Prednisone
Prednisone can be used for standard therapy in adults at a dose of, 1.0 - 1.5 mg/kg/day.
Ref. N Engl J Med, Vol 346, No 13. page 1000 . March 28, 2002 Immune Thrombocytopenic Purpura Douglas B Cines, Victor S Blanchette
Mode of Action
Modulation of the autoimmune response.
Corticosteroids may also have many suppressive effects on the immune system including RES blockade, altered FcR-mediated immune clearance, decreased platelet-antibody binding, T-cell and B-cell suppression and diminished cytokine synthesis.
Ref. Seminars in Hematology, Vol 35, No 1 (January), 1998 pp 19: Anti-D: Mechanisms of Action Russel E Ware and Sherri A Zimmerman
Side Effects
Possible side effects of long term steroid use include bone resorption with fragility of long bones, induction of diabetes, alteration of mood resulting in psychoses or hyperactivity in children, weight gain, increase in acne, thinning of the skin and other cosmetic changes.
Ref. Blood, Vol 88, No 1 (July 1), 1996: pp 3-40. Idiopathic Thrombocytopenic Purpura: A Practice Guideline Developed by Explicit Methods for The American Society of Hematology; James N George et al.
Response Rate
50%-75 % initially. Long term response is variable. Response in roughly 3 weeks.
Ref. Ref. N Engl J Med, Vol 346, No 13. page 1000 . March 28, 2002 Immune Thrombocytopenic Purpura Douglas B Cines, Victor S Blanchette
The following Precautions are listed in the CPhA Monograph for Corticosteroids: Systemic
Because complications of treatment with corticosteroids are dependent on the dosage regimen, a risk/benefit decision must be made in each individual case with respect to dose and duration of treatment and whether daily or intermittent therapy should be used. Patients on long term corticosteroids therapy who are subjected to unusual stress such as injury or surgery may require an increased dosage of corticosteroid during and after the stress.
Cortocosteroid therapy can cause mental or mood disturbances including hypomania, mania, depression and psychosis. These reactions appear to be dose-related and more commonly seen in the first few weeks of therapy, but are sometimes seen following sharp decreases in corticosteoid dosage .
Avascular or aseptic necrosis of the femoral or humeral head has been associated with long-term use, however, it has also occurred in patients receiving high dose, short-term therapy. This adverse effect is more likely to occur in patients with a predisposing illness such as rheumatoid arthritis or systemic lupus erythematosis.
Systemic corticosteroid therapy has been associated with loss of bone density and osteoporosis, that are reversible after discontinuation of the corticosteroid.
There is an enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis.
ASA and nonsteroidal anti-inflammatory agents should be used cautiously in conjunction with corticosteroids in patients with hypoprothrombinemia.
Adverse Effects Include but not limited to:
Cardiovascular: thromboembolism, hypercholesterolemia, arrythmias
Dermatologic: impaired wound healing, thin fragile skin, petechiae and ecchymoses, facial erythema, striae, hursutism, acneiform eruptions, urticaria, allergic stomatitis, angioneurotic edema.
Endocrine: decreased carbohydrate tolerance, hyperglycemia, glycoruria, increased insulin requirement in diabetes, manifestations of latent diabetes, menstrual irregularities, development of cushingoid state, suppression of growth in children.
Fluid and Electrolyte Disturbances: sodium retention, fluid retention, congestive heart failure, potassium loss, hypokalemic alkalosis, hypertension, hypocalcemia .
Gastrointestinal: nausea, vomiting, anorexia, increased appetite, ciarrhea or constipation, abdominal distension, pancreatitis, gastric irritation and ulcerative esophagitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large bowel .
Hematologic: leukocytosis, thrombocytopenia, lymphopenia.
