Prednisone • Johns Hopkins Vasculitis Center
Once considered a fatal disease, vasculitis is now effectively treated as a chronic condition. Five main drug therapies are helping patients better manage their symptoms. Vasculitis is a complex illness. This spectrum of conditions involving blood vessel inflammation usually has unknown causes — and symptoms can be hard to pin down. Cleveland Clinic is a non-profit academic medical center.
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Treatment options vary among the different types of vasculitis. Doctors treat almost all types with a glucocorticoid medication, such as prednisone. For certain types of vasculitis, another medication in addition to prednisone is needed.
You want to consider ways to reduce this risk. Here are some of the more commonly used medications. In addition, there are other medications that your doctor may prescribe for vasculitis beyond those listed below. The side effects that are included below are not intended to be complete. People should review their treatment plan carefully with their doctor and pharmacist to understand about the risks of their medications and what can be done to monitor for and prevent side effects.
Prednisone is a glucocorticoid medication also called a steroid. Glucocorticoids are very valuable in the treatment of vasculitis as they have very broad effects on inflammation and are rapidly acting. Glucocorticoids are used in almost all forms of vasculitis. They can be given by mouth or by vein. The initial dosage will be determined by your doctor based upon many factors including the type of vasculitis and the severity of the vasculitis.
Usually, this is started at a higher dose and then reduced. Prednisone is a relative of a nature body hormone called cortisol which our body delivers in the morning. Because of this, we ideally give prednisone once a day in the morning to replicate what the body does naturally.
Increased infection risk is the number one concern with prednisone. Other prominent side effects include increased blood sugar diabetes , increased blood pressure, loss of bone density osteoporosis , easy bruising, and poor healing. Prednisone is also associated with increased appetite and weight gain and can result in mood swings and insomnia. People taking prednisone also notice a change in appearance related to redistribution of normal fat cells in the face and trunk which usually improves as the dose is lowered.
Rituximab is given by vein in an infusion center or hospital. The dose and frequency of rituximab will be determined by your doctor based on a number of different factors.
The main side effects of rituximab are reactions during the infusion, rashes and sores of the skin and mouth. An extremely rare described event is a type of brain virus infection called PML. Cyclophosphamide is a tried-and-true older drug, taken orally or intravenously, that doctors also use to treat cancer. It is currently given mainly in the setting of severe small- and medium-vessel vasculitis. Taken orally, the typical daily dose is 1. Throughout the day people should drink a large amount of fluid which helps to flush the medication out of the body in the urine so it is not sitting in the bladder.
If your doctor administers the drug intravenously, he or she will determine the dosage based on your height, weight and kidney function levels from what has been used in published studies. Cyclophosphamide has a number of potentially serious side effects that must be understood before this is taken.
As it can lower the blood counts, blood tests are performed every weeks. Cyclophosphamide can cause injury to the bladder and potentially bladder cancer.
Cyclophosphamide increases the risk of birth defects in pregnant women. Methotrexate is taken once a week. This drug comes in 2. Your doctor will base the dosage on what has been successfully used in studies, as well as your weight and other factors. The drug can also be given as an injection just under the skin, which some people prefer.
You may experience nausea or vomiting. Methotrexate can be associated with lowering of the blood counts, irritation of the lungs called pneumonitis , and liver injury. It is important to avoid drinking alcohol while taking methotrexate.
Avoidance of pregnancy is essential as methotrexate can cause miscarriages and birth defects. Your doctor will order blood tests to monitor your blood counts and liver function abnormalities show up in the tests. Prior to beginning treatment, doctors usually perform a blood test called TPMT which is a natural body enzyme which breaks down the medication. People who do not make this enzyme cannot take azathioprine and people who make lower amounts will need to be treated cautiously with a smaller dose.
In those who have a normal TPMT test, the dosage is usually based on your body weight. You may receive a single or twice-daily dose. Taking the drug twice a day instead of all at once, or taking it with meals helps some people avoid these side effects.
Rarely, people may have an allergic reaction to azathioprine that requires the medication to be stopped. It depends on the following factors: Fortunately for most patients, vasculitis will go into remission following treatment. The concern is that for most forms of vasculitis, a relapse or return of vasculitis can occur. Because of this, you need to be continually monitored by a physician experienced in treating vascultis. Ongoing monitoring and active communication between you and your doctor is the key to detecting and minimizing any relapses, Dr.
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