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CORRESPONDING AUTHOR : There was initial alarm and anxiety about the large doses
of corticosteroids and cyclophosphamide, but today this
Dr. RASHMI MITTAL
therapy is given as a routine infusion, often in a day care or
Assistant Professor
OPD setting, with the patient going home a few hours after
Department of Dermatology & STD
completion of the infusion.
Sri Ramachandra Medical College and Research Institute
Porur, Chennai – 600116. There have been modifications of DCP therapy 10.
E-mail : saresh15@hotmail.com Cyclophosphamide is known to cause oligo / azoospermia
a
Department of Dermatology and amenorrhoea. For unmarried patients who have not
44 N Sri Ramachandra Journal of Medicine Vol. 1 Issue 2 January 2007
Short Review
completed their family, cyclophosphamide is replaced OTHER FORMS OF PULSE THERAPY
with azathioprine 50 mg (DAP therapy). Methotrexate,
1. Cyclophosphamide pulse therapy
7.5 mg (DMP) was instituted in patients who were not
completing Phase I even after 12 pulses (1 year) of DCP Gokhale et al 14 evaluated the response to pulse
or DAP therapy. intravenous cyclophosphamide therapy in patients of
pemphigus vulgaris. Cyclophosphamide 500 mg pulses
Contraindications of DCP therapy
are given in 500 ml of 5% dextrose solution slowly
DCP therapy can be given to patients of all ages but intravenously. These pulses are given monthly for
the doses have to be reduced to half for children below the 12 months and 2 monthly for further 6 pulses. Close
age of 12 years 9. It can also be administered to patients monitoring of kidney and bladder function was done. The
having other medical problems like diabetes mellitus, response to therapy was good to excellent in more than
hypertension, osteoporosis, tuberculosis. Diabetic patients 60% of patients. This form of pulse therapy has been tried
need to be given 10 units of soluble insulin for every 500
in other conditions like lupus nephritis, serious central
ml bottle of 5% dextrose dissolved in the same drip. In
nervous involvement in lupus erythematosus and
addition they must be given the routine treatment for diabetes
Wegener’s granulomatosis.
mellitus. Similarly patients having concomitant diseases like
hypertension and tuberculosis must receive the respective 2. Pulse therapy with antifungals
medication. If there is serious infection elsewhere or if the Itraconazole, fluconazole are used to treat superficial
patient has severe bacterial, viral or fungal infections, the and deep fungal infections. These drugs are administered in
pulse may be delayed for a week or two till the infection weekly doses every month.
has been brought under control. Pulse therapy is absolutely
contraindicated in pregnant, lactating and unmarried Itraconazole - 400 mg / day for 1 week every month for
patients. 3 months, for treatment of Tinea unguium.