Prednisolone Cyclophosphamide

Myeloma Melphalan (or cyclophosphamide) + prednisolone Vincristine + adriamycin + dexamethasone high dose mdphalan autograft... 

Outcome measurements used in the evaluation of the outcome of treatment of RA with sulfasalazine, parenteral gold salts, D-penicillamine, hydroxychloroquine, prednisolone, MTX, cyclophosphamide (CyC), and azathioprine in single drug therapy cannot be compared with endpoints used in SBC-5-lMNs and biological-DMARDs combined with MTX. 

There is no cure for SLE. Guillermo el al. (G16) found only 10 randomized controlled trials during the past 5 years, 5 for lupus nephritis and 5 for all SLE patients. Compared to conventional therapies for lupus nephritis, a monthly bolus with intravenous cyclophosphamide is more effective than a monthly bolus with methyl prednisolone, but has significant side effects (including amenorrhea, cervical dysplasia, avascular necrosis, and herpes zoster) in both groups (G14). In order to avoid these side effects, more recent therapies have been developed. However, neither plasmapheresis (Wl), intravenous immunoglobulin (B21), recombinant human DNase (rhDNase) (D3), nor mycophenolate mofetil (C14) was shown to be more effective than conventional therapy. However, some of these... 

Astralagus 2. Echinacea 3. Liquorice 4. Milk thistle 5. Neem 6. Sea buckthorn 1. Ciclosporin 2. Azathioprine 3. Methotrexate 4. Tacrolimus 5. Dadizumab 6. Cyclophosphamide Possibility of graft rejection 1 blood level unknown mechanism (astralagus). Other mechanisms alkyl amides from echinacea modulate tumour necrosis factor alpha mRNA expression in human monocytes/macrophages via the cannabinoid type 2 receptor Unknown mechanism (milk thistle is known to l cyclosporine levels neem L effects of azathioprine, prednisolone and dadizumab sea buckthorn may 1 effect of cyclophosphamide) Induces metabolizing enzymes, CYP3A4 and P-gp (St John s wort L ciclosporin and tacrolimus levels) Avoid concomitant use of the herb... 

Diffuse large-cell lymphoma CHOP cyclophosphamide + doxorubicin + vincristine (Oncovin) - prednisolone... 

Follicular lymphoma Cyclophosphamide or chlorambucil + prednisolone Rituximab... 

If life-threatening, prednisolone up to 70 mg, or its equivalent of another steroid. The dose is then increased if necessary until the disease is controlled or adverse effects occur as much as prednisolone 2-3 mg/kg/d can be needed. Cyclophosphamide or azathioprine (see p. 292) are valuable adjuncts they may enhance the initial control of the disease and have a sparing effect on the maintenance dose of prednisolone required. 

Nephrotic syndrome. Patients with minimal change disease respond well to daily or alternate day therapy. With a total of prednisolone 60 mg/d, 90% of those who will lose their proteinuria will have done so within 4-6 weeks, and the dose is tapered off over 3-4 months. Longer courses only induce adverse effects. Relapses are common (50%) and it is then necessary to find a minimum dose of steroid that will keep the patient well. If a steroid is for any reason undesirable, cyclophosphamide or chlorambucil may be substituted. Membranous nephropathy may respond to high dose corticosteroid with or without chlorambucil. 

High-dose chemotherapy with cyclophosphamide, vincristine, prednisolone, and intrathecal methotrexate given for post-transplant lymphoproliferative disease was suggested to have favored the occurrence of acute ciclosporin neurotoxicity (headache, fever, seizures, and visual agnosia) in a 9-year-old cardiac transplant patient (239). Ciclosporin serum concentrations were normal and a further similar episode occurred on ciclosporin readministration. 

Five of thirty-two patients treated with the alternating drug regimen CAMBO-VIP (cyclophosphamide, doxorubicin, methotrexate, bleomycin, vincristine, etoposide, ifosfamide, and prednisolone) for non-Hodgkin s lymphoma developed blisters under the thickened skin of the palms and/or soles, followed by desquamation (28). 

Daily prednisolone significantly reduced the total clearance of cyclophosphamide and the peak concentration and AUC of 4-hydroxycyclophosphamide (78). It is not known whether this interaction has clinical consequences. 

Procarbazine is an alkylating agent that is used in the treatment of Hodgkin s disease in regimens such as MOPP (chlormethine (mechlorethamine), vincristine (Oncovin), procarbazine, and prednisolone) and BEACOPP (bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine, procarbazine, and prednisone) (1). It is also used to treat glioblastoma multiforme. 

An 18-year-old man with lymphocytic leukemia became completely blind for 6 months after a fifth 10-day cycle of therapy with vincristine 2 mg intravenously followed by cyclophosphamide 600 mg orally for 5 days with prednisolone 100 mg orally for 5 days (63). 

Johnson, M.A., Kwan, S., Snell, N.J.C. et al. (1989). Randomized controlled trial comparing prednisolone alone with cyclophosphamide and low dose prednisolone in combination in cryptogenic fibrosing alveolitis. Thorax 44, 280-288. 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Cytotoxic agents, when used in conjunction with corticosteroids, are effective in increasing the remission rate of nephrotic syndrome and reducing the frequency of ESKD at 10 years. Ponticelli and colleagues devised such a regimen by combining intravenous methyl-prednisolone (1 g) for 3 days followed by oral methylprednisolone (0.4 mg/kg) for the subsequent 27 days of months 1, 3, and 5. Oral chlorambucil (0.2 mg/kg) is to be given daily in months 2, 4, and 6. They also substituted cyclophosphamide (2.5 mg/kg per day) for chlorambucil, which resulted in similar rates of proteinuria remission and relapse, but with fewer serious side effects in those who received cyclophosphamide. ... 

