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Re: Dexamethasone can be given over two days
My partner used to take 20 mg the day of Velcade and the day after. I think it is a common protocol.
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guest
Re: Dexamethasone can be given over two days
Hi everyone,
Wow, I am on 80 mg of dex a week, double of most people. I see the doctor on Friday and am going to check why.
Can't believe how much I learn from this site.
Cheers,
Sharon
Wow, I am on 80 mg of dex a week, double of most people. I see the doctor on Friday and am going to check why.
Can't believe how much I learn from this site.
Cheers,
Sharon
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Sharon01 - Name: Sharon
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: September 2014
- Age at diagnosis: 48
Re: Dexamethasone can be given over two days
I have multiple myeloma and used dexamethasone for a long time. In varying doses. I have also reviewed all the scientific literature on the subject. A few points.
There is really no good scientific data regarding dosing and scheduling. It is all trial and error.
I have been able to cut my dex down to 12mg / week and still have it work (I think), but it is hard to be sure. Quality of life is much better on a lower dose.
Taking it at night seems to work better than in the AM.
Dex counteracts the effects of vitamin D and causes osteoporosis, so it is a good idea to take supplemental vitamin D. I take 50,000 units (1 capsule) weekly. This is a very safe dose.
Dex also counteracts testosterone, which causes a loss of libido and loss of energy and interest in life, so men can try to see if additional testosterone helps them feel better. One can check a testosterone blood level before starting, but the blood levels do not always predict benefit.
I have no experience or knowledge regarding 2 successive days of dex, but if this is done every week so that one has a 5 day break, this would probably be ok. One wants some time between doses so your body can recover, and it is a long acting drug, so pushing it to only a five day break could increase side effects such as muscle weakness, decreased resistance to infection, high blood sugar, increased abdominal girth, stretch marks, a red face, loss of calcium from bone, etc, etc.
Hang in!
There is really no good scientific data regarding dosing and scheduling. It is all trial and error.
I have been able to cut my dex down to 12mg / week and still have it work (I think), but it is hard to be sure. Quality of life is much better on a lower dose.
Taking it at night seems to work better than in the AM.
Dex counteracts the effects of vitamin D and causes osteoporosis, so it is a good idea to take supplemental vitamin D. I take 50,000 units (1 capsule) weekly. This is a very safe dose.
Dex also counteracts testosterone, which causes a loss of libido and loss of energy and interest in life, so men can try to see if additional testosterone helps them feel better. One can check a testosterone blood level before starting, but the blood levels do not always predict benefit.
I have no experience or knowledge regarding 2 successive days of dex, but if this is done every week so that one has a 5 day break, this would probably be ok. One wants some time between doses so your body can recover, and it is a long acting drug, so pushing it to only a five day break could increase side effects such as muscle weakness, decreased resistance to infection, high blood sugar, increased abdominal girth, stretch marks, a red face, loss of calcium from bone, etc, etc.
Hang in!
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stephen j gordon
Re: Dexamethasone can be given over two days
Sharon01 wrote:
Hi Sharon,
I've just finished my first cycle of CyBorD in RPA [Royal Prince Albert] (Sydney) - also on 80 mg per week. 20 on day 1 & 2, 4/5. So it seems to be common. I was advised they prefer to start on that dosage and lower if problems occur. My Velcade is subcutaneous though, not IV.
john
Wow, I am on 80 mg of dex a week, double of most people. I see the doctor on Friday and am going to check why.
Hi Sharon,
I've just finished my first cycle of CyBorD in RPA [Royal Prince Albert] (Sydney) - also on 80 mg per week. 20 on day 1 & 2, 4/5. So it seems to be common. I was advised they prefer to start on that dosage and lower if problems occur. My Velcade is subcutaneous though, not IV.
john
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JohnHamill - Name: John Hamill
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 50
Re: Dexamethasone can be given over two days
Stephen J Gordon touches on an oft-overlooked issue when he mentions that dexamethasone is long-acting.
If you look into how long dex stays in the blood, you'll find estimates that it has a half life of 3-4 hours. That means that half of it is out of your blood 3-4 hours after you take it, and it will take another 3-4 hours for the concentration in your blood to drop by another half, etc.
It turns out, though, that dex is one of those drugs where the half life in the blood doesn't give full story of how long acting the drug is. There is a difference between the drug's "plasma half life" (3-4 hours) and its "biological half life", which is how long it lingers in the parts of the body where it eventually accumulates after first being in the blood.
The biological half life of dex is MUCH longer -- about 2 days. See this link for the details.
However, I'm not sure I would completely agree with Stephen's comment that "There is really no good scientific data regarding dosing and scheduling" of dex. One of the most important studies in myeloma of the last five years focused specifically on the issue of whether a high dose of dex or a low dose of dex, in combination with Revlimid, is more better. The study found that a low dose was better.
