Treatment for vasculitic neuropathy?
Dec 2012
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hi sir my name is XXXXXX
last month i was diagnosed as vasculitic neuropathy..can you tell me the guidelines of treatment
last month i was diagnosed as vasculitic neuropathy..can you tell me the guidelines of treatment
Posted Sun, 5 May 2013
in Brain and Spine
Answered by Dr. Nsah Bernard 4 hours later
Hello XXXXXX,
Thanks for posting on XXXXXXX
**Treat systemic vasculitic neuropathy and nonsystemic vasculitis with a combination of prednisone and cyclophosphamide or, less commonly, azathioprine (Imuran), methotrexate, and intravenous immunoglobulin.
- Take prednisone for 2-3 months or until clinical beneficial effect is noted; then taper gradually according to clinical/symptomatic response. The typical starting dose is 40-100 mg daily, which is eventually tapered to every other day dosing to avoid side effects. Cyclophosphamide is started at 100-150 mg daily.
- Continue treatment for 6 months to 1 year or longer. Some patients may require long-term immunosuppression for years.
- Discuss adverse affects and toxicity of long-term use of corticosteroids and immunosuppressive agents with your treating doctor prior to onset of therapy.
** Symptomatic treatment of neuropathic pain can be initiated with amitriptyline and/or nortriptyline, carbamazepine, or gabapentin. Other systemic manifestations of systemic vasculitis require management according to organ involvement and specialty consultation.
I suggest you get the opinion of a neurologist or an internist before you follow through the above guidelines.
Hope this helps and wish you the best.
Dr. Nsah
Thanks for posting on XXXXXXX
**Treat systemic vasculitic neuropathy and nonsystemic vasculitis with a combination of prednisone and cyclophosphamide or, less commonly, azathioprine (Imuran), methotrexate, and intravenous immunoglobulin.
- Take prednisone for 2-3 months or until clinical beneficial effect is noted; then taper gradually according to clinical/symptomatic response. The typical starting dose is 40-100 mg daily, which is eventually tapered to every other day dosing to avoid side effects. Cyclophosphamide is started at 100-150 mg daily.
- Continue treatment for 6 months to 1 year or longer. Some patients may require long-term immunosuppression for years.
- Discuss adverse affects and toxicity of long-term use of corticosteroids and immunosuppressive agents with your treating doctor prior to onset of therapy.
** Symptomatic treatment of neuropathic pain can be initiated with amitriptyline and/or nortriptyline, carbamazepine, or gabapentin. Other systemic manifestations of systemic vasculitis require management according to organ involvement and specialty consultation.
I suggest you get the opinion of a neurologist or an internist before you follow through the above guidelines.
Hope this helps and wish you the best.
Dr. Nsah
Follow-up: Treatment for vasculitic neuropathy? 8 hours later
sir what about parenteral therapy,,i was suggested to take methyl prednisolone 1g IV in 0.5 NS run over 4-6 hrs...once in 5 days upto three months...
is this dose heavy or normal..kindly guide me
is this dose heavy or normal..kindly guide me
Answered by Dr. Nsah Bernard 11 minutes later
Hello,
Yes methylprednisolone (solu-methrol) injection can be used and the dose of 1g IV is allowed daily. But be rest assured that you will derive the same benefit if you considered oral route instead of parenteral route. The only difference is you will have to go through a session of 4-6hrs every 5 days for three months when placed on parenteral where as oral treatment, you could be ambulatory while taking your treatment. Each route has both its benefits and it disadvantages and I believe your doctor can sit you down and explain the benefits (Note that you are also free to choose which route suits you).
Hope this helps and wish you the best.
Dr. Nsah
Yes methylprednisolone (solu-methrol) injection can be used and the dose of 1g IV is allowed daily. But be rest assured that you will derive the same benefit if you considered oral route instead of parenteral route. The only difference is you will have to go through a session of 4-6hrs every 5 days for three months when placed on parenteral where as oral treatment, you could be ambulatory while taking your treatment. Each route has both its benefits and it disadvantages and I believe your doctor can sit you down and explain the benefits (Note that you are also free to choose which route suits you).
Hope this helps and wish you the best.
Dr. Nsah
Follow-up: Treatment for vasculitic neuropathy? 2 minutes later
sir i heard that side effects are more for oral medication comparing to parenteral preparation...
i consulted 2 neurologists and they said like that,,its better to take parentral therapy than oral one
i consulted 2 neurologists and they said like that,,its better to take parentral therapy than oral one
Answered by Dr. Nsah Bernard 4 hours later
Hello,
Like I said both have advantages and disadvantages. Side effects are more for oral than parental as it is given in sessions and not daily. You may go in for the parenteral (you will have little or no side effects). I did only try to provide you with a treatment guideline as you requested and I gave you WHO recommendation (1st line treatment).
Hope this helps and wish you the best.
Dr. Nsah
Like I said both have advantages and disadvantages. Side effects are more for oral than parental as it is given in sessions and not daily. You may go in for the parenteral (you will have little or no side effects). I did only try to provide you with a treatment guideline as you requested and I gave you WHO recommendation (1st line treatment).
Hope this helps and wish you the best.
Dr. Nsah
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