Dexamethasone-
cyclophosphamide pulse (DCP) is the prefered mode of
therapy in
pemphigus in India because it is relatively free from the side effects seen with heavy doses of daily oral
steroids. One hundred forty-six
pemphigus patients treated with DCP were observed for side effects of this regimen. One hundred forty mg of
dexamethasone was administered IV in 200 ml of 5%
dextrose over a period of 60-90 minutes on 3 consecutive days. Five hundred mg of
cyclophosphamide was added on first day of the pulse and 50 mg given orally daily in the intervening period. DCP was repeated every 4 weeks and continued for 6 months after subsidence of the disease (no new lesions).
Flushing over the face was the most common event recorded during the adiministration in 78 subjects followed by palpitations in 11,
hiccups in 9, and
numbness of feet in 6. Fourteen patients had
polyurea, and 3 developed
skin rash. Shivering, shooting pains along thighs,
breathlessness, seizure and unilateral limb
edema were observed in one patient each. Generalized weakness/malaise was the most troublesome delayed side effect in 81 (55.4%) patients; it lasted for 8-15 days after the pulse. Thirty-six (24.6%) had
inadequate sleep syndrome, 23 (15.7%) had
headache, 21 (14.3%) complained of
arthralgias, 19 (13%) experienced alteration in taste, and 13 (9%) had diffuse
hair loss. 28 females developed menstrual disturbances, and 14 (9.5%) had blurring of vision (
glaucoma in 3 and posterior subcapsular
cataract in 1). Thirteen of eighteen diabetics had an increase in
blood sugar requiring higher doses of
insulin. Five
NIDDM patients needed
insulin. Four (2.7%) developed
hypertension. Pulse
therapy is not absolutely free from side effects.
Hypertension and diabetes occur less frequently as compared to conventional
steroid therapy. Generalized weakness,
flushing,
headache and taste alteration occur exclusively with pulse
therapy.