Oral steroid is most frequently used for maintenance treatment (prednisolone 5 to 15 mg/day or equivalent). " Alternate-day regimens, although not evaluated, are often used in children to minimize growth retardation. Monthly pulse IV steroids in conjunction with cyclophosphamide resulted in more sustained remission, fewer relapses, and no significant increase in side effects. This combination has also been shown by meta-analysis to be more beneficial than steroid or cyclophosphamide alone. Cyclophosphamide, because of its bladder and gonadal toxicity, has been given as monthly and then bimonthly intravenous injection, instead of daily administration, for up to 2 or more years. However, toxicity is still a concern. A recent trial in Emope showed that after initial lower pulse doses of IV cyclophosphamide, oral azathioprine was able to attain remission rates similar to those of higher initial pulse doses of cyclophosphamide with quarterly foUow-up doses. ... 

CONVERSION TO MORE ACTIVE PRODUCTS The conversion of cyclophosphamide to aldophosphamide and prednisone to prednisolone are examples of active com-ponnds that are converted to more active substances. 

Delon, A. Favreliere, S. Couet, W. Courtois, P. Bouquet, S. Rapid and sensitive determination of thalidomide in human plasma hy high-performance liquid chromatography. J.Liq.Chromatogr., 1996, 18, 297—309 [SPE ciprofloxacin is IS simultaneous acyclovir, azathioprine, cefotaxime, ceftazidime, flucytosine, metronidazole non-interfering amphotericin, clobazam, clonazepam, cyclophosphamide, cyclosporin, diazepam, diltiazem, hydro zine, nifedipine, prednisolone]... 

Noninterfering acetaminophen, acyclovir, allopurinol, amoxicillin, amphotericin B, am-picillin, aspirin, azlocillin, bendrofluazide, bumetanide, buprenorphine, carbenidllin, cefazolin, cefotaxime, cefoxitin, ceftazidime, cefuroxime, cephalexin, chlorambucil, chloramphenicol, chlordiazepoxide, chlorpheniramine, chlorpropamide, cyclophosphamide, cyclosporin, C5d arabine, daunorubicin, dextropropoxyphene, dihydrocodeine, domperidone, flucytosine, furosemide, gentamicin, griseofulvin, melphalan, methotrexate, metochlo-pramide, metronidazole, miconazole, nabilone, netilmicin, nicotinamide, nitrazepam, penicillin G, piperacillin, prednisolone, procarbeizine, prochlorperazine, riboflavin, rifampin, sulfamethoxazole, thioguanine, tobramycin, tolbutamide, trimethoprim... 

Etretinate. A man with T-cell lymphoma who had recently been given chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisolone) was anticoagulated with warfarin after developing a pulmonary embolism. About three weeks later, he started etretinate 40 mg daily and it was found necessary to increase his warfarin dosage from 7 to 10 mg daily. His liver function tests were normal. This patient had also recently started taking co-proxamol , (p.436), tolbutamide , (p.380) and cimeti-dine , (p.412) , but all of these have been reported to only rarely increase the effect of warfarin. 

There is limited and conflicting evidence on the effect of prednisone and prednisolone on the metabolic activation of cyclophosphamide. Synergistic increases in enzyme induction may occur if cyclophosphamide is given with dexamethasone. Dexamethasone does not appear to alter ifosfamide metabolism. 

In an early study, single doses of prednisone were shown to inhibit the metaholie aetivation of cyclophosphamide, whereas another study briefly mentioned that massive single doses of prednisolone given just before eyelophosphamide did not inhibit cyclophosphamide metabolism. Longer-term prednisone treatment (50 mg daily for 1 to 2 weeks) increased the rate of aetivation of cyclophosphamide in the first study. Conversely, another study in 7 patients with systemic vasculitis given prednisone 1 mg/kg daily and cyclophosphamide 600 mg/m intravenously every 3 weeks for 6 eyeles found that, by the last cycle, the AUC of cyclophosphamide had significantly increased while that of its active metabolites had significantly decreased. ... 

Gastrointestinal A 51-year-old man with a jejunal B-cell lymphoma developed an acute ischemic colitis during treatment with cyclophosphamide, doxorubicin, and vincristine [29 ]. After switching to benda-mustine, prednisolone, and rituximab, he had no further episodes. 

Kondoh Y, Taniguchi H, Yokoi T, et al. Cyclophosphamide and low-dose prednisolone in idiopathic pulmonary fibrosis and fibrosing nonspecific interstitial pneumonia. Eur Respir J 2005 25 528-533. 

Various immunosuppressive drugs have been employed in SSc-ILD including cyclophosphamide, azathioprine, and mycophenolate mofetil (MMF). The most frequent treatment regimen involves low-dose prednisolone (<10 mg/day or 20 mg on alternate days). Higher-dose corticosteroid therapy has been implicated in the precipitation of renal crises. 

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