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Arthritis (Expert Forum)
Immune disorders, medication
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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Immune disorders, medication
by Systemic, Feb 07, 2007 12:00AM
Dear Doctor,
Many medication makes the patient dependent: for example prednisone, taken for a long time, you can not suddenly withdraw from it because a life threatening flare up will happen.
Is it true for the other medication?
I am intereste mainly into:
enbrel
cyclosporin
cyclophophamide (this is the most important I am worried about)
An experiment: a healthy person (i.e. no immune disorder ever) takes cyclophospahmide IV for 6 month; what could happen if she abruptly stops taking it?
How could I say a flare is from stopping a medication or it is from the disease? If I can not make the difference clinically ( I am not talking here about lab tests which are always interpretable, having too many inputs of all kinds: ferritin, LDH, D-Dimer, CBC, ESR, CRP and so on; one of them will be always bad and nobody really understand why some got good and the others tests got bad. There is not a clear interpretation; 2 doctors see different from the same results!).
Could you make light into this?
Thank you!
Systemic
Many medication makes the patient dependent: for example prednisone, taken for a long time, you can not suddenly withdraw from it because a life threatening flare up will happen.
Is it true for the other medication?
I am intereste mainly into:
enbrel
cyclosporin
cyclophophamide (this is the most important I am worried about)
An experiment: a healthy person (i.e. no immune disorder ever) takes cyclophospahmide IV for 6 month; what could happen if she abruptly stops taking it?
How could I say a flare is from stopping a medication or it is from the disease? If I can not make the difference clinically ( I am not talking here about lab tests which are always interpretable, having too many inputs of all kinds: ferritin, LDH, D-Dimer, CBC, ESR, CRP and so on; one of them will be always bad and nobody really understand why some got good and the others tests got bad. There is not a clear interpretation; 2 doctors see different from the same results!).
Could you make light into this?
Thank you!
Systemic
Doctor's Answer
by Kevin Pho, MD, Feb 08, 2007 12:00AM
, Feb 08, 2007 12:00AM
I am not aware of habitual or dependent behavior associated with immunomodulator medication. To my knowledge, these medications do not need to be tapered the way prednisone does, although this should be discussed with your physician.
However, if these medications are appropriately controlling the disease, there is the possibility that it will flare up after stopping these medications.
Regarding the prednisone, you're right in that they shouldn't be stopped abruptly. That is why many physicians taper the dose over time.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
However, if these medications are appropriately controlling the disease, there is the possibility that it will flare up after stopping these medications.
Regarding the prednisone, you're right in that they shouldn't be stopped abruptly. That is why many physicians taper the dose over time.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
