Pulse therapy

Itraconazole can be administered continuously (200 mg daily) or as pulse therapy (200 mg twice daily for 1 week per... 

Itraconazole (Sporanox), a triazole, is highly lipophilic and concentrates in skin. It is approved for both cutaneous deep fungal infections and dermatophyte nail disease, for which shorter courses of therapy are probably effective. Pulse therapy, whereby the drug is administered for 1 week and then the patient is off treatment for 3 weeks between pulses, may reduce toxicity without compromising antifungal efficacy. 

Empty sella syndrome occurred in a boy who developed hypopituitarism after long-term pulse therapy with prednisone for nephrotic syndrome (107). 

When markedly impaired growth is noted in patients treated with glucocorticoids long-term or in pulses, it is necessary to assess pituitary function and the anatomy of the pituitary gland. Children who receive glucocorticoid pulse therapy may develop an empty sella more frequently than is usually recognized. 

Two patients developed hypopituitarism and empty sella syndrome during glucocorticoid pulse therapy for nephrotic syndrome (SEDA-22, 444 118). 

Glucocorticoids should be used with caution in progressive systemic sclerosis, and concomitant administration of anticoagulants to prevent ischemic colitis is recommended when administering glucocorticoids in high doses, especially by pulse therapy (SEDA-21, 415 150). 

There has been a report of seven cases of acute severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Grave s ophthalmopathy (159). 

Among the adverse effects of pulse glucocorticoid therapy, joint manifestations are rare. A woman with systemic lupus erythematosus and nephritis developed transient bilateral knee effusions during pulse therapy with high doses of glucocorticoids (279). 

A 43-year-old woman developed cavitary lung tuberculosis after she received methotrexate and glucocorticoid pulse therapy for rheumatoid arthritis (321). 

The authors commented that the onset of the lung infection appeared to be closely related to methotrexate and glucocorticoid pulse therapy, because of the interval between drug administration and the onset of tuberculosis, and the lack of other risk factors for opportunistic infections. 

No adverse effects are to be expected after a single injection of a high dose of a glucocorticoid, but some serious complications have been observed with repeated use, including both infections and the known direct adverse effects of glucocorticoids. Cases of ventricular dysrhythmias and atrial fibrillation have been reported (SEDA-18, 391). With pulse therapy, the nature of the injected glucocorticoid seems to be important for example, hydrocortisone, which is more rapidly metabolized, seems to be better tolerated than dexamethasone (SEDA-6, 331). 

Kamoda T, Nakahara C, Matsui A. A case of empty sella after steroid pulse therapy for nephrotic syndrome. J Rheumatol 1998 25(4) 822-3. 

Kobayashi S, Warabi H, Hashimoto H. Hypopituitarism with empty sella after steroid pulse therapy. J Rheumatol 1997 24(l) 236-8. 

Yamanishi Y, Yamana S, Ishioka S, Yamakido M. Development of ischemic colitis and scleroderma renal crisis following methylprednisolone pulse therapy for progressive systemic sclerosis. Intern Med 1996 35(7) 583-6. 

Weissel M, Hauff W. Fatal liver failure after high-dose glucocorticoid pulse therapy in a patient with severe thyroid eye disease. Thyroid 2000 10(6) 521. 

Use corticosteroid intra-articular therapy or pulse therapy for disease flares... 

Methylprednisolone is similar to prednisone it is used i.v. for megadose pulse therapy (see below). 

Glucocorticoids inhibit the formation of antibodies. Of 111 consecutive heart transplant recipients taking oral prednisone (mean 13.8 months), 57% developed hypogammaglobulinemia (IgG below 7 g/1) (266). Those with severe hypogammaglobulinemia (IgG below 3.5 g/1) were at increassed risk of opportunistic infections compared with those with IgG concentrations over 3.5 g/1 (55 versus 5%, OR = 23). Parenteral glucocorticoid pulse therapy... 

Omdal R, Husby G, Koldingsnes W. Intravenous and oral cyclophosphamide pulse therapy in rheumatic diseases side effects and complications. Clin Exp Rheumatol 1993 ll(3) 283-8. 

A 26-year-old asthmatic woman had severe acute necrotizing eosinophilic endomyocarditis while taking pranlukast, inhaled beclomethasone, and oral theophylline (4). Oral prednisolone had been replaced by pranlukast 9 months before the event. Cardiac injury was accompanied by peripheral eosinophilia, cardiogenic shock, and pulmonary infiltrates, suggesting atypical Churg-Strauss syndrome. She recovered after intensive treatment, steroid pulse therapy, and withdrawal of pranlukast. 

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