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Cytotoxic drugs

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Two main cytotoxic agents are used, with steroids:

  • cyclophosphamide
  • azathioprine - less effective but used for it's steroid sparing effects in maintenance treatment. Dose 1.0-2.5 mg/kg/day; either started with steroids or added at a later date. Lymphoma is a feared side effect

Less commonly:

  • cyclosporin - high renal toxicity. Reserved for patients unresponsive to conventional immunosuppression or in whom marrow toxicity is a major problem

  • methrotrexate - long history of intermittent use

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