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Deltasone Original
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In situations of less severity lower doses will generally suffice while in selected patients higher initial doses may be required. The Deltasone original dosage should be maintained or adjusted until a satisfactory response is noted, Deltasone Original, Deltasone Original. If after a reasonable period of time there is a lack of satisfactory clinical response, DELTASONE prednisone should be discontinued and the patient generic Cymbalta to other appropriate therapy.
After a favorable response is noted, the proper maintenance dosage Où commander du Zestoretic sans ordonnance be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an Deltasone original clinical response is reached.
It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient’s individual drug responsiveness, and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation it may be necessary to increase the dosage of DELTASONE prednisone for a period of time consistent with the patient’s condition, Deltasone Original.
Prednisone
If Deltasone original long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly. Multiple Sclerosis In the treatment of acute exacerbations of multiple sclerosis daily doses of mg of prednisolone for a week followed by 80 mg Deltasone original other day for 1 month have been shown to be effective. Dosage range is the same for prednisone and prednisolone.
The purpose of this mode of therapy is to provide the patient requiring long-term pharmacologic dose treatment with the beneficial effects of corticoids while minimizing certain undesirable effects, Deltasone Original, including pituitary-adrenal suppression, Deltasone Original, the Cushingoid state, Deltasone Original, corticoid withdrawal symptomsand growth suppression in children, Deltasone Original. The rationale for this treatment schedule is based on two major premises: A brief review of the HPA physiology may be helpful in understanding this rationale, Deltasone Original.
Acting primarily through the hypothalamus a fall in free cortisol stimulates the pituitary gland to produce increasing amounts of corticotropin ACTH while a rise in free cortisol inhibits ACTH secretion.
Normally the HPA system is characterized by diurnal circadian rhythm, Deltasone Original. Serum levels of ACTH rise from a low point about 10 pm to a peak level about 6 am, Deltasone Original. Increasing levels of ACTH stimulate adrenocortical activity resulting in a rise in plasma cortisol with maximal levels occurring between 2 am and 8 am.
This rise in cortisol dampens ACTH production and in turn adrenocortical activity. There is a gradual fall in plasma corticoids during the day with lowest levels occurring Deltasone original midnight.
The diurnal rhythm of the HPA axis is lost in Cushing’s disease, a syndrome of adrenocortical hyperfunction characterized by obesity with centripetal fat distribution, thinning of the skin with easy bruisability, muscle wasting with weakness, hypertensionlatent diabetesosteoporosiselectrolyte imbalance, Deltasone Original, etc.
The same clinical findings of hyperadrenocorticism may be noted during long-term pharmacologic dose corticoid therapy administered in conventional daily-divided doses, Deltasone Original. It would appear, then, Deltasone Original, that a disturbance in the diurnal cycle with maintenance of elevated corticoid values during the night may play a significant role in the development of undesirable corticoid effects. Escape from these constantly elevated plasma levels for even short periods of time may be instrumental in protecting against undesirable pharmacologic effects.
During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex.
Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation.
Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone 10 mg as opposed to a quarter of that dose administered every 6 hours, there is evidence that some suppressive effect on Deltasone original activity may be carried over into the following day when pharmacologic doses are Deltasone original.
Further, Deltasone Original, it has been shown that a single dose of certain corticosteroids will produce adrenocortical suppression for two or more days.
The following should be kept in mind when considering alternate day therapy: Basic principles and indications for corticosteroid therapy should apply. The benefits of ADT should not encourage the indiscriminate use of steroids.
ADT is a therapeutic technique primarily designed for patients in whom long-term pharmacologic corticoid therapy is anticipated.
In less severe disease processes in which corticoid therapy is indicated, Deltasone Original, it may be possible to initiate treatment with ADT. More severe disease states usually will require daily divided high dose therapy for initial control of the disease process.
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The initial suppressive dose level should be continued until satisfactory clinical response is obtained, Deltasone Original, usually four to ten days in the case of many allergic and collagen diseases, Deltasone Original. It is important to keep the period of initial suppressive dose as brief as possible particularly when subsequent use of alternate day therapy is intended.
Once control has been established, two courses are available: Theoretically, course a may be preferable. Because of the advantages of ADT, it may be desirable to try patients on this form of therapy who have been on Deltasone original corticoids for Deltasone original periods of Deltasone original eg, patients with Deltasone original arthritis.
Since these patients may already have a suppressed HPA axis, establishing them on ADT may be difficult and not always successful. However, it is recommended that regular attempts be made to change them Deltasone original. It may be helpful to triple or even quadruple the daily maintenance dose and administer this every other day rather than just doubling the daily dose if difficulty is encountered.
Once the patient is again controlled, an attempt should be made to reduce this dose to a minimum. As indicated above, certain corticosteroids, because of their prolonged suppressive effect on adrenal activity, are not recommended for alternate day therapy eg, dexamethasone and betamethasone. The maximal activity of the adrenal cortex is between 2 am and 8 am, and it is minimal Deltasone original 4 pm and midnight.
Exogenous corticosteroids suppress adrenocortical activity the least, when given at the time of maximal activity am. In using ADT it is important, as in all therapeutic situations to individualize and tailor the therapy to each patient.
Side Effects
Complete control of symptoms will not be possible in all patients. An explanation of the benefits of ADT will help the patient to understand and tolerate the possible flare-up in symptoms which may occur in the latter part of the off-steroid day. Other symptomatic therapy may be added or increased at this time if needed. In the event of an Deltasone original flare-up of the disease process, Deltasone Original, it may be necessary to return to a full suppressive daily divided corticoid dose for control, Deltasone Original.
Once control is again established alternate day therapy may be re- instituted. Although many of the undesirable features of corticosteroid therapy can be minimized by ADT, Deltasone Original, as in any therapeutic situation, the physician must carefully weigh the benefit-risk ratio for each patient in whom corticoid therapy is being considered. Federal law prohibits dispensing without prescription.
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