The Hotline

Biaxin: Beware Of Drug Interactions

2011-02-21T21:08:38Z

Biaxin, also known by its generic name, clarithromycin, is most commonly used as an antibiotic to treat infections of the lung, bronchus, ear, sinus, skin, and throat. Many of you may know Biaxin in a different context, however: as part of your treatment for myeloma. It is a component of many regimens, several of which are still in clinical trials (thalidomide + Biaxin + dexamethasone (dex); Biaxin + Revlimid + dex [BiRd]; thalidomide + Biaxin + Revllimid + dex [T-BiRd]; pomalidomide + Biaxin + dex.).

Biaxin made its debut in the myeloma world in the early '90s, when thalidomide was the only "novel therapy." Doctors noticed that patients who were receiving Biaxin treatment for an infection (or to prevent infection) while they were being treated with thalidomide and dex responded better to treatment than those who were receiving thalidomide and dex but not Biaxin. Researchers concluded that the synergy between thalidomide, Biaxin, and dexamethasone was responsible for the improved response rate. Biaxin made the so-called "thal/dex" regimen more effective. A recent phase II Mayo Clinic study of Biaxin + Revlimid + low-dose dexamethasone vsersus Revlimid + low-dose dexamethason alone in patients with newly diagnosed myeloma [Gay et al, Am. J Hematol. 2010 Sep;85(9):664-9] demonstrated that "there is significant additive value when clarithromycin is added to Rd." A phase III trial is planned to confirm these results.

In fact, Biaxin interacts with many other drugs, not just those used to treat myeloma. The National Center for Biotechnology Information (NCBI), part of the National Institutes of Health, has a large compendium of information on drugs. In their entry for clarithromycin, there is a long list of drugs with which clarithromycin has interactions. Patients are cautioned to:

Tell your doctor if you are taking astemizole (Hismanal) (not available in the U.S.), cisapride (Propulsid), dihydroergotamine (DHE 45, Migranal), ergotamine (Ergomar, in Cafergot, in Migergot), pimozide (Orap), or terfenadine (Seldane) (not available in the U.S.). Your doctor may tell you not to take clarithromycin if you are taking one or more of these medications.
Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
Be sure to mention any of the following: anticoagulants ('blood thinners') such as Warfarin (Coumadin); alfentanil (Alfenta); alprazolam (Xanax); bromocriptine (Parlodel); carbamazepine (Tegretol); cholesterol-lowering medications such as lovastatin (Mevacor), simvastatin (Zocor), or atorvastatin (Lipitor); cilostazol (Pletal); colchicine; cyclosporine (Neoral, Sandimmune); darifenacin (Enablex); digoxin (Lanoxin); erlotinib (Tarceva); eszopiclone (Lunesta); fluconazole (Diflucan); certain medications for HIV such as nelfinavir (Viracept), ritonavir (Norvir), and zidovudine (AZT, Retrovir); certain medications for irregular heartbeat such as disopyramide (Norpace) and quinidine; methylprednisolone (Medrol), midazolam (Versed); omeprazole (Prilosec); phenytoin (Dilantin); ranitidine (Zantac); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); sildenafil (Viagra), tacrolimus (Prograf); theophylline (Theo-Dur); triazolam (Halcion); valproate (Depacon) and valproic acid (Depakote).

Many other medications may also interact with clarithromycin, so tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

This information about Biaxin is important in its own right, for those of you who are taking it, but should also serve as a warning about drugs in general. MANY DRUGS CAUSE UNDESIRED OR UNANTICIPATED INTERACTIONS WHEN THEY ARE COMBINED.

You should make it a practice to have your pharmacist check on drug-drug interactions no matter which medications you're taking, and no matter which days of the week or which times of day you take them. They don't have to be literally taken in combination. This includes vitamins and supplements, not just prescription drugs.

There is computer software available to pharmacists so that they can perform due diligence and prevent you from having problems with drug interactions. Present you pharmacist with a complete list of all medications, vitamins, and supplements that you're taking. This is part of being a good patient- just ask blogger Mike Katz, The Good Patient.

Supplements: What's The Story?

