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About to start Rituxan

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9 years 3 months ago #56244 by Barb111
Replied by Barb111 on topic About to start Rituxan
So, I get my second infusion tomorrow. The week has been good. No new bruises. Count was 45 last week, so that was good. I have had no significant side effects. I have had a sinus headache and feeling a bit like I have a slight cold. I talked to the doctor and he doesn't feel it is from the Rituxan, just a cold. I did read that sinus pressure was a side effect though. It is a bit better today. Took a Sudafed yesterday and it helped but trying not to because of that stupid BP issue. Tylenol helps at night to sleep. Well, we shall see what tomorrow brings. Hopefully no need to stop and start again.

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9 years 2 months ago #56415 by aero8991
Replied by aero8991 on topic About to start Rituxan
Hey Barb, how did your second infusion go ? Hope it all went smooth for you. My doctor wants me to start Rituxan in a few weeks. Im hesitant because the side effects sound worse than condition itself! I'm currently taking Promacta and my numbers usually fluctuate in the ~100 range. It would be nice to not be on any meds for awhile though.

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9 years 2 months ago - 9 years 2 months ago #56416 by Barb111
Replied by Barb111 on topic About to start Rituxan
Hi! My second one went great! No reactions at all. Not even sleepiness. And, I don't seem to be having any effects during the weeks between treatments either! Obviously everyone has different reactions, but the nurses at my infusion center said they rarely hear of any difficulties.

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  • Hal9000
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  • Give me all your platelets and nobody gets hurt
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9 years 2 months ago #56432 by Hal9000
Replied by Hal9000 on topic About to start Rituxan
aero8991, would it be fair to say that you are looking for a remission, both Nplate and Promacta haven't provided that, so now, doc is suggesting Rituxin?

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9 years 2 months ago #56447 by aero8991
Replied by aero8991 on topic About to start Rituxan
Yes that's exactly it - remission sounds nice !

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  • Hal9000
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  • Give me all your platelets and nobody gets hurt
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9 years 2 months ago #56495 by Hal9000
Replied by Hal9000 on topic About to start Rituxan
Ok. I'm a little surprised doc didn't go directly to Rituxin first before the Nplate and Promacta. Increased risks of that drug maybe?

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9 years 2 months ago #56506 by Barb111
Replied by Barb111 on topic About to start Rituxan
So, todays platelets are 49. Doc feels the Rituxan stabalizes before counts go up. So I have been in the 40's for 2 weeks. Not bad. Currently getting my 3rd. Infusion.
Prednisone taper is as follows:
Drop 50 to 40 tomorrow for 1 week
30 1 week
20 1 week
15 1 week
10 1 week
5 1 week
2.5 1 week
2.5 every other day 1 week.
I asked about 10 to 7. 5 instead of to 5 and was told he has never had a patient have a problem with it.
We shall see......

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  • mrsb04
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  • ITP since 2014. Retired nurse. My belief is empower patients to be involved as much as possible in their care. Read, read, read & ALWAYS question medics about the evidence base they use.
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9 years 2 months ago - 9 years 2 months ago #56517 by mrsb04
Replied by mrsb04 on topic About to start Rituxan
I've posted this so many times it's unbelievable but I'll do it again.


Rapid taper of steroids is dangerous it can kill. It is also extremely unpleasant to go thorough.


These are UK guidelines supported by the reference list below.

Gradual withdrawal should be considered for people who received more than 40 mg prednisolone daily for more than 1 week.

•The problem has resolved and treatment has been given for only a few weeks. Reduce by 2.5 mg every 3–4 days, down to 7.5 mg per day, then reduce more slowly, for example by 2.5 mg every week, fortnight, or month.

•There is uncertainty about disease resolution and/or therapy has been given for many weeks. Reduce by 2.5 mg every fortnight or month down to 7.5 mg per day, then reduce by 1 mg every month.

•Symptoms of the disease are likely to recur on withdrawal Reduce by 1 mg every month.

References
ABPI Medicines Compendium (2014) Summary of product characteristics for Deltacortril 5mg Gastro-resistant Tablets.Electronic Medicines CompendiumDatapharm Communications Ltd. www.medicines.org.uk [Free Full-text]

Arlt, W. and Allolio, B. (2003) Adrenal insufficiency.Lancet361(9372), 1881-1893. [Abstract]

Aronson, J.K. (Ed.) (2006a) Meyler's side effects of drugs. The international encyclopedia of adverse drug reactions and interactions. Volume 1: A-B.15th edn. Amsterdam: Elsevier.

