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Suggest Effective Alternatives To Prednisone And Dapsone For Bullous Pemphigoid
Question: Hello Doctor,
My mother is diagnosed with Bullous Pemphigoid. She is on titrating dose of Prednisone. She also taking Dapsone. She had no new flare up of blisters. I would really like to see her off these medications. She says predinisone and dapsone is making her real tired, aches mainly in her legs and very shaky. Is there anything suggestive or alternative medications that we can use. That is less potent while keeping her symptom free.
Thank you
My mother is diagnosed with Bullous Pemphigoid. She is on titrating dose of Prednisone. She also taking Dapsone. She had no new flare up of blisters. I would really like to see her off these medications. She says predinisone and dapsone is making her real tired, aches mainly in her legs and very shaky. Is there anything suggestive or alternative medications that we can use. That is less potent while keeping her symptom free.
Thank you
Brief Answer:
Side effects are likely due to hypokalemia;increase in take of fruits/juice
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your queery and I have understood it.
Bullous pemphigoid (BP) responds very well to Oral steroids i.e Prednisolone. Oral steroids are the drugs of choice in BP and are necessary for disease control.
Side effects like muscle aches and pains are quite common with oral prednisolone. This is because of the mineralocorticoid action of Oral steroids which causes hypokalemia (low serum potassium). This can be documented by measuring her serum potassium levels which if < 3.5 mEql/ L confirms hypokalemia.
Either she can be switched to a purely glucocorticoid steroid like methylprednisolone Or Deflazacort which unlike prednisolone are devoid of mineralocorticoid actions.
Alternatively, to rectify hypokalemia, potassium can be supplemented from outside by increasing intake of fruits like banana and fruit juices.
Another option is to give her potassium hydrochloride in syrup form. The dose of syrup would depend on serum potassium levels below normal (normal levels are 3.5-5.5 mEql/L).
Since her disease is in remission now, prednisolone would anyways be tapered gradually and stopped if no new lesions appear and by the time dapsone takes over disease control.
Regards
Side effects are likely due to hypokalemia;increase in take of fruits/juice
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your queery and I have understood it.
Bullous pemphigoid (BP) responds very well to Oral steroids i.e Prednisolone. Oral steroids are the drugs of choice in BP and are necessary for disease control.
Side effects like muscle aches and pains are quite common with oral prednisolone. This is because of the mineralocorticoid action of Oral steroids which causes hypokalemia (low serum potassium). This can be documented by measuring her serum potassium levels which if < 3.5 mEql/ L confirms hypokalemia.
Either she can be switched to a purely glucocorticoid steroid like methylprednisolone Or Deflazacort which unlike prednisolone are devoid of mineralocorticoid actions.
Alternatively, to rectify hypokalemia, potassium can be supplemented from outside by increasing intake of fruits like banana and fruit juices.
Another option is to give her potassium hydrochloride in syrup form. The dose of syrup would depend on serum potassium levels below normal (normal levels are 3.5-5.5 mEql/L).
Since her disease is in remission now, prednisolone would anyways be tapered gradually and stopped if no new lesions appear and by the time dapsone takes over disease control.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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