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Corticosteroids

(ex. Prednisone, prednisolone, Decadron (dexamethasone) and deflazacort)

Prednisone is often the first-line treatment for ITP. Some research indicates that short courses of dexamethasone are preferable in treating newly diagnosed cases.1

Both prednisone and dexamethasone are types of corticosteroids, drugs based on a naturally occurring hormone produced by the adrenal glands involved in the control of inflammation, stress response, metabolism, behavior, electrolyte balance and more.2 Prednisone is prescribed for a number of diseases including asthma and other autoimmune diseases.

Prednisone and other corticosteroids disrupt the communication between the pituitary and adrenals which can lead to adrenal insufficiency. It is very important that the corticosteroid dose be tapered gradually, especially with after a high dose or long term use, giving the adrenals a chance to resume natural hormone production. 3

While from 50% to 90% of patients with ITP see a rise in platelet counts with an initial high dose of corticosteroids, only 10% to 30% have a durable remission, and some of those may require further treatment.4

Dexamethasone, in combination with rituximab, has produced better results in newly diagnosed patients than dexamethasone alone.6

Dosage

The usual starting dose for prednisone or prednisolone for ITP patients is .5 to 2 mg/kg. for 2-4 weeks before tapering, depending on the response. 5 1 kilogram (kg) is equal to 2.2 pounds; so you would divide your body weight by 2.2 to figure the starting dosage, that is: 120 pounds would be a dose of 60 mg.

Dexamethasone is given at the rate of 40 mg per day for 4 days, equivalent to about 400 mg of prednisone a day.  There is no taper. The series can be repeated periodically as needed.

Side Effects

A partial list of the possible problems: cataracts, gastrointestinal discomfort, osteoporosis, obesity, moon face, hypertension (high blood pressure), diabetic metabolism (blood sugar changes), sleep disturbances (insomnia), psychiatric syndromes (mood changes), delayed wound healing, atrophy (muscle wasting, including the heart muscle), potassium loss, and changes in the skin.5

The side effects can be difficult to manage and grow in severity if the treatment is continued for a long time.

The side effects of withdrawing from prednisone can also cause problems. It is important to work closely with a physician as the drug is discontinued.  

Suggested Reading

Coping with Prednisone: it may work miracles, but how do you handle the side effects? - by Eugenia Zukerman and Julie Ingelfinger, MD, St Martin's Press, 1997.

Buy your copy at the Platelet Store

Predicting Success

 (under construction)

References

1.Cheng Y et al. “Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone.” N Engl J Med. 2003 Aug 28;349(9):831-6.http://content.nejm.org/cgi/content/short/349/9/831
2. Wikipedia: corticosteroid http://en.wikipedia.org/wiki/Corticosteroid
3. Guignat L et al. “Glucocorticoid treatments and adrenal function.” Rev Prat. 2008 May 15;58(9):966-70 http://www.ncbi.nlm.nih.gov/pubmed/18672662
4. Cines DB, Bussel JB. “How I treat idiopathic thrombocytopenic purpura (ITP).”Blood. 2005 Oct 1;106(7):2244-51. http://bloodjournal.hematologylibrary.org/cgi/content/full/106/7/2244
5. Provan, D, “International consensus report on the investigation and management of primary immune thrombocytopenia,” Blood. 2010 Jan 14; 115 (2):168-86. http://bloodjournal.hematologylibrary.org/cgi/content/full/115/2/168
6. Gudbrandsdottir S, "Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia." Blood. 2013 Jan 4.
http://www.ncbi.nlm.nih.gov/pubmed/23293082