Your Pediatric Nephrologist has advised you that your child has accumulated significant unwanted effects from long-term prednisone therapy, used to treat the frequent relapses of nephrosis. Several alternative medications are available, each with their own unwanted effects. However, in most, but not all children, these drugs will reduce the frequency of relapses, and thus the need for prednisone, so that over several months, all of the prednisone side-effects will disappear.
Please examine this list, which has been prepared, to allow you to compare each of these prednisone alternatives, and the ways in which we can minimize their unwanted effects.
| NAME . |
LENGTH OF Rx | SIDE EFFECTS . |
MONITORING . |
| Cellcept | 6-12 mo | Abdominal Pain Diarrhea Low Blood Cell Counts Infection |
Dose Reduction . Measure Periodically Parental Surveillance |
| Neoral | 6-12 mo | High Blood Pressure Extra Hair Growth Kidney Damage . Thick Gums Infection |
Measure BP – Rx if Necessary . Periodic Measurement of Blood Level of Drug & Kidney Function Good Dental Hygiene Parental Surveillance |
| Prograf (Tacrolimus) |
6-12 mo | High Blood Pressure Kidney Damage . Infection |
Measure BP – Rx if Necessary Periodic Measurement of Blood Level of Drug & Kidney Function Parental Surveillance |
| *Cytoxan (Cyclophosphamide) |
3 mo | Decline in WBC Temporary Hair Thinning Infection Bladder Irritation Fertility? |
Measure WBC weekly . Parental Surveillance Lots of Fluids . |
*Cytoxan is the standard treatment, with the longest experience (more than 25 years). It may give your child a prolonged remission, that is, no relapses even many months and perhaps years after the 3 months of medication has been completed. The three other medications usually prevent relapses or reduce their frequency while your child is taking any one of them, but are unlikely to maintain that effect after they are stopped. We are reluctant to continue treatment for more than one year with any of these drugs; 6-12 months is more than enough time to allow the unwanted effects of prednisone to disappear. Typically, relapses resume and we return to prednisone treatment. Such drug treatment cycles are well tolerated by most children until they “outgrow” this condition.