Corticosteroids

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Corticosteroids

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

Prednisone is often the first-line treatment for ITP. Recently 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 It is prescribed for a number of other diseases such as asthma or other autoimmune diseases.

Prednisone and other corticosteroids disrupt the communication between the pituitary and adrenals and can lead to adrenal insufficiency. It is very important that the corticosteroid dose be tapered gradually, especially with 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 even some of those may require further treatment.4

Dosage

The usual starting dose for prednisone or prednisolone for ITP patients is 1 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 i.e.-120 pounds would be a dose of 60 mg.

Dexamethasone is give at the rate of 40 mg ? d for 4 days. There is no taper. The series can be repeated periodically as needed.

Side Effects

A partial list of the possible problems contains the following: 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.

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

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