rationale but when I asked the doc he thought it provided enough coverage
Since it was being used as prevention.
I will ask about biaxin.
Glad a holiday from drugs is an option..
Not sure we will do antibiotic, but we will continue acyclovir.. I will research efficacy
in prevention of shingles..
Really want to cut down on meds.
Our doc wants us to continue zometa iv monthly but I found a clinical trial result that
stated that every 3 months zometa " is not inferior" to every month infusion so I think we
are going to choose to cut back on the zometa since it kicks my husbands butt. He is
down for 2 days after his zometa infusion with flu like symptoms without fever.
Thanks again. Kerri
Re: Antibiotics & antivirals during maintenance therapy
I'm not on a maintenance regimen, but on a regimen for relapsed myeloma. I had a case of shingles one year post transplant on my face and in my left eye. I recognized what was happening quickly and got immediate treatment with Acyclovir 800 mg 4x per day. Because of this I didn't have too many problems with the shingles. No pain, just really feeling sick for several days and lots of blisters.
After I recovered from the acute shingles outbreak, I continued to have some problems with my left eye from it. My ophthamologist started me taking 800 mg of Acyclovir 2x per day every day for life. I haven't had any problems with the Acyclovir. If it helps to keep the shingles from happening again, I am happy to continue with Acyclovir.
From all of the reading that I've done, it seems that Velcade increases the probability of developing shingles and is routinely prescribed for anyone taking Velcade.
Nancy in Phila
After I recovered from the acute shingles outbreak, I continued to have some problems with my left eye from it. My ophthamologist started me taking 800 mg of Acyclovir 2x per day every day for life. I haven't had any problems with the Acyclovir. If it helps to keep the shingles from happening again, I am happy to continue with Acyclovir.
From all of the reading that I've done, it seems that Velcade increases the probability of developing shingles and is routinely prescribed for anyone taking Velcade.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Antibiotics & antivirals during maintenance therapy
Kerrirunnergirl, I read about the clinical study that concluded that Zometa every three months is not inferior to monthly infusions here in the forum a few weeks ago. I will be discussing this issue with my specialist at Hopkins in about three weeks, and will report back anything useful that I learn.
Re: Antibiotics & antivirals during maintenance therapy
I am on Velcade maintenance every other week.
I take acyclovir 400 mg twice a day to prevent Shingles. I also take penicillin twice a day as well to keep from getting pneumonia. My oncologist told me that as long as I'm on Velcade I will take acyclovir. Penicillin possibly for 2 years. For the most part I handle the oral meds OK, but once in a while my stomach feels blah. Eating yogurt daily seems to help with the blah feeling.
I take acyclovir 400 mg twice a day to prevent Shingles. I also take penicillin twice a day as well to keep from getting pneumonia. My oncologist told me that as long as I'm on Velcade I will take acyclovir. Penicillin possibly for 2 years. For the most part I handle the oral meds OK, but once in a while my stomach feels blah. Eating yogurt daily seems to help with the blah feeling.
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CabinGirl - Who do you know with myeloma?: Self
- When were you/they diagnosed?: Sept. 2014
- Age at diagnosis: 57
Re: Antibiotics & antivirals during maintenance therapy
Hi,
I have been on a regimen of Velcade and dexamethasone for 7 years with essentially no side effects other than constipation. This regimen has kept me in remission since February 2009. I also take 400 mg of acyclovir once each day to prevent shingles or other viral illnesses. I have never been on an antibiotic regimen. I would think that a penicillin regimen might have the opposite effect than that what was intended. That is, when you really need an antibiotic to fight off pneumonia, for example, the traditional antibiotics may not work and much stronger antibiotics may be necessary. However, I'm not a doctor, and this is just my opinion.
Good luck to you.
Larry Gaito
I have been on a regimen of Velcade and dexamethasone for 7 years with essentially no side effects other than constipation. This regimen has kept me in remission since February 2009. I also take 400 mg of acyclovir once each day to prevent shingles or other viral illnesses. I have never been on an antibiotic regimen. I would think that a penicillin regimen might have the opposite effect than that what was intended. That is, when you really need an antibiotic to fight off pneumonia, for example, the traditional antibiotics may not work and much stronger antibiotics may be necessary. However, I'm not a doctor, and this is just my opinion.
Good luck to you.
Larry Gaito
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LarryG
Re: Antibiotics & antivirals during maintenance therapy
I am at post stem-cell transplant day 92. My specialist prescribed the same two medications during chemo (Velcade/dex/cytophosphamide) and for 100 days after SCT to protect me from shingles, viruses and other infections. Has worked well, so best wishes to you. 
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LesleyRae515
9 posts
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