Pulse glucocorticoid therapy: The 'big shot' revisited

Abstract

The term pulse therapy refers to discontinuous intravenous infusion of very high doses of drugs over a short time. Methylprednisolone (and dexamethasone in some countries) is the glucocorticoid most frequently administered this way. Doses of each pulse are not standardized but are usually 10 to 20 mg per kilogram of body weight for methylprednisolone (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 100 mg of dexamethasone are both considered equivalent to 625 mg of prednisone. These very high doses, sometimes termed megadoses, are usually 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 indications, pulse glucocorticoid therapy is accompanied and/or followed by the continuous administration of low- or intermediate-dose glucocorticoids and/or immunosuppressive agents.