Dexamethasone 20 mg Home Dosing Schedule in RVD/Daratumumab Regimen
When combining RVD with daratumumab (Darzalex), patients take 20 mg dexamethasone at home on the day after each bortezomib dose, since the 20 mg dose on the day of bortezomib is given as a pre-infusion medication at the clinic before daratumumab. 1
Standard Dosing Pattern for DVRd (Daratumumab + VRd)
Cycles 1-8 (21-day cycles):
Bortezomib days: Days 1,4,8, and 11 2
Dexamethasone 20 mg schedule:
- At clinic (IV pre-infusion): Days 1,4,8,11 (given before daratumumab infusion) 2
- At home (oral): Days 2,5,9,12 (the day after each bortezomib dose) 2
This creates the pattern described in the FDA label as "dexamethasone 20 mg orally days 1,2,4,5,8,9,11,12" for cycles 1-8. 2
Cycles 9+ (28-day cycles):
The regimen typically transitions after cycle 8, though specific dexamethasone dosing may vary based on the protocol being followed. 2
Key Clinical Considerations
The critical distinction is that on bortezomib/daratumumab infusion days, the entire 20 mg dexamethasone dose is administered intravenously as pre-infusion medication at the clinic. 2 The patient then takes an additional 20 mg dose at home the following day. 2
For patients over 75 years or with reduced dexamethasone tolerance (20 mg total weekly dose): The entire 20 mg dose is given as pre-infusion medication on daratumumab days, with no additional home dose the following day. 2
Common Pitfall to Avoid
Do not confuse this 20 mg twice-weekly dosing pattern with the standard VRd regimen without daratumumab, where dexamethasone can be given as either 20 mg on the day of and day after bortezomib OR as 40 mg on days 1,8,15,22. 1 When daratumumab is added, the dosing must account for the pre-infusion requirement, fundamentally changing when patients take home doses. 2
Patient education should emphasize: Take the 20 mg dexamethasone at home only on days 2,5,9, and 12 during the first 8 cycles—specifically the day after each clinic visit for bortezomib/daratumumab. 2