[Jade]

Exhaustion and cortisol levels

by Jade on Mon May 05, 2014 6:48 pm

Hi Everyone,

My husband has been on Pomalyst [pomalidomide, Imnovid], Kyprolis [carfilzomib], Cytoxan [cyclophosphamide], and dexamethasone [Decadron] for about 9 cycles.

The myeloma has responded well, but the fatigue is overwhelming. He cut back the Decadron because he has the most difficulty with it (insomnia, irritability etc.) Now he's been found to have low cortisol levels, I guess from the Decadron, even though it was only once a week.

Has anyone experienced this? Were you put on daily prednisone and how was that tolerated? How about vitamins?

Any experiences would be appreciated.

[Multibilly]

Re: Exhaustion and cortisol levels

by Multibilly on Mon May 05, 2014 7:01 pm

What dose was he taking and what dose is he taking now? How quickly did he make the switch? As I understand it, one usually wants to taper its use down gradually to help minimize any side effects.

[Jade]

Re: Exhaustion and cortisol levels

by Jade on Mon May 05, 2014 8:07 pm

Thanks for your reply,

He had been on 20mg once a week and did taper to 12mg weekly, then 8mg weekly and then off over about 4 weeks. Do you think that was too fast?

[Multibilly]

Re: Exhaustion and cortisol levels

by Multibilly on Mon May 05, 2014 8:29 pm

I'm not qualified to answer that since I have no personal experience with it and I'm not a doc. A quick google yielded:

http://www.medscape.com/viewarticle/498465_5

"In clinical practice, dexamethasone tapering schedules are often prescribed for short-term therapy, and usually consists of an empiric reduction in dose of 2-4 mg every 1-3 days, by either reducing the dose and/or the interval. Other tapering schedules have been reported in this patient population and include a "slow taper" of lowering the dose by 4 mg every week. In reality, the dose of dexamethasone and tapering schedule should be adjusted to the patient's tolerance."

Hopefully others will chime in here.