[JimsKayak]

How long do RVD side effects last after treatment?

by JimsKayak on Thu Feb 05, 2015 7:50 am

I completed the seventh 21-day cycle of RVD (Revlimid, Velcade, dexamethasone) two weeks ago. At the ends of these cycles, I had a 6-7 day "rest" period , during which most of the side affects would resolve. After 6 cycles, my oncologist is satisfied that the treatment has reached a "plateau", and I'm having a new marrow biopsy Monday to confirm.

I had been in the habit of blaming everything on the Revlimid and Velcade, but I'm beginning to suspect that the dexamethasone was worse than I thought. I had blurring vision, sexual dys­func­tion, and insomnia, which are happily beginning to resolve.

In the meantime, between Christmas and New Year's, I was admitted to the hospital with chest pain. I got "the works" – stress test (fail), angioplasty, and a coronary stent. Since returning home, I feel as though my leg and lower back muscles have wasted, and I have less strength and stamina. I attributed this to 3 days in the hospital, and physical activity restriction.

Now, a month after the procedure and no chemo drugs, my back and legs still feel weak and "beat up". My oncologist says its from the dexamethasone.

Question: How long can it still be causing side effects after cessation?

BTW, I am taking clopidogrel (Plavix) and (the ubiquitous) atorvastatin (Lipitor) after the stent procedure.

[Two Cents]

Re: How long do RVD side effects last after treatment?

by Two Cents on Thu Feb 05, 2015 7:47 pm

I am far from a medical professional, but atorvastatin (Lipitor) can cause rhab­do­my­olysis, which can manifest as muscle weakness / soreness. My 80+ year old grandma had this issue, as did a 40 year old co-worker while on atorvastatin. My co-worker felt it in his chest and described it as soreness from bench pressing for the first time in years, but it never resolved. Something to consider ...

[Ron Harvot]

Re: How long do RVD side effects last after treatment?

by Ron Harvot on Fri Feb 06, 2015 12:16 pm

The side effects you are describing are primarily attributed to the dex. It is often referred to as the Devil Dex. I am a veteran of taking it - now 6 years. I am also very athletic and do long bike rides. I have found that it takes about 48 hours for the effects to wear off. (I was originally on VRD [Velcade, Revlimid, dexamethasone], but now just the Velcade-dex doublet once every 2 weeks as maintenance.)

Dex common side effects: insomnia, face flush, elevated heart rate, hiccups and indigestion, mood­iness. Dex often times causes one to feel like they are on a "speed" high, which effect lasts about 24 hours. That effect makes you feel like your mind is racing 100 mph. However, it is often followed by a "crash" where you are very fatigued. A good night's sleep and it usually passes. With me, the effects when I was on 40 mg a week, were much more severe than now, when it is only 8 mg every two weeks.

I take dex in pill form and I can time when I take it. I am supposed to take it the same day I get my Velcade injection. I found that if I wait until around 9 p.m. that day, I can sleep the first night. I have my dex high the next day, and sleeping that second evening is usually problematic. I found that if I take a Benadryl pill that helps to make me drowsy. By day 3, I am ready to ride my bike in earnest - 40 miles or more.

Ron

[Eric Hofacket]

Re: How long do RVD side effects last after treatment?

by Eric Hofacket on Fri Feb 06, 2015 12:30 pm

I second what Ron has said. I too experienced all the side effects you described from dexa­metha­sone.

Dexamethasone is a muscle wasting cortisol steroid, and I have experienced significant muscle loss while I have been using it. Often I have to explain this to people who think all steroids are of the anabolic type, like those used by sports cheaters to build up muscle mass. I can say that, in my case, exercise and time brought me back to where I was before.

With the heart problems you have, I believe you would want to approach exercise cautiously and in consultation with your doctor.

[JimsKayak]

Re: How long do RVD side effects last after treatment?

by JimsKayak on Sun Feb 08, 2015 6:27 am

Thank you for the informative responses. I'd love to resume my athletic activities, and rebuild my leg strength, but at the moment, I'd settle for being able to climb one flight of stairs without having to pull myself up using the banisters!

I read the link about rhabdomylosis, and it seems that my symptoms don't quite match. I don't have intense pain, and my problem seems confined to my lower body, not all muscles. I hope its not that.

However, it seems strange to me that side effects of dex should kick in a month after I've stopped taking it.