[appleParticipant]

Hello all. Just a bit of background. I was diagnosed with MGUS in 2008 ish which developed into Myeloma in the Spring of 2013. I started Trial chemo (RCD) in June but suffered liver cirrhosis (and also a sodium crash). Both these were blamed partially on the trial drug (Relivmid) and this was stopped after 3 cycles. Cyclophoshate (?) and Dexamethosone were continued for a 4th cycle by which time my paras had dropped to 5-6, and so chemo was “temporarily” suspended. I’m glad to say that my paras remained pretty much stable until this last Summer, when they started creeping up from around the 10 mark to 16.1 5 weeks ago. Consequently, almost 5 years to the day, I restarted treatment yesterday. Because of my liver, SCT is not being considered and I am (for now) just having sub-cutaneous Velcade weekly & 8x 10mg Dextro per 4 weekly cycle. However, there are the other anti-side effect meds, some of which have potential side effects of their own. These are all common drugs associated with myeloma treatment so hopefully someone can advise me how best to space so many drugs to avoid dangerous inter-reactions and minimise side effects in general.

The drugs directly concerning the Myeloma are, with general recommended dosage times:

Dexamethosone (with/after breakfast; currently scheduled for Wed & Thurs)

Ferrous Fumerate (twice daily avoiding milk/grain/cereal)

Omeprazole (morning)

Co-trimoxazole (with food)

Aclicovir (twice daily)

Allopurinol (with food)

In addition, I am on Carvedilol to minimise the risk of bleeds caused by the liver cirrhosis (varices). This is to be taken with food, but apart from a temporary reduction in blood pressure is well tolerated with very few dangerous inter-reactions. Note, I have been taking these for some years with Omeprazole, so the latter is not newly prescribed.

Thanks for any advice

Phil, Manchester

[finnParticipant]

Hi Phil
I am having dexa, omeprazole and aciclovir too, and I take them in the morning as you do (plus evening for aciclovir). I am not on antibiotics (co-trimoxazole) and I do not know if that can cause any inter-reactions with the other meds, most likely not. I am a little surprised with the other two medications you are having though. Do you have problems in absorbing iron? Ferrous fumarate is iron supplement but in most cases myeloma patients have anemia because they are not producing enough red blood cells and not because of iron deficiency. Iron supplements do not help when you have reduced number of red blood cells. In fact your iron levels can get too high and cause you stomach pain. However, if you do have problems in iron absorption then of course this iron supplement is good. The other drug you are having, allopurinol, is for increased uric acid level and gout. If chemotherapy causes you that then it is good to take it but this drug has lots of interactions with other medicines and it can also reduce the number of blood cells. So maybe good to have a chat with your medical team about when to take it. All the best

[appleParticipant]

Thanks, Finn. I’ve managed to speak to a specialist nurse today and they are confident of no clashes as they are all tried and tested meds used extensively with no reported problems through interactions.
As regards Ferrous Fumarate; When originally diagnosed with Myeloma in 2013, the ONLY symptom I presented to the GP with was severe anaemia. I also have a history of low blood pressure. IIRC, I was put on FF straight away even before Myeloma was confirmed – at which point my HG was 69. I was on 3x 200 mg a day throughout chemo and into 2014. I was then reduced to 2x210mg which is where I am now, despite restarting chemo. Mind you, my last HG was 116 which I believe is only about 15% lower than a safe level. I have very little stomach pain per se, but the one continuing symptom throughout semi-remission is regular, if usually short-lived indigestion (not neccessarily acid reflux). This I pit down to a combination of liver cirrhosis, permanent physical damage (including hernia which surgery is not advised unless strangulation symptoms present); side effects of omeprazole; lack of exercise (its more problematic in winter) and posture (basically we need a new sofa!); and certain foods (too many carbs and not enough bran?).
I think it is certainly an idea to raise the subject of Allopurinal even though they tell me it does react with anything else I’m on (this backed by a website on interactions, I’ve looked at). However, I have no history of gout and (touch wood) my kidney function has remained very good throughout my illness. So thanks for that point in patricular.

[Author]

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