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

Generic drug: dexamethasone

Brand name: Hemady

What is Hemady (dexamethasone), and how does it work?

Hemady (dexamethasone) tablets is a corticosteroid indicated in combination with other anti-myeloma products for the treatment of adults with multiple myeloma.

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)

What is the dosage for Hemady?

The recommended dosage of Hemady is 20 mg or 40 mg, orally, once daily, on specific days depending on the treatment regimen. Refer to the Prescribing Information of the other anti-myeloma products used in combination with
Hemady for specific Hemady dosing. Hemady can be administered with or without food.

Dose Modification For Elderly Patients

Dose-reduction for
Hemady is recommended for elderly patients, due to increased toxicity in these patients. Refer to the Prescribing Information of the other anti-myeloma products used as part of a combination regimen with
Hemady, for dosing recommendations in elderly patients.

What drugs interact with Hemady?

Strong CYP3A4 Inhibitors

Coadministration of strong and moderate CYP3A4 inhibitors increased
dexamethasone exposure, which may increase the risk of adverse reactions. Avoid coadministration of strong CYP3A4 inhibitors or consider alternative medication that are not strong CYP3A4 inhibitors.If concomitant use of strong CYP3A4 inhibitors cannot be avoided, closely monitor for adverse drug reactions.

Strong CYP3A4 Inducers

Coadministration of strong CYP3A4 inducers may decrease dexamethasone
exposure, which may result in loss of efficacy.Avoid coadministration of strong CYP3A4 inducers or consider alternative medication that are not CYP3A4 inducers. If concomitant use strong CYP3A4 inducers cannot be avoided, consider increasing the dose of
Hemady.

Cholestyramine

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.