Losartan

[Michelle Scaglione]

David

I am not sure what caused my sons side effects. Losartan was the only new drug we gave him so I am ruling it out.

He didnt have any problems with the Enalapril.

Michelle

[ddrahal]

My son is on prednilosone since two years. Can start Losartan with Prednilosone, would be there any complications
Thanks
ddrahal

[David Feder]

There are no complications with the use of prednisolone or other steroids with losartan

[ddrahal]

My son is eight years old, ambulant, weight 30 kg. What Losartan dose start with?
Your opinion is great help.
Thanks
ddrahal

[David Feder]

I think that 12,5mg is a good suggestion to start. It's important to measure the blood pressure to choice the adequate dose. This medication must be used under medical supervision.

[mugla]

Hi everybody.I am from Turkey.I am member of turkish MD web site also.In my country at our biggest university hospital(hacettepe)our doctors began to give losartan to our children who are already on deltacortil.They are begining losartan with 25 mg..I know four years old boy with duchenne from our web site,they suggest his family 25 mg.also. Our doctors saying losartan very safe medicine and 25 mg. safe for blood pressure.But i agree with David.Some couple days we have to check with 12.5 mg.

[mugla]

David,
I read some discussions at ppmd forums about losartan few days ago.Some people worry about losartan because possiblity of limited quantity of sattelite cells..I asked our doctor and he is not agree with them.What are you thinking about that.Your opinion very important for me.

[kaganim]

Dear David Feder,
I,m from Turkey, I have 3 years old son. My son is muscular dystophy. at the gene deletion analysis there is not found any gene deletion. But its CPK level is 11600. he has other physical symptoms of DMD/BMD such as difficulty in jumping, and rising from the floor, he is not able to climb stairs by himself, he started walking when he was one year and five months.

Our doctor didn't give him any drug. doctor said that "he is little to use drug.after five years old,he can be use." we are so worried. what should we do? can we use steroids and losartan to our son? should we wait until he is five years old? what are your advices for us?

[David Feder]

Mugla: I not agree with them too but only a trial can give us this information with 100% of confidence. This treatment in Turkey is a trial or the doctor give to all boys?

Kaganim: I don't agree with your doctor. In young boys the disease put on a trigger that start the damge of muscles. Why your son must wait to muscle damage to start therapy. The logical is start as soon as possible. There are several articles about the early use of steroids. In my opinion you can start steroids, under medication supervision, now. If you want I can find some papers about the early use of steroids and you can sen to your doctor.

[kaganim]

Thanks David Feder,
If you send papers about the early use of streoids, I will be very pleased.
regards

[David Feder]

Kaganim:
Two summaries. I can look for another summaries or full articles if you want

An effective, low-dosage, intermittent schedule of prednisolone in the long-term treatment of early cases of Duchenne dystrophy.Kinali M, Mercuri E, Main M, Muntoni F, Dubowitz V.

Neuromuscul Disord. 2002 Oct;12 Suppl 1:S169-74


Department of Paediatrics, Dubowitz Neuromuscular Centre, ICSM Hammersmith Campus, London W12 ONN, UK.

The aim of this study was to evaluate the long-term effects in young children with Duchenne dystrophy of an intermittent low dosage regime of prednisolone (0.75 mg/kg per day for 10 days per month, or 10 days on and 10 days off). Six children under 5 years with Duchenne dystrophy have been commenced on this schedule, four of whom have been followed for at least 30 months and are reported here. All four presented with classical Duchenne dystrophy, and had an out-of-frame deletion in the Duchenne gene and absence of dystrophin in their muscle. All four showed a rapid and dramatic response in muscle function and strength. In three of the four there was an almost complete remission of all clinical signs of dystrophy. Their functional scores remained well above the average scores recorded in untreated Duchenne boys at the same age. There was no increase in weight, stunting of growth, decreased bone density or any other significant side effects related to the prednisolone. Our current experience suggests that this intermittent, low-dosage prednisolone regime is well tolerated and can be safely given long-term in young children with Duchenne dystrophy. The striking response also suggests that there may be an optimal window for treatment of Duchenne dystrophy in the early stages of the disease.

www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12206813&query_hl=2&itool=pubmed_docsum



Early prednisone treatment in Duchenne muscular dystrophy.Merlini L, Cicognani A, Malaspina E, Gennari M, Gnudi S, Talim B, Franzoni E.
Neuromuscular Unit, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. [e-mail]

Muscle Nerve. 2003 Feb;27(2):222-7.

The purpose of this long-term, open parallel-group, double-consent study of alternate-day, low-dose prednisone in 2-4-year-old patients with Duchenne muscular dystrophy (DMD) was to determine whether prednisone produces a beneficial effect when given earlier than usual. Muscle function was evaluated by timed tests, and muscle strength with a hand-held myometer. After 55 months of treatment, the five patients (mean age 8.3 years) in the prednisone group were still able to get up from the floor, whereas two of the three in the control group had lost this ability. Side effects included a decline in growth rate in the prednisone-treated patients and excessive weight gain in one control and three treated patients. Because steroids are effective in prolonging function, but not in recovering lost function, we propose that treatment be started with low-dose prednisone in DMD patients as soon as the diagnosis is definite.


www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12548530&query_hl=2&itool=pubmed_docsum

[mugla]

david,it is trial.It began with demand of families.

[David Feder]

Mugla: all children receive the drug or some don't receive (control drug)? It's a doble bind study (the doctor and the patient don't know the treatment, losartan or control)?

[mugla]

david,it is not double blind study.And all children not taking losartan.I will send email to you about the story .

[David Feder]

Mugla: I ask this questions because we want make a trial in Brazil with losartan, double bind, in young and old boys (with and without cardiac dysfunction).