Prednisolone/tetracosactide

Prednisolone/tetracosactide Reactions 1704, p317 - 2 Jun 2018 Various toxicities: 4 case reports In a retrospective review, four patients (3 boys and 1 girl) aged 6 8 months were described, of whom, one patient developed Cushingoid features and hirsutism, one patient developed adrenal insufficiency and one patient developed Cushingoid features during treatment with prednisolone, and the remaining one patient developed hyperirritability and increased blood pressure during treatment with tetracosactide [durations of treatments to reactions onsets and outcomes not stated]. Patient 1: The 6-months-old girl presented in October 2010, with a diagnosis of infantile spasms. She subsequently received an initial treatment. However, after two weeks, she again presented with no improvement in her seizures. Hence, she started receiving oral high dose prednisolone tablet 40 mg/day as per the United Kingdom infantile spasms study (UKISS) protocol. In the following seven days, her seizures stopped. Therefore, the prednisolone dose escalation was not required. However, she subsequently developed side effects of Cushingoid features and hirsutism. Patient 2: The 7-months-old boy presented in November 2012, with hypotonia. While assessing the hypotonia, he was diagnosed with infantile spasms. He subsequently started receiving oral high dose prednisolone tablet 40 mg/day as per the UKISS protocol. On day 4 of the treatment, his clinical spasms resolved, however, a the electrographic spasmcomplexes were persisted. Hence, the dose of prednisolone was increased to 60 mg/day in the second week, and then was tapered off subsequently. Considering the use of high dose steroid therapy, a short Synacthen test was performed, results of which revealed adrenal insufficiency. The adrenal insufficiency was suspected to be due to the use of high-dose steroids. Consequently, a replacement dose of steroids was administered. Patient 3: The 8-months-old boy presented in September 2013, with complaints of increasing frequency of clusters of extensor spasms, initiated in August 2013. He was subsequently diagnosed with infantile spasms, and started receiving oral high dose prednisolone tablet 40 mg/day as per the UKISS protocol. However, the clinical spasms persisted beyond the first week. Hence, the dose of prednisolone was increased to 60 mg/day in the second week. Following the dose escalation in week 2, the spasms resolved. He subsequently developed a side effect of Cushingoid features. Patient 4: The 7-months-old boy presented in August 2016, with clusters of extensor spasms. He was subsequently diagnosed with infantile spasms, and started receiving SC depot tetracosactide injection at 0.5mg on alternate days, as per the UKISS protocol. However, the spasms persisted with this dose. Additionally, he also developed side effects that included hyperirritability and raised blood pressure (raised up to 99 percentile). Although, the dose of tetracosactide was increased to 0.6mg, on alternate days. Author comment: "No serious side effects were documented with the exception of Cushingoid features and hirsutism [patient 1]." "Given the use of a very high dose steroid treatment. . .he was found to have adrenal insufficiency [patient 2]." "No severe side effect occurred except Cushingoid features [patient 3]." "[S]ide effects of [tetracosactide] occurred, including hyperirritability and blood pressure shooting up to 99 percentile [patient 4]." Yuen CL, et al. Local Experience in using Hormonal Therapies according to the UKISS Studies in the Treatment of Infantile Spasms in Hong Kong. Journal of Pediatric Epilepsy 7: 27-30, No. 1, Mar 2018. Available from: URL: http:// doi.org/10.1055/s-0038-1636947 - Hong Kong 803322912 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Prednisolone/tetracosactide

Reactions Weekly , Volume 1704 (1) – Jun 2, 2018
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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-018-46960-0
Publisher site
See Article on Publisher Site

Abstract

Reactions 1704, p317 - 2 Jun 2018 Various toxicities: 4 case reports In a retrospective review, four patients (3 boys and 1 girl) aged 6 8 months were described, of whom, one patient developed Cushingoid features and hirsutism, one patient developed adrenal insufficiency and one patient developed Cushingoid features during treatment with prednisolone, and the remaining one patient developed hyperirritability and increased blood pressure during treatment with tetracosactide [durations of treatments to reactions onsets and outcomes not stated]. Patient 1: The 6-months-old girl presented in October 2010, with a diagnosis of infantile spasms. She subsequently received an initial treatment. However, after two weeks, she again presented with no improvement in her seizures. Hence, she started receiving oral high dose prednisolone tablet 40 mg/day as per the United Kingdom infantile spasms study (UKISS) protocol. In the following seven days, her seizures stopped. Therefore, the prednisolone dose escalation was not required. However, she subsequently developed side effects of Cushingoid features and hirsutism. Patient 2: The 7-months-old boy presented in November 2012, with hypotonia. While assessing the hypotonia, he was diagnosed with infantile spasms. He subsequently started receiving oral high dose prednisolone tablet 40 mg/day as per the UKISS protocol. On day 4 of the treatment, his clinical spasms resolved, however, a the electrographic spasmcomplexes were persisted. Hence, the dose of prednisolone was increased to 60 mg/day in the second week, and then was tapered off subsequently. Considering the use of high dose steroid therapy, a short Synacthen test was performed, results of which revealed adrenal insufficiency. The adrenal insufficiency was suspected to be due to the use of high-dose steroids. Consequently, a replacement dose of steroids was administered. Patient 3: The 8-months-old boy presented in September 2013, with complaints of increasing frequency of clusters of extensor spasms, initiated in August 2013. He was subsequently diagnosed with infantile spasms, and started receiving oral high dose prednisolone tablet 40 mg/day as per the UKISS protocol. However, the clinical spasms persisted beyond the first week. Hence, the dose of prednisolone was increased to 60 mg/day in the second week. Following the dose escalation in week 2, the spasms resolved. He subsequently developed a side effect of Cushingoid features. Patient 4: The 7-months-old boy presented in August 2016, with clusters of extensor spasms. He was subsequently diagnosed with infantile spasms, and started receiving SC depot tetracosactide injection at 0.5mg on alternate days, as per the UKISS protocol. However, the spasms persisted with this dose. Additionally, he also developed side effects that included hyperirritability and raised blood pressure (raised up to 99 percentile). Although, the dose of tetracosactide was increased to 0.6mg, on alternate days. Author comment: "No serious side effects were documented with the exception of Cushingoid features and hirsutism [patient 1]." "Given the use of a very high dose steroid treatment. . .he was found to have adrenal insufficiency [patient 2]." "No severe side effect occurred except Cushingoid features [patient 3]." "[S]ide effects of [tetracosactide] occurred, including hyperirritability and blood pressure shooting up to 99 percentile [patient 4]." Yuen CL, et al. Local Experience in using Hormonal Therapies according to the UKISS Studies in the Treatment of Infantile Spasms in Hong Kong. Journal of Pediatric Epilepsy 7: 27-30, No. 1, Mar 2018. Available from: URL: http:// doi.org/10.1055/s-0038-1636947 - Hong Kong 803322912 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704

Journal

Reactions WeeklySpringer Journals

Published: Jun 2, 2018

References

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