Managing the Side Effects of Multiple Myeloma Treatment
- The medications used to treat multiple myeloma can trigger both temporary and long-term side effects, but understand that everyone's experience with these drugs is unique.
- In some cases, changing the type of medication or adjusting the dose may be enough to reduce side effects.
- You may need to take additional medications and supplements or make various lifestyle changes to manage your side effects.
Countering certain side effects sometimes calls for additional medications or adjusting the dose or timing of the cancer-fighting drugs, explains Matthew Pianko, MD, a hematologist with the Rogel Cancer Center at the University of Michigan in Ann Arbor.
Read MoreDexamethasone
The corticosteroid dexamethasone is prescribed to reduce inflammation. It is also used by some patients to reduce side effects such as nausea and vomiting associated with chemotherapy. Dexamethasone or other corticosteroid is usually part of a two- or three-drug treatment regimen. Dexamethasone can cause some people to have trouble sleeping. "Sometimes this can be addressed by using sleep aids or potentially, if the symptoms are severe enough, we may consider a reduction in the dose of dexamethasone to help with that symptom," Dr. Pianko says.Dexamethasone may also cause a rise in blood sugar (glucose). "Sometimes patients who don’t have diabetes can sometimes develop diabetes or require insulin when they’re on dexamethasone," Dr. Pianko says. High blood sugar and other side effects such as weight gain and mood swings tend to go away once the medication use stops. However, managing increased blood sugar levels with insulin, the diabetes drug metformin, and dietary adjustments may be necessary to avoid further complications.
Managing dexmethasone side effects
Bortezomib
Another common myeloma drug, bortezomib (Velcade), may cause a different but potentially harder to treat side effect called peripheral neuropathydamage to the nerves in the hands and feet that can cause pain and/or numbness. "If one develops neuropathy from their myeloma treatments, it’s important to discuss these with their treating provider so that their treatments can be adjusted or modified before the neuropathy symptoms get too severe, as they sometimes can be permanent," Dr. Pianko says.
Certain pain medications can be used to treat neuropathy. Some of the more commonly used drugs include gabapentin (Gralise), pregabalin (Lyrica), or duloxetine (Cymbalta). "Each of these drugs can be effectively used to treat nerve pain that could come from the medications we use to treat myeloma," Dr. Pianko says.
Managing boretzomid side effects
Lenalidomide
Lenalidomide (Revlimid) is an immune-modulating therapy that is a cornerstone of multiple myeloma treatment. "It is one of the most important drugs we have for the treatment of myeloma," Dr. Pianko says. "But it can cause some side effects that are common in patients, such as cramping in the hands and feet or in the muscles."
He adds that cramping may be related to an electrolyte imbalance triggered by the drug. "Sometimes we recommend people consider using a magnesium supplement," Dr. Pianko says, adding that home remedies, such as pickle juice, yellow mustard and tonic water (which contains quinine) may be helpful. "Sometimes people use an a electrolyte solution like Gatorade or something like that to help with cramping. This can usually be dealt with using one of these options."
Other common side effects include a change in the sense of taste, along with diarrhea. Dr. Pianko explains that lenalidomide may lead to poor absorption of bile acid, a compound critical to a healthy digestive system by allowing the small intestine to absorb fat.
“We have been successful in treating lenalidomide-related diarrhea using some cholesterol medications, which soak up these extra bile acids and can lead lenalidomide to be a more tolerable regimen for patients."
Managing lenalidomide side effects
Takeaway
As with any medication, the type and severity of the side effects you experience may be much different than those encountered by someone else. But you shouldn't view any side effect as an unavoidable consequence of starting a new medication. While not all side effects have an easy solution, there may be ways to at least minimize the discomfort and other problems they create.
Don't hesitate to tell your doctor if you are having side effects, even if they seem minor. There may be a quick fix, such as changing the time of day you take the drug or trying a weaker dose. Or there may be other therapies, such as pain relievers or supplements that can offer some help. Likewise, making dietary and lifestyle changes may be necessary to provide further assistance in managing medication side effects.
Living with multiple myeloma is challenging enough, so work with your doctor to help reduce the treatment's impact on your quality of life.
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