Arthralgia | |
Rheumatologic arthralgia | |
 •May be unmasked during mifepristone treatment | |
 •Consult with Rheumatology. Consider treatment with nonsteroidal therapies (e.g., biologics/targeted immune modulators) | |
Non-rheumatologic arthralgias | |
 •Recommend treatment with acetaminophen or transdermal preparations (e.g., lidocaine). Avoid systemic/targeted injectable steroids and NSAIDs | |
 •Nonpharmacological treatments may also be considered, including acupuncture, physical therapy, yoga, weight loss, and TENS | |
Nausea and vomiting | |
Mild nausea and vomiting (i.e., non-emergency setting) | |
 •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) | |
 •Alternative agents include promethazine or scopolamine patch | |
 •Consult with pharmacy for potential drug-drug interactions | |
Intractable nausea/vomiting | |
 •If patient is showing signs of volume depletion or is seeking emergency help, temporarily hold mifepristone and give dexamethasone | |
Fatigue | |
Mild fatigue | |
 •Reassure patients that this is a sign of therapeutic effect and may resolve over time | |
Moderate-severe fatigue | |
 •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 | |
 •Address other comorbidities (e.g., obstructive sleep apnea) |