Several medications are used to treat chronic inflammatory demyelinating polyradiculoneuropathy, or CIDP. These drugs do not cure the disease. They do, however, improve symptoms in most cases.

Prednisone (Deltasone®, Orasone®) is the corticosteroid of choice for treating CIDP. This is a synthetic hormone that suppresses abnormal reactions on the part of the immune system. For patients with CIDP, the suppression means the body will produce fewer antibodies to its own myelin.

Prednisone improves symptoms of CIDP in most but not all patients. Some patients may have increased symptoms for a short time just after they begin taking prednisone.

The most common side effects of prednisone are weight gain, easy bruising, mood swings, and irritability. Serious side effects may occur if the drug is stopped too quickly. Therefore, patients should not stop prednisone abruptly nor increase the rate of “tapering” (that is, slowly decreasing the dosage) without first consulting their doctor.

Long-term use of high doses of prednisone can cause serious health problems. It can trigger diabetes in a susceptible patient or cause osteoporosis, especially in post-menopausal women. To reduce the risk of these disorders, prednisone is usually given in high doses for only a short time. Prednisone is then tapered by giving a high dose one day and a low dose the next day. Over time, the amount of the high dose is reduced.

IVIg (Gamimune®, Gammagard® S/D, Gammar®-P IV, Panglobulin®, Polygam® S/D, Sandoglobulin®, Venoglobulin®-I, Venoglobulin®-S) is pooled human gamma globulin. IVIg decreases the production of antibodies, but the method by which it works is unknown. All blood is screened to prevent blood that contains viruses such as HIV, Hepatitis B, and Hepatitis C from being added to the pool. To further insure safety, the pooled blood is then processed to inactivate any viruses that may be present.

IVIg may be used in place of prednisone, but the effect of IVIg tends to last only a few weeks or months, and periodic infusions are usually required.

IVIg is injected into a vein over the course of several hours. Patients receive a series of treatments over two to five days, usually in a medical setting In some cases, the patient may be treated at home by a home health agency.

The most common side effects of IVIg are headache, fever, nausea, and rash. More rarely, deep venous thrombosis (blood clots in the veins) and strokes can also occur.

Immunosuppressant agents include azathioprine (Imuran®) and cyclosporine (Sandimmune®, Neoral®). These drugs suppress the immune system, which causes a decreased production of antibodies. In CIDP, this translates to lower concentrations of the antibodies that attack the protective coating (myelin) of peripheral nerves. Treatment usually leads to a decrease in the number and severity of symptoms and lower antibody titers, or concentrations. Patients using immunosuppressants may also need less prednisone and less frequent plasma exchange treatments, known as plasmapheresis

Azathioprine

It usually takes four to eight months for the effect of the immunosuppresant drug azathioprine to be felt. Azathioprine can help reduce the amount of prednisone that is needed. Symptoms usually return in two to three months after the drug is stopped.

Most patients tolerate azathioprine well. However, in about 15 percent of patients, there is an unusual and immediate reaction of flu-like symptoms. These go away when the medication is stopped. Azathioprine can also cause a decrease in the number of white blood cells, red blood cells, and platelets. Patients must have CBC (complete blood count) tests at regular intervals while using this drug. A CBC measures the number of blood cells in the body.

Some general precautions should be taken before beginning azathioprine. Tell your doctor if you're allergic to it or any other drugs, and let your doctor and pharmacist know all other prescription and over-the-counter medications, supplements, and vitamins you're taking. This is especially important because combining certain drugs or supplements can be hazardous.

Azathioprine is generally well tolerated, but it sometimes causes side effects such as nausea, loss of appetite, joint pain, vomiting, diarrhea, and cold hands and feet. Talk with your doctor if these symptoms persist or if they are severe.

If you experience any of the following side effects, call your doctor immediately: sore throat, fever, mouth sores, bloody or dark, tarry stools, bruising or unusual bleeding, blood in urine, yellow skin or eyes, shortness of breath or trouble breathing, skin rash, rapid heartbeat, and changes in eyesight.

Cyclosporine

The immunosuppressant drug cyclosporine may be used with patients who have not responded to other treatments. Symptoms of CIDP usually improve within one or two months after cyclosporine is started. The maximum effect is usually reached within six months of treatment.

Cyclosporine is expensive and also has a fair risk for side effects. It can also cause kidney problems, so it should be performed at regular intervals to monitor kidney function while you're using the drug.

Before taking this medication, let your doctor know if you're allergic to it or any other drug, and let both the doctor and pharmacist know all other prescription and over-the-counter medications you're taking (mixing certain drugs or supplements with cyclosporine may be harmful. (Grapefruit juice also interacts with cyclosporine, so you should wait to 1 hour before or 2 hours after taking the drug to drink it.) Tell your doctor if you're pregnant or planning to be, or if you're breastfeeding; also, let him or her know if you've ever had liver or kidney disease, low cholesterol, high blood pressure, or low levels of magnesium.

The most common side effects of cyclosporine include hypertension, headache, painful or swollen gums, nausea, vomiting, increased hair growth, and breast enlargement. Let your doctor know if these symptoms don't go away or if they are severe. Call your doctor immediately if you experience any of the following symptoms: tremors, sore throat, fever, chills, unusual bleeding or bruising, yellow eyes or skin, weight gain, changes in vision, confusion, lack of control over body movement, seizures, decreased urination, and swelling of the feet, ankles, lower legs, and torso.

Another important fact to know about cyclosporine is that it leaves you more vulnerable to infections, so you should avoid people with contagious illnesses like the flu. The National Institutes of Health recently included the following warning in its literature on cyclosporine:

"Keep all appointments with your doctor and the laboratory while taking cyclosporine, especially if your doctor changes which type (capsules or liquid) or brand (Neoral or Sandimmune) of cyclosporine you are taking. Cyclosporine makes you more susceptible to illnesses. If you are exposed to chicken pox, measles, or tuberculosis (TB) while taking cyclosporine, call your doctor. Do not have a vaccination, other immunization, or any skin test while you are taking cyclosporine unless your doctor tells you that you may. Call your doctor if you have any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment."

First published April 1, 2000
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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