Q: Why do high doses of glucocorticoids work better in some medical emergencies than conventional doses?
Answer: It is a common clinical practice to use high (massive) doses of glucocorticoids in certain emergencies such as severe acute asthma, or transplant rejection. When given over 3-5 days they are also called 'pulse glucocorticoids'. Interestingly, despite its use over decades, the answer is not established with certainty as to why massive doses work in such emergencies. One plausible explanation is that the high-dose glucocorticoid dissolves in cell membranes, altering their physicochemical properties, and the activities of membrane-associated proteins. This leads to effectiveness which may not be apparent with less conventional doses.
#pharmacology
References:
1. Franchin G, Diamond B. Pulse steroids: how much is enough? Autoimmun Rev. 2006 Feb;5(2):111-3. doi: 10.1016/j.autrev.2005.08.003. Epub 2005 Aug 29. PMID: 16431338.
2. Edel Y, Avni T, Shepshelovich D, Reich S, Rozen-Zvi B, Elbaz M, Leibovici L, Molad Y, Gafter-Gvili A. The safety of pulse corticosteroid therapy- Systematic review and meta-analysis. Semin Arthritis Rheum. 2020 Jun;50(3):534-545. doi: 10.1016/j.semarthrit.2019.11.006. Epub 2019 Nov 14. PMID: 31812351.
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