2011-02-19T07:48:21Z

Here is a subject bound to raise a lot of discussion and perhaps some hackles: supplements. It's a big subject, one that is hard to define. For now, let's just call supplements substances that are taken orally and can be easily purchased over the counter, often in health food stores. They are often touted as treatments for all sorts of ailments, which is up for debate, but we know some supplements can be helpful to some people. For myeloma patients, here is some information about supplements that you should know. For starters, never take a supplement without first talking to your doctor. Supplements that you might think can only help you, might turn out to hurt you, either directly or by interfering with your myeloma treatment.

Like any other drugs, supplements can have unexpected effects. There have been a series of scientific articles published within the last few years that indicate that some common supplements may inhibit the activity of Velcade (bortezomib). They are alpha lipoic acid, Vitamin C and green tea.

While these articles only look at the effect of these substances on Velcade in the lab and not in people, most doctors recommend caution with their use for patients taking Velcade. Usually, the suggestion is that patients avoid alpha lipoic acid, Vitamin C, and green tea on the day before, the day of, and the day after they receive their Velcade. Again, make sure you discuss this issue with your doctor before either starting or abandoning these substances while taking Velcade.

We'll continue to blog occasionally on other supplements that are of particular interest to myeloma patients.

Knowledge Is Power: Power Up At An IMF Patient/Family Seminar

2011-02-02T22:49:43Z

Have you ever had the desire or the need to sit with a world-renowned myeloma specialist to learn about and ask questions about your own or your loved one's disease? How about four world-renowned myeloma specialists? We thought so!

With that in mind, the International Myeloma Foundation created one of our flagship programs back in 1992, and we have been holding them ever since: Patient & Family Seminars. Seminars are offered throughout the year in the US and in other countries. The seminars are usually held over a Friday and Saturday and cover a wide range of issues, including: How to be a Better Patient, Management of Side Effects, Understanding Scientific Literature, Myeloma 101, Best Therapies for Elderly Patients, Stem Cell Transplantation, Management of Bone Disease, Clinical trials and New Drugs.

The knowledge gained will empower you. The experiences shared with other patients and caregivers will enrich and strengthen you.

Our 2011 Patient & Family Seminars in the US:

Boca Raton, FL - February 25-26 SOLD OUT

San Francisco, CA - March 11-12

Dallas, TX - July 15-16

Philadelphia, PA - August 26-27 http://

Click here to register online or register by phone, please call (800) 452-2873. Don't delay. Hotel discounts are only valid up to 30 days prior to each seminar.

If you are unable to attend one of these events this year, we have made available a free DVD of our Los Angeles 2010 seminar. To obtain one, just give us a call at (800) 452-2873. There are also a number of videos from past seminars that can be viewed online.

Protect Your Stomach!

2011-01-25T19:32:38Z

Almost everyone hates dexamethasone (affectionately and hereafter referred to as "dex")! We hear this over and over again and the reasons are legion. However, one problem for patients taking oral steroids, stomach problems (aka gastrointestinal side effects), can usually be avoided or minimized quite easily. First, always take dex with food or after a meal. Avoid anything that irritates the stomach...such as caffeine-containing foods and drinks such as colas, coffee, tea and chocolate. In addition to helping with stomach problems, most dex veterans will tell you that anything else that "revs" them up, isn't a good idea anyway. The same can be said of other steroids such as prednisone and solumedrol.

Many patients will also be helped by antacids such as Prilosec...... but as always, the doctors should guide you in the choice of drugs (either prescription or over the counter) that they think will work best for you.

We'll blog about dex and other steroids from time to time since almost every myeloma patient will take them at some point during their treatment.

For more information see the Understanding Dexamethasone and other Steroids brochure or call the Hotline at 800-452-2873.

Blood Clots

2011-01-17T22:22:43Z

Here's a topic that's important to know about, even for those of you with MGUS: BLOOD CLOTS.

Myeloma, in and of itself, is a risk factor for a blood clot, known in med-speak as a deep vein thrombosis, or DVT. Simply being over 65 is a risk factor for blood clots as well. Blood clots can be life-threatening if they become dislodged, or embolize, from their original site (usually the lower leg) and enter the lungs.

