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Arthralgia
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Rheumatologic arthralgia
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•May be unmasked during mifepristone treatment
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•Consult with Rheumatology. Consider treatment with nonsteroidal therapies (e.g., biologics/targeted immune modulators)
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Non-rheumatologic arthralgias
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•Recommend treatment with acetaminophen or transdermal preparations (e.g., lidocaine). Avoid systemic/targeted injectable steroids and NSAIDs
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•Nonpharmacological treatments may also be considered, including acupuncture, physical therapy, yoga, weight loss, and TENS
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Nausea and vomiting
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Mild nausea and vomiting (i.e., non-emergency setting)
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•5-HT3 receptor antagonists are the first-line treatment. Do not exceed 8 mg of oral ondansetron in order to minimize the potential for drug-drug interactions and side effects (e.g., fatigue)
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•Alternative agents include promethazine or scopolamine patch
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•Consult with pharmacy for potential drug-drug interactions
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Intractable nausea/vomiting
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•If patient is showing signs of volume depletion or is seeking emergency help, temporarily hold mifepristone and give dexamethasone
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Fatigue
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Mild fatigue
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•Reassure patients that this is a sign of therapeutic effect and may resolve over time
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Moderate-severe fatigue
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•For fatigue that interferes with the patient’s activities of daily life, recommend additional laboratory assessments, such as thyroid function tests, complete blood count, iron panel, 25-hydroxy vitamin D level, and B12 level
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•Address other comorbidities (e.g., obstructive sleep apnea)
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