Steroid sparing drugs for lupus

Yasmin contains 3 mg of the progestin DRSP, which has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to a 25 mg dose of spironolactone. Yasmin is contraindicated in patients with conditions that predispose to hyperkalemia (that is, renal impairment, hepatic impairment, and adrenal insufficiency). Women receiving daily, long-term treatment for chronic conditions or diseases with medications that may increase serum potassium concentration should have their serum potassium concentration checked during the first treatment cycle. Medications that may increase serum potassium concentration include ACE inhibitors , angiotensin –II receptor antagonists, potassium-sparing diuretics , potassium supplementation, heparin , aldosterone antagonists, and NSAIDs . Consider monitoring serum potassium concentration in high-risk patients who take a strong CYP3A4 inhibitor long-term and concomitantly. Strong CYP3A4 inhibitors include azole antifungals (. ketoconazole, itraconazole, voriconazole), HIV /HCV protease inhibitors (., indinavir, boceprevir), and clarithromycin [see CLINICAL PHARMACOLOGY ].

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

The value of glucocorticoids in the treatment of PMR has been established by decades of clinical experience and observational studies. Though we are not aware of any controlled trials comparing prednisone or prednisolone with placebo or other single agents, the brisk and dramatic therapeutic response to low-dose glucocorticoids remains a widely appreciated feature of PMR. Some patients with PMR may experience symptomatic improvement after only one or two doses of glucocorticoids, and the vast majority of such patients experience a marked improvement in symptoms within days of starting treatment, despite experiencing longstanding symptoms. Medications other than glucocorticoids, such as methotrexate (MTX) or tumor necrosis factor (TNF) inhibitors, have not conclusively been proven effective in PMR. Nonsteroidal antiinflammatory drugs (NSAIDs) have no role in the primary management of PMR.

Two small trials recruiting 23 participants met the inclusion criteria for the review . Participants may have been suffering from comorbid lung disease. No data on oral steroid consumption were reported. No significant differences were observed in the studies for FEV 1 , FVC, PaO 2 and symptoms. One study reported a statistically significant difference in SGaw, but the clinical importance of this is uncertain. Due to concerns over the small sample sizes and methodological shortcomings in terms of inadequate washout in one study , and methods used in outcome assessment for both studies, the findings of the studies are not generalisable to the issue of steroid tapering. An update search conducted in August 2010 did not identify any new studies for consideration in the review .

Steroid sparing drugs for lupus

steroid sparing drugs for lupus

Two small trials recruiting 23 participants met the inclusion criteria for the review . Participants may have been suffering from comorbid lung disease. No data on oral steroid consumption were reported. No significant differences were observed in the studies for FEV 1 , FVC, PaO 2 and symptoms. One study reported a statistically significant difference in SGaw, but the clinical importance of this is uncertain. Due to concerns over the small sample sizes and methodological shortcomings in terms of inadequate washout in one study , and methods used in outcome assessment for both studies, the findings of the studies are not generalisable to the issue of steroid tapering. An update search conducted in August 2010 did not identify any new studies for consideration in the review .

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