B. SPECIFIC REGIMENS
(1) Giant Cell Arteritis
Notes: 1) Opinions on treatment varies between rheumatologists and among neuro-ophthalmologists. Some feel oral prednisone10 mg BID is sufficient (J. Rheumatol. 1990;17:1340–1345). Others have written that if no visual symptoms have occurred, oral prednisone 60–80 mg QD (Ann Intern. Med. 1978;188:162–167, Surv Ophthalmol. 1976;20:547–260, and Am. Heart J. 1980;100:99–107 as discussed in Arch. Fam. Med. 1994;3:623–627) is adequate.
2)Most patients have visual symptoms and we recommend high dose intravenous methylprednisolone (Arch. Fam. Med. 1994;3:623–627).
Drug |
Trade |
Preparation |
Dosage |
methylprednisolone |
Solu-Medrol |
IV Soln |
250 mg IV Q 6 hrs x 3 days |
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day 4: begin taper with oral prednisone |
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(2) Optic Neuritisg |
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Notes: 1) |
Intravenous steroids may speed the recovery of visual acuity. |
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2) |
Oral steroids do not hasten recovery time of visual acuity and may worsen the relapse rate. |
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Drug |
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Trade |
Preparation |
Dosage |
methylprednisolone |
Solu-Medrol |
IV Soln |
250 mg IV Q 6 hrs 3 days (N. Eng. J. Med. 329: |
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1764–1769, day 4: begin taper with oral prednisone Dec. 9, 1993) 1 mg/kg/day for 11 days then, 4 day taper of oral prednisone (20 mg, 10 mg, 0 mg, then 10 mg)
Neuro-Ophthalmology 67
(3) Traumatic Optic Neuropathyg |
68 |
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Notes: 1) This is an experimental alternative protocol to decompressive surgery; definitive treatment has not been established (Seminars in Ophthalmology, Vol. 9, No. 3 (Sept), 1994: pp 200–211)
Drug |
Trade |
Dose |
Notes |
methylprednisolone |
Solu-Medrol |
IV Soln |
30 mg/kg IV load (2 Gm for healthy adult), then either 4.0 |
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mg/kg/hr continuous IV infusion 24 hrs or additional |
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15 mg/kg 2 hrs later and 15 mg/kg (1 Gm in healthy |
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adults) Q6 hrs 72 hour |
(4) Pseudotumor cerebri
Notes: 1) Treatment is not indicated in all cases. Consider treatment if there is evidence of visual acuity or visual field decline or severe headaches.
2) Weight loss is a very important component of treatment if the patient is overweight.
Drug |
Trade |
Dose |
Notes |
acetazolamide |
Diamox |
250 mg PO QID |
Slowly build up to 500 mg PO QID if tolerated |
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Acetazolamide is a sulfa containing medication |
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gConsultation with neuro-ophthalmologist is recommended for duration of taper