Hemady (dexamethasone) for Multiple Myeloma: Side Effects & Dosage

What are the side effects of Hemady?

Common side effects of Hemady include:

• allergic reactions,
• vision changes,
• heart problems,
• acne,
• thin fragile skin,
• thinning scalp hair,
• hives,
• menstrual irregularities,
• fluid retention,
• weight gain,
• bloating,
• increased appetite,
• nausea,
• decreased resistance to infection,
• muscle weakness,
• osteoporosis,
• headache,
• nerve pain,
• numbness and tingling,
• spinning sensation (vertigo),
• mood changes sleep problems (insomnia),
• dry skin,
• bruising or discoloration,
• slow wound healing,
• increased sweating,
• dizziness,
• stomach pain, and
• changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist)

• Cholestyramine may increase the clearance of corticosteroids and potentially decrease corticosteroid exposure. Avoid coadministration of cholestyramine and
  Hemady and consider alternative agents.

Anticholinesterases

• Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.

Ephedrine

• Ephedrine may decrease dexamethasone exposure. Decreased exposure may result in loss of efficacy. Consider increasing the dose of
  Hemady when used concomitantly with ephedrine.

Estrogens, Including Oral Contraceptives

• Estrogens may decrease the hepatic metabolism of certain corticosteroids
  and increase exposures, which may increase the risk of adverse reactions.

Effect Of Hemady On Other Drugs

CYP3A4 Substrates

• Coadministration of dexamethasone with drugs that are CYP3A4 substrates may decrease the concentration of these drugs. This may result in loss of efficacy of these drugs.

Oral Anticoagulants

• Coadministration of anticoagulants with corticosteroids may reduce the
  response to anticoagulants. Frequently monitor coagulation indices to maintain the desired anticoagulant effect when administered with
  Hemady.

Amphotericin B Injection And Potassium-Depleting Agents

• Sodium retention with resultant edema and potassium loss may occur in
  patients receiving corticosteroids. Closely monitor potassium levels when potassiumdepleting agents are coadministered with
  Hemady. In addition, there have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure.

Antidiabetics

• Corticosteroids, including Hemady, may increase blood glucose
  concentrations. Consider adjusting the dose of antidiabetic agents, as necessary, when coadministered with
  Hemady.

Isoniazid

• Serum concentrations of isoniazid may be decreased with corticosteroids.

Cyclosporine

• Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use.

Digitalis Glycosides

Patients on digitalis glycosides may be at
increased risk of arrhythmias due to hypokalemia.

Nonsteroidal Anti-Inflammatory Agents (NSAIDS)

• Concomitant use of aspirin (or other nonsteroidal anti-inflammatory
  agents) and corticosteroids increases the risk of gastrointestinal side
  effects.
• The clearance of salicylates may be increased with concurrent use of corticosteroids. Monitor for toxicity when aspirin is used in conjunction with
  Hemady in hypoprothrombinemia.

Phenytoin

• In post-marketing experience, there have been reports of both increases and decreases in phenytoin levels with dexamethasone coadministration, leading to alterations in seizure control.

Vaccines

• Patients on corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. If possible, defer routine administration of vaccines or toxoids until
  Hemady therapy is discontinued.

Concomitant Therapies That May Increase The Risk Of Thromboembolism

• Erythropoietic agents, or other agents that may increase the risk of thromboembolism, such as estrogen containing therapies, coadministered with
  Hemady may increase the risk of thromboembolism. Monitor for risk of thromboembolism in patients with MM receiving anti-myeloma products with
  Hemady.

Thalidomide

• Toxic epidermal necrolysis has been reported with concomitant use of thalidomide. Closely monitor for toxicity when thalidomide is coadministered with
  Hemady.

Laboratory Test Interference

Skin Tests

• Corticosteroids may suppress reactions to skin tests.

Is Hemady safe to use while pregnant or breastfeeding?

• Corticosteroids, including Hemady, readily cross the placenta.
• Adverse developmental outcomes including orofacial clefts (cleft lip with or without cleft palate), intrauterine growth restriction, and decreased birth weight have been reported with maternal use of corticosteroids, including
  Hemady, during pregnancy.
•  Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Advise women not to breastfeed during treatment and for 2 weeks after the last dose.