PULSE GLUCOCORTICOID THERAPY - THE BIG SHOT REVISTED

The term pulse therapy refers to discontinuous intravenous infusion of very high doses of drugs over a short time. Methylprednisolone (and d examethasone in some countries) is the glucocorticoid most frequently administered this way. Doses of each pulse are not standardized but ar e usually 10 to 20 mg per kilogram of body weight for methylprednisolo ne (250-1000 mg) and 2 to 5 mg per kilogram of body weight (50-200 mg) for dexamethasone. Single doses of 500 mg of methylprednisolone and 1 00 mg of dexamethasone are both considered equivalent to 625 mg of pre dnisone.(1) These very high doses, sometimes termed megadoses, are usu ally given as intravenous infusions over 30 minutes to 1 hour daily or every other day for a total of 1 to 5 administrations. In most indica tions, pulse glucocorticoid therapy is accompanied and/or followed by the continuous administration of low- or intermediate-dose glucocortic oids and/or immunosuppressive agents.