"Lenalidomide plus low-dose dexamethasone is associated with better short-term overall survival and with lower toxicity than lenalidomide plus high-dose dexamethasone in patients with newly diagnosed myeloma."
(SV Rajkumar et al, "Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial," The Lancet Oncology, Jan 2010 (full text).)
If you look into how long dex stays in the blood, you'll find estimates that it has a half life of 3-4 hours. That means that half of it is out of your blood 3-4 hours after you take it, and it will take another 3-4 hours for the concentration in your blood to drop by another half, etc.
It turns out, though, that dex is one of those drugs where the half life in the blood doesn't give full story of how long acting the drug is. There is a difference between the drug's "plasma half life" (3-4 hours) and its "biological half life", which is how long it lingers in the parts of the body where it eventually accumulates after first being in the blood.
The biological half life of dex is MUCH longer -- about 2 days. See this link for the details.
However, I'm not sure I would completely agree with Stephen's comment that "There is really no good scientific data regarding dosing and scheduling" of dex. One of the most important studies in myeloma of the last five years focused specifically on the issue of whether a high dose of dex or a low dose of dex, in combination with Revlimid, is more better. The study found that a low dose was better.
"Lenalidomide plus low-dose dexamethasone is associated with better short-term overall survival and with lower toxicity than lenalidomide plus high-dose dexamethasone in patients with newly diagnosed myeloma."
(SV Rajkumar et al, "Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial," The Lancet Oncology, Jan 2010 (full text).)
Re: Dexamethasone can be given over two days
I agree with Ian's last comments. While every patient is unique and should be looked at as such, I was definitely under the impression that many in the myeloma medical community had already transitioned to "lower-dose" dex in the last several years. The study Ian references was pretty instrumental in documenting the benefits of the lower dose approach.
Some in Canada also seem to agree:
http://www.hindawi.com/journals/ah/2012/621958/
Some in Canada also seem to agree:
http://www.hindawi.com/journals/ah/2012/621958/
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Dexamethasone can be given over two days
Practice considerations are as follows.
- Len/Dex is approved for the treatment of RRMM in patients who have received ≥1 prior therapy and is appropriate irrespective of the number or type of therapies previously given.
- Lenalidomide dose must be adjusted based on creatinine clearance.
- Dosing should take into account pre-existing and developing cytopenias.
- Dexamethasone is usually administered at doses of 20–40 mg once per week. However, this LD regimen has not been formally studied in the setting of relapsed myeloma, and the results may not be the same as those reported in the pivotal MM009/MM010 trials.
- Len/Dex treatment should be maintained as in the pivotal trials, that is, continued until disease progression or until significant toxicity persists despite dose reduction.
Thanks Multibilly and Ian for those links. I excerpt the portion above from the second, Canadian, study. I have met Dr. Reece at patient education conferences. She is a top myeloma specialist and researcher working from the Princess Margaret Hospital in Toronto.
I can see from the study that the dose of dex may vary from 20 to 40 mg, depending on the patient. This may explain why some of us are on 20 mg and others on 40 mg.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Dexamethasone can be given over two days
I just want to say thanks for all the replies. I wanted to reply sooner but, while my wife and I were away for our anniversary, my Mother had a stroke and life has been turned upside down.
As far as my post, I just wanted to share something my oncologist shared with me. I haven't seen much posted about the split dex treatment over two days while taking Velcade.
I have been getting Velcade subQ on days 1, 4, 8 and 11, with 10 off. Also 40 mg dex once per week. Not all of us have the ability to be near a specialist for multiple myeloma. The closest hospital with a specialist in multiple myeloma is 200 miles away from me. My oncologist relies on what the South West Oncology Group (SWOG) has as far as treatments and trials. He also works with USC Norris / Keck cancer hospital that has specialists in multiple myeloma. From what I have been told, they also use SWOG.
One other thing that plays a huge part in all this is Insurance. My Insurance is contracted with USC Norris cancer hospital. That's where I will be going in a few weeks for another opinion on my current treatment and the harvest / transplant options.
Castaway
As far as my post, I just wanted to share something my oncologist shared with me. I haven't seen much posted about the split dex treatment over two days while taking Velcade.
I have been getting Velcade subQ on days 1, 4, 8 and 11, with 10 off. Also 40 mg dex once per week. Not all of us have the ability to be near a specialist for multiple myeloma. The closest hospital with a specialist in multiple myeloma is 200 miles away from me. My oncologist relies on what the South West Oncology Group (SWOG) has as far as treatments and trials. He also works with USC Norris / Keck cancer hospital that has specialists in multiple myeloma. From what I have been told, they also use SWOG.
One other thing that plays a huge part in all this is Insurance. My Insurance is contracted with USC Norris cancer hospital. That's where I will be going in a few weeks for another opinion on my current treatment and the harvest / transplant options.
Castaway
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
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