[jade]

Dex

by jade on Thu Apr 19, 2012 8:42 pm

My husband has been on a maintenance dose of Revlimid since his transplant a year ago. Recently his numbers have begun trending up and his doc wants to but him back on dex with the Revlimid. Having been on dex before I know he doesn't sleep and becomes very irritable. He's already taking ativan which he started the last time he was on dex. Has anyone found anything that helps with the dex side effects?

[Kevin J]

Re: Dex

by Kevin J on Thu Apr 19, 2012 10:58 pm

There are so many issues people have reported due to the dex and some seem to be able to manage them, others have difficulty. I'm on CRD, and usally feel quesay for a day or two after treatment, but as soon as I'm up to it I exercise, whether it's walking, biking, gardening with my wife, or whatever I can manage. The exercise is the best thing I've found - it tires me out to counter the hyperness from the dex, and exercise is psychologically therapeutic for me so it counters the irritability dex can cause.

[MRELKAY]

Re: Dex-Impact on Patients with type 2 Diabetes

by MRELKAY on Fri Apr 20, 2012 2:16 pm

I have been on Dexamethasone & Revlimid for about nine months and my M spike levels have been declining. This is good however I do have a problem with dexamethasone. I unfortunately have type 2 diabetes and taking the DEX raises my blood sugar readingd to high levels for about 2 days after I take the DEX. My original treatment involved 21 days of 10mg Revalamid per day and 40mg DEX on Days 1, 7, 14 followed by 1 week of no Revalamid and no DEX. My oncologist suggested that I cut the DEX to 20mg per week. However the blood glucose levels continue to spike for 2 days with readings of about 200+mg/dl!
Has anyone reading this forum encountered this problem? Are there any suggestions on how to handle this?

[suzierose]

Re: Dex

by suzierose on Fri Apr 20, 2012 7:14 pm

Hi Mrelkay!

Large Increases in blood levels of glucose is a known Side Effect of corticosteroids like dexamethasome. Many non-diabetics become diabetic when they take steroids long term. The medical term for that is 'steroid-induced diabetes'

You might want to ask your doctor to decrease your Dex dose to 4mg or even choose another corticosteroid, like prednisone, although prednisone will lincrease your blood glucose levels as well, perhaps it will likely be less of an increase as Dexamethasone is 10x as strong as prednisone.

OTOH, it sounds like you are getting a spike for only 2 days and then it returns to normal, so perhaps the change would be to up your anti-diabetic med/insulin on those 2 days.

[Sarah]

Re: Dex

by Sarah on Sat Apr 21, 2012 12:28 pm

My husband (Type II Diabetic) was dxd with multiple myeloma 18 months ago. Prior to a protocol of Velcade/Dex, his diabetes was treated with diet and 2.5 mg of Glyburide (oral), daily. On the day he takes the Dex, and the following day, his Blood Glucose is elevated. On those days, we treat the Blood Sugar with Insulin, based on a sliding scale provided by his doctor. Usually, by day three, the Blood Glucose is back to a normal range and he is off the Insulin.

Because of back issues (compression fractures, degenerative tissues, etc.), he has received several Steroid injections, lately. The injections, combined with the oral Dex, has not only played havoc with his Blood Glucose (sending it over 500, at times), but also with his emotions, his ability to sleep, his attitude, etc.

He's in CR and is now on a maintenance dose, so his onc. has taken him off the Dex for awhile - in an attempt to let his body rest, and settle down, which should also (hopefully) help the emotions. (His and mine!!)

Sarah in MS
Wife/Caregiver

[Eric Hofacket]

Re: Dex

by Eric Hofacket on Sat Apr 21, 2012 2:12 pm

I did not know about the possibility that dex could induce diabetes. In induction therapy I was on the standard 40mg dex once a week. The biggest difficulty I had was not sleeping for up to two days at a time then crashing hard. I ate a lot but did not gain much weight, actually losing about 50lbs after I was off dex. My girlfriend said I did not become too irritable but I sure did talk a lot while I was peaking on dex days. I am back to work now and too young to retire early. I could not see being able to function very well at work on dex it if I was not sleeping and crashing every week in cycles. For maintenance therapy with a very near CR after SCT, I went on Revlimid but asked the doctor if it was really necessary to take the dex. With my concerns he agreed to start with just Revlimid and see how that does. I hope I do not regret it. If it becomes necessary to add dex then that is what I will have to do, but my quality of life is better without the dex.