Aging and medications

[Pete]

I had rtx infusion #23(?) yesterday. Thirty minutes before the rtx was started, I got a dose of solu medrol, benadryl, and Tylenol. The infusion proceeded normally under the accelerated protocol. (It only took two hours for the rtx after they started it.)

I usually don’t sleep well the night following treatment. Last night/this morning was worse than usual. I had mild heartburn again (second time), so I will do a 14-day course of Prilosec OTC at Dr Fussner’s recommendation. Being sleepless at 3:30 AM, I researched the side effects of rituximab, solu medrol, and Benadryl. Rtx and solu medrol both list heartburn as a side effect. I’ll mention this to Dr Fussner when I see her in a couple weeks, and I’ll make a note to self to start a course of Prilosec a couple days before my next rtx.

On another note, I wonder if age has anything to do with reactions to medications. @drz mentioned his thoughts in a post a couple weeks ago. He’s 80 and I’m 77. I had pronounced reaction to the flu, Covid, and RSV vaccines when I got them in early October. I had injection site soreness from all three and I fainted once after the RSV (fainting listed as a side effect). It was the first time I reacted to the flu vaccine in over 30 years.

[John S]

I get two infusions a year. In Spring I get it at Cleveland Clinic, in the Fall at Loyola in Chicago. I’m pretty sure they both use all the same meds. After a Cleveland infusion I am typically awake all night long (that’s why we stay at the Intercontinental Suites). After a Chicago infusion I sleep fine.
I have no idea why.

[Pete]

@John S

I also get two 500 mg infusions a year. This most recent is the first I’ve had at OSU since 2017. All of my infusions have been under Dr VillaForte’s protocol. (Dr Fussner followed the same protocol as Dr Villa Forte.) My first experience with the accelerated protocol was at Cleveland in May. I was told that this was appropriate because I have not demonstrated an adverse reaction to rtx.

The pre-rtx protocol for all my infusions has been solu medrol, benadryl, and Tylenol. The only difference between the last two infusions has been the location where I got them. I’m used to finishing the infusion and immediately starting the drive to home. The two-plus hour drive from Cleveland must have tired me enough so that I could sleep fitfully. The ten-minute drive within the Columbus area was a piece of cake. I guess I should’ve gone for an abbreviated power walk when I got home.

At any rate, I consider this to be a minor issue. I was able to relax and watch football all day yesterday!

[CapeKay]

Hi Pete,

I am not surprised you could not sleep. They usually administer 100 mg of solu medrol. That amount of steroid alone will prevent me from being able to sleep for a few days. I am anxiously waiting for my 2nd set of infusions to get scheduled. It is going on 7 months now and has hit a bunch of snags that I think I finally got resolved on Friday. I never experienced close to a remission after my first set of infusions in April/May. Hoping I see better results after this next set. Recently you posted a link to the Vasculitis Foundations document of treatment guidelines for the various forms of vasculitis. I believe I read there that they did not recommend continuing with the same therapy if one did not experience good results after the first six months. However I have seen here that many have experienced a very long haul out from the ravages of their disease. Although my quality of life is but a fraction of what it was a year ago, I am not nearly as sick as many. Hoping another round of rituximab will bring more healing.
I just turned 70 and have been lucky for most of my life that I have not had adverse reactions to much. However, last year I had an anaphylactic reaction to mono clonal antibodies after a bout of nearly asymptomatic covid. I also have a good 3 day flu like reaction to the vaccines. I stay away from NSAIDS but may take some Prilosec after your report here. Nice that your infusions are down to nearly 2 hrs. That is something to look forward to. Glad you are feeling better.

kathy