Pricing
Prices are indicative MRP and may vary by pharmacy. Trend compares against the last recorded price.
সব দামের পরিবর্তন →ইঙ্গিত ও ব্যবহার
Midothal, combined with dexamethasone, is used to treat patients newly diagnosed with multiple myeloma (MM). Midothal is also used to treat the skin symptoms of moderate to severe erythema nodosum leprosum (ENL) flare-ups, and to help prevent and control these skin symptoms from recurring as a maintenance therapy.
ডোজ নির্দেশিকা
শুধুমাত্র নির্দেশিকা তথ্য
প্রদর্শিত ডোজগুলি সরকারি উৎসের সাধারণ নির্দেশিকা। ব্যক্তিগতকৃত ডোজের জন্য সর্বদা আপনার ডাক্তার বা ফার্মাসিস্টের পরামর্শ নিন।
Adults:
Multiple Myeloma: The recommended dosing of thalidomide in combination with dexamethasone is 200 mg once daily, taken orally with water in 28-day treatment cycles, preferably at bedtime and at least 1 hour after the evening meal. Erythema Nodosum Leprosum: The recommended dosing of thalidomide for an episode of cutaneous ENL is 100 to 300 mg per day, taken orally once daily with water, preferably at bedtime and at least 1 hour after the evening meal. Patients weighing less than 50 kilograms should begin dosing at the low end of this range. A higher dosage range should be considered for patients with a severe cutaneous ENL reaction, or for those who have previously needed higher doses to control the reaction (possibly up to 400 mg per day), taken once daily at bedtime or in divided doses with water, at least 1 hour after meals. Using corticosteroids alongside thalidomide should be considered for patients with moderate to severe neuritis linked to a severe ENL reaction. Steroid use can be tapered and stopped once the neuritis has improved. The higher dosage of thalidomide should be continued until signs and symptoms of the active reaction have subsided, usually for at least 2 weeks. Patients can then be tapered off the medication in 50 mg decrements every 2 to 4 weeks.
পার্শ্বপ্রতিক্রিয়া
The most frequently reported adverse reactions are fatigue, hypocalcemia, edema, constipation, sensory neuropathy, dyspnea, muscle weakness, leukopenia, neutropenia, rash/desquamation, confusion, anorexia, nausea, anxiety/agitation, tremor, fever, weight loss, thrombosis/ embolism, neuropathy-motor, weight gain, dizziness, and dry skin.
সতর্কতা ও নিষেধাজ্ঞা
Warnings & Precautions
Embryo-Fetal Toxicity: Midothal is a powerful human teratogen that induces a high frequency of severe and life-threatening birth defects, even after a single dose. Mortality at or shortly after birth has been reported in about 40% of infants. When there is no satisfactory alternative treatment, females of reproductive potential may be treated with Midothal provided adequate precautions are taken to avoid pregnancy. There are no specific data available regarding the reproductive risks of cutaneous absorption or inhalation of Midothal; however, females of reproductive potential should avoid contact with Midothal Capsules. If there is contact with non-intact Midothal capsules or the powder contents, the exposed area should be washed with soap and water. If healthcare providers or other care givers are exposed to body fluids from patients receiving Midothal, the exposed area should be washed with soap and water. Appropriate precautions should be utilized, such as wearing gloves, to prevent the potential cutaneous exposure to Midothal. Blood Donation: Patients must not donate blood during treatment with Midothal and for 4 weeks following discontinuation of the drug. Venous and Arterial Thromboembolism: The use of Midothal in patients with MM results in an increased risk of venous thromboembolism, such as deep venous thrombosis and pulmonary embolism. This risk increases significantly when Midothal is used in combination with standard chemotherapeutic agents including dexamethasone. Thromboprophylaxis should be considered based on an assessment of individual patients' underlying risk factors. Patients and physicians should be observant for the signs and symptoms of thromboembolism. Thrombocytopenia: Thrombocytopenia, including Grade 3 or 4 occurrences, has been reported in association with the clinical use of Midothal. Blood counts, including platelet counts, should be monitored. Dose reduction, delay, or discontinuation may be required. Patients should be monitored for signs and symptoms of bleeding including petechiae, epistaxis, and gastrointestinal bleeding, especially if concomitant medication may increase the risk of bleeding. Drowsiness and Somnolence: Midothal frequently causes drowsiness and somnolence. Patients should be instructed to avoid situations where drowsiness may be a problem and not to take other medications that may cause drowsiness without adequate medical advice. Patients should be advised of the possible impairment of mental and/or physical abilities required for the performance of hazardous tasks, such as driving a car or operating other complex or dangerous machinery. Dose reductions may be required. Peripheral Neuropathy: Midothal is known to cause nerve damage that may be permanent. Peripheral neuropathy is a common (over 10%) and potentially severe adverse reaction to treatment with Midothal that may be irreversible. Peripheral neuropathy generally occurs following chronic use over a period of months; however, peripheral neuropathy following relatively short term use has been reported. Medications known to be associated with neuropathy should be used with caution in patients receiving Midothal. Dizziness and Orthostatic Hypotension: Patients should also be advised that Midothal may cause dizziness and orthostatic hypotension and that they should therefore sit upright for a few minutes prior to standing up from a recumbent position. Neutropenia: Decreased white blood cell counts, including neutropenia, have been reported in association with the clinical use of Midothal. Treatment should not be initiated with an absolute neutrophil count (ANC) below 750 per cubic millimeter. White blood cell count and differential should be monitored on an ongoing basis, especially in patients who may be more prone to neutropenia, such as patients who are HIV seropositive. If ANC decreases to below 750 per cubic millimeter while on treatment, the patient's medication regimen should be re evaluated, and if the neutropenia persists, consideration should be given to withholding Midothal if clinically appropriate.
নিষেধাজ্ঞা
Thalidomide must not be used by women who are pregnant, as it can cause serious harm to the developing fetus. It should also not be used by anyone known to be hypersensitive to thalidomide or any of its components.