Overview | Schedule | Side Effects | Monitoring | Tips | Patient Assistance | Emotional Wellness | Drugs | References
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Treatment Name: Dexamethasone (Decadron®)
How does dexamethasone (Decadron®) work?
Dexamethasone (Decadron) is designed to increase the platelet count by slowing the destruction of platelets. Oral courses of highdose dexamethasone temporarily suppresses the body’s immune system so that it stops destroying platelets. Dexamethasone may help your bone marrow cells make more platelets.
Dexamethasone may also make your blood vessels less “leaky” so that more platelets stay within the blood stream and increase the platelet count.
Alternative drug name: dex
Alternative disease name: idiopathic thrombocytopenic purpura
Goals of therapy:
Oral dexamethasone (by mouth) is taken to decrease the risk of bleeding and bruising in patients with ITP who have a very low platelet count. Dexamethasone is also commonly taken with the goal of achieving a long-term remission from ITP.
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Schedule
- Initial therapy with dexamethasone: 40 mg (ten 4 mg tablets) by mouth once daily with food on Days 1, 2, 3, and 4
- A four-day course of dexamethasone may be repeated on Day 10 if the platelet count did not increase to safe level (above 30 k/μL) or if bleeding did not stop
Oral dexamethasone is dispensed by a pharmacy and usually taken at home. Typical duration of therapy with highdose dexamethasone is usually four days per course. A total of 40 tablets will be dispensed per course.
It is important to take oral dexamethasone as early in the day as possible because it can cause difficulty sleeping at night (insomnia). Dexamethasone should also be taken with food to prevent a stomach ulcer.
Note: Individual doses and treatment options may vary based upon your Doctor's recommendation, or drug availability.
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Side Effects
In clinical studies with ITP, clinically significant side effects of oral dexamethasone (Decadron®) are shown here:
- Insomnia [trouble sleeping] (8%)
- Change in mood, sometimes more irritable (7%)
- High blood sugar (4%)
- High blood pressure (4%)
- Dizziness (2%)
- Nausea (2%)
- Stomach ulcer (2%)
- Fast heart beat (2%)
- Fatigue (1%)
- Fever (1%)
No patient discontinued dexamethasone treatment in the clinical study due to unacceptable side effects.
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Monitoring
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, as often as daily during the first week if you are bleeding, on Day 10, then often weekly thereafter until the platelet recovery has happened. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging is rarely needed for ITP. Imaging may include a chest X-ray if signs or symptoms of pneumonia are present. A CT scan (computerized tomography) may be needed if there is concern of a bleed in the head.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to repeat a courses of highdose dexamethasone therapy on Day 10, reduce the dose of future treatments, delay the next dose or course until the side effect(s) from dexamethasone go away, or switch to an alternative therapy.
As many as 20% of patients with ITP will not respond to dexamethasone therapy and require other forms of ITP treatment to increase the platelet count.
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
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ChemoExperts Tips
- In the clinical study, dexamethasone was well tolerated in patients 60 years old or older. Side effects, or adverse effects, that may be slightly higher in older patients include: high blood sugar, dizziness, trouble sleeping, irritability, high blood pressure, or fast heart rate
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for ITP. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Dexamethasone (Decadron®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Dexamethasone (Decadron®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Dexamethasone (Decadron®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
Emotional Wellness
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Dexamethasone (Decadron®)
What is Immune Thrombocytopenic Purpura (ITP)?
A disorder where platelets decrease in number due to decreased production in the bone marrow and increased destruction in the blood. This can lead to an increased risk of spontaneous bruising or bleeding (without injury), especially when the platelet count drops below 30,000 cells per microliter of blood.
I = Immune, ITP is caused by a disturbance in the immune system
T = Thrombocytopenic, a medical term meaning low platelet count
P = Purpura, a type of bleeding in the skin
ITP is NOT a cancer, but it is commonly managed by hematologists (blood doctors) who often treat blood cancers as well. ITP is an uncommon condition and may be caused by auto-immune disorders, infections, certain medications, or pregnancy. However, in many cases, a cause cannot be identified which gives rise to its other name-idiopathic (meaning “cause unknown”) thrombocytopenic purpura. Although ITP may spontaneously resolve, for some patients lifelong therapy may be needed.
The effectiveness of medications may depend upon the causes of ITP and the ability to remove these causes, or whether a splenectomy (removal of the spleen) has been performed, or is able to be performed.
Deciding on a treatment for ITP is in a way like buying, owning, and driving a car. Think about the following similarities to help you understand which treatment is right for you:
BUYING: "0 - 50 time" (0 to 50 k/µL platelets, instead of 0 - 60 m.p.h) is an important performance feature
Once the platelet count exceeds 50 k/µL, bleeding episodes are rare. Therefore, the time it takes to go from very few platelets to a platelet count over 50 k/µL matters. In general, steroids such as prednisone and dexamethasone have the fastest "0 - 50" time.
- Although exceptions, the thrombopoeitin receptor agonists romiplostim and eltrombopag usually have a 0 - 50 k/µL platelet time of 1 - 2 weeks
- Although exceptions, one-half of rituximab recipients have a 0 - 50 k/µL platelet time below 5.5 weeks, and the other half over 5.5 weeks. The response to rituximab is often unpredictable
OWNING: Warranty offered?
A 5-year bumper-to-bumper warranty helps us worry less about something breaking or going wrong with our vehicle after we buy it. Likewise, not all medications used for ITP have a long-lasting effect in keeping the platelet count above 50 k/µL.
- When it works, rituximab can work for 1 - 2 years, but lasting responses beyond two years are rarer. The 5 year rituximab response rate is estimated at 20 - 25%. When the rituximab "warranty" runs out and platelets fall, patients with ITP that had a long lasting response to rituximab may respond to another course of therapy. Certain insurances require the platelet count to be less than 30 k/µL before it will be covered.
- When they work, the thrombopoeitin receptor agonists romiplostim and eltrombopag generally have lasting effect beyond that of rituximab. The "warranty" period where the platelet count remains above 50 k/µL often lasts 2 years or longer
DRIVING: Cruise control optional?
The ability for a treatment to maintain the platelet count within the goal range is similar to setting the cruise control on a car.
- Steroids are given in a pulse (example: dexamethasone daily for 4 consecutive days) or given daily for several weeks (example: prednisone), then decreased over several weeks and eventually discontinued a few months after it is started. As a result, when steroids are no longer taken there is a chance for ITP to relapse
- Because eltrombopag and romiplostim are administered continuously, these medications have the highest likelihood of keeping the platelet count in the goal range for the long haul
- Rituximab is typically given once weekly for 4 doses, and usually takes several weeks to determine if it is working (see above), therefore it is difficult to predict who will have a lasting response to this therapy
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.
Clinical Studies
If you are interested in reading the clinical trials results, please click on references below:
Wei Y, Ji XB, Wang YW. High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial. Blood. 2016;127:296-302.
What is a CBC?
A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.
Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.
2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.
3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.
What is a CMP?
A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.
Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride
Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
Blood sugar:
13) Serum glucose
Calcium:
14) Serum calcium
What is k/μL ?
<p>It is an abbreviation for <strong><em>thousand per microLiter</em></strong>, which is a measurement of quantity per volume unit of blood.</p>