Even people with MGUS (monoclonal gammopathy of undetermined significance) and smoldering (or asymptomatic) myeloma are at increased risk for blood clots, though at lower risk than those with active disease. Add to this the increased risk of a blood clot posed by treatment with thalidomide or Revlimid, especially in combination with dexamethasone or chemotherapy, and the odds of having a DVT become even higher.

The good news is that there is a system for evaluating risk in each patient based both on the factors mentioned above and the patient's own individual characteristics and medical history. Based upon that risk assessment, preventive strategies ranging from a daily baby aspirin for those with the lowest risk to strong blood thinners for those at greatest risk can be taken.

Every patient with MGUS, asymptomatic myeloma, or active myeloma should be evaluated by their hematologist/oncologist for their risk of developing a blood clot. For further information, please see the International Myeloma Working Group (IMWG) publication, "Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma," and the simplified IMWG Guidelines on this topic.

Hypercalcemia

2011-01-13T19:02:33Z

Our blog topic for this week is hypercalcemia. It is part of the CRAB criteria (the "C" stands for calcium) as outlined in our Patient Handbook and it is important for myeloma patients to be aware of the risks it poses.

Hypercalcemia is a higher-than-normal level of calcium in the blood. It usually results from bone destruction - the calcium is released into the blood stream as the bone breaks down. It can be associated with reduced kidney function; calcium can be toxic to the kidneys. It is treated on an emergency basis using IV fluids combined with drugs to reduce bone destruction along with direct treatment for the myeloma.

Symptoms include:

Nausea and vomiting
Loss of appetite
Excessive thirst
Frequent urination
Constipation
Abdominal pain
Muscle weakness/aches, joint aches
Confusion
Lethargy and fatigue

It is a rare but serious complication of myeloma, however easily diagnosed and easily treated. If you are experiencing any of these symptoms, inform your doctor right away. The doctor can easily test for elevated blood calcium and would typically have results available within a few hours. If it is elevated, your doctor will have to assess the cause. While it could be a symptom of myeloma, there are other reasons a patient may have elevated blood calcium, e.g., hyperparathyroidism and side effects of certain medications, most commonly diuretics.

Hot Topic - Flu Shot

2010-11-29T17:14:03Z

IMF Hotline Coordinators, (left to right): Paul Hewitt, Missy Klepetar, Nancy Baxter and Debbie Birns

In recent weeks we've noticed an upswing in patients calling us (the IMF's Hotline) wondering if they can get a flu shot and if so, which one to get - the regular shot or this new "high-dose" one recommended for patients 65 and older.

OK. Here's the deal, blog readers!

The flu vaccine is not a live virus and is therefore safe for myeloma patients. It is recommended annually. If one is undergoing a stem cell transplant, they should be immunized prior to, and 6 months after the procedure - (Pomeroy, MD and Oken, MD - Mayo Clinic).

This year, both the regular flu vaccine and the high dose vaccine protect against three influenza viruses that research indicates will be most common during the upcoming season. Both will protect against 2009 H1N1, and two other influenza viruses (an H3N2 virus and an influenza B virus). The high-dose vaccine is approved for use in people 65 years of age and older. Human immune defenses become weaker with age, which places older people at greater risk of severe illness from influenza. The high dose vaccine contains 4 times the amount of antigen contained in the regular flu shot, to create a stronger immune response.

We spoke with one of our scientific advisors about myeloma patients receiving the high-dose flu vaccine, and this is what he said:

Image via Wikipedia

It is still "early days" for the high-dose vaccination and we don't have full data on it yet. It is possible there could be more side effects that result from getting this higher-dose shot. If a patient 65 or older has had the flu shot before with no complications, it is probably OK for them to get the high-dose shot, but as always, they should talk to their doctors about it first. If a patient has never had the flu shot before, they should probably get the "regular" seasonal one, because of the potential side effects.

For more information about the Fluzone High Dose Vaccine, please visit the CDC's Questions and Answers page - http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm#what_fluzone