Aronson, J.K. (Ed.) (2006b) Meyler's side effects of drugs. The international encyclopedia of adverse drug reactions and interactions. Volume 2: C-D.15th edn. Amsterdam: Elsevier.

Aronson, J.K. (Ed.) (2006c) Meyler's side effects of drugs. The international encyclopedia of adverse drug reactions and interactions.15th edn. Oxford: Elsevier.

Ashwood, P., Crowther, C., Willson, K. et al. (2006) Neonatal adrenal function after repeat dose prenatal corticosteroids: a randomized controlled trial.American Journal of Obstetrics and Gynecology194(3), 861-867. [Abstract]

Autio, P., Oikarinen, A., Nelkko, J. et al. (1994) Systemic glucocorticoids decrease the synthesis of type I and type III collagen in human skin in vivo, whereas isotretinoin treatment has little effect.British Journal of Dermatology131(5), 660-663. [Abstract]

Baxter, K. and Preston, C.L. (Eds.) (2013) Stockley's drug interactions: a source book of interactions, their mechanisms, clinical importance and management.10th edn. London: Pharmaceutical Press.

BNF 69 (2015) British National Formulary. 69th edn. London: British Medical Association and Royal Pharmaceutical Society of Great Britain.

Brayfield, A. (2014) Martindale: the complete drug reference.MICROMEDEX. .London: Truven Health Analytics.

Coulson, I. (1996) Topical steroids for skin disease.Dermatology in Practice4(2), 5-9.

CSM (1998) Focus on corticosteroids.Current Problems in Pharmacovigilance24(May), 5-10. [Free Full-text]

GINA (2015) Global strategy for asthma management and prevention.Global Initiative for Asthma. www.ginasthma.org [Free Full-text]

Jameison, K. and Dinan, T.G. (2001) Glucocorticoids and cognitive function: from physiology to pathphysiology.Human Pyschopharmacology16(4), 293-302. [Abstract]

LactMed (2015) Prednisolone.National Library of Medicine. www.toxnet.nlm.nih.gov

Liu, D., Ahmet, A., Ward, L. et al. (2013) A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy, asthma, and clinical immunology9(30), 1-25. [Abstract] [Free Full-text]

London and South East Medicines Information Service, South West Medicines Information Service and Croydon Clinical Commissioning Group (2014) Suggestions for drug monitoring in adults in primary care.UK Medicines Information. www.ukmi.nhs.uk [Free Full-text]

Menter, A., Korman, N.J., Elmets, C.A. et al. (2009) Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies.Journal of the American Academy of Dermatology60(4), 643-659. [Abstract] [Free Full-text]

Micromedex (2014) MICROMEDEXTruven Health Analytics Inc.

Oren, D., Nulman, I., Makhija, M. et al. (2004) Using corticosteroids during pregnancy. Are topical, inhaled, or systemic agents associated with risk?Canadian Family Physician50(), 1083-1085. [Abstract] [Free Full-text]

Peltoniemi, O., Kari, M. and Hallman, M. (2011) Repeated antenatal corticosteroid treatment: a systematic review and meta-analysis.Acta obstetricia et gynecologica Scandinavica90(7), 19-27. [Free Full-text]

Rang, H.P., Ritter, J.M., Flower, R.J. and Henderson, G. (2015) Rang and Dale's pharmacology. 8th edn. Edinburgh: Churchill Livingstone.

Richter, B., Neises, G. and Clar, C. (2002) Glucocorticoid withdrawal schemes in chronic medical disorders: a systematic review.Endocrinology and Metabolism Clinics of North America31(3), 751-778. [Abstract]

Schaefer, C., Peters, P. and Miller, R. (Eds.) (2015) Drugs during pregnancy and lactation: treatment options and risk assessment.3rd ed. edn. London: Academic Press.

SIGN and BTS (2014) British guideline on the management of asthma: a national clinical guideline (revised 2014).Scottish Intercollegiate Guidelines Network and The British Thoracic Society. www.sign.ac.uk [Free Full-text]

UKTIS (2012) Use of corticosteroids in pregnancy.TOXBASEUK Teratology Information Service. www.toxbase.org

Walker, R. and Whittlesea, C. (Eds.) (2011) Clinical Pharmacy and Therapeutics.5th edn. Edinburgh: Churchill Livingstone.

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9 years 2 months ago #56519 by Barb111
Replied by Barb111 on topic About to start Rituxan
I actually showed him this post. I felt no need to push it anymore today. I will bring it up again as we get closer, I will just do it mysel! Lol! I have a feeling knowing my doc, he will be fine with it if I say I am still uncomfortable with